Bed rails are being used less often in aged care because there is tighter regulation of their use and a greater awareness of their risks. But the alternative practice – of placing residents in low beds with sensor mats beside them – has its own problems, says an expert in the field.
According to Professor Joseph Ibrahim, a specialist in geriatric medicine and aged care safety at Monash University, older residents can’t get up out of the low beds and can become “incontinent, immobilised, and frightened” in them.
This investigation began when a reader commented that aged care is now so regulated, staff are not using bed rails and are instead using sensor mats to detect falls from beds.
This seemed unreasonable, so HelloCare decided to take a look at the issue.
What we found was there are real dangers associated with using bedrails.
“Some like them [bed rails], and others don’t,” said Prof Ibrahim.
Bed rails can cause serious physical and psychological harm, and even death, though they are necessary in some circumstances.
Prof. Ibrahim said in the early 2000s, there was a lot of concern about strangulation of older people from bed rails, as well as aged care residents being injured from trying to climb over them.
More recently, discussions of physical restraint, which bed rails are considered to be, has tightened regulation of their use.
A Health Department spokesperson told HelloCare, “From 1 July 2019, new regulations significantly strengthen the requirements that apply to the use of physical and chemical restraints in aged care homes.”
“Restraint must only be used as a last resort.”
According to the Aged Care Royal Commission report, “Restrictive Practices in Residential Aged Care in Australia”, using physical restraint “may be necessary to mitigate risks to a resident or others in an emergency”.
But the report says there is evidence to show that physical restraint (of all kinds) can cause death, “fear, shame, anxiety, loss of dignity, agitation, depression, lower cognitive performance, bruising, direct skin injuries, pressure injuries, contractures, respiratory complications, urinary and faecal incontinence and constipation, undernutrition, reduced mobility and increased dependence in activities of daily living, impaired muscle strength and balance, reduced cardiovascular endurance, and serious injury”.
The recent changes to Quality of Care laws mean, before bed rails can be used, aged care residents have to be assessed, alternatives have to be considered, and the resident has to give their consent.
Getting rid of bed rails through tighter regulation has been seen in the industry as a “great success”, Prof. Ibrahim said.
But the solution to the bed rail issue – which is putting residents in “low, low” beds with sensor mats beside the beds – has created a whole new set of problems, Prof. Ibrahim said.
Older people, whether they be at home, in hospital, or in residential aged care, can not get out of low beds because they lack the muscle strength, according to Prof. Ibrhaim.
As a result, in low beds older people can become “incontinent, immobilised, and frightened”.
So, what’s the solution?
Prof. Ibrahim said the industry needs to find a “middle ground” between using standard beds with bed rails and low beds with sensor mats.
“There’s no easy answer, and there hasn’t been the debate with people who know enough about the topic,” he said.
“People are doing the best they can with the knowledge they have,” he said.
Prof. Ibrhaim said it would be helpful for aged care staff to have more information about what options are available for residents in a range of different circumstances, so they can make better informed decisions.
I seen them get there leg catch in be rails and nasty injuries even with the padding on them better with the mats
Absolute rubbish!! Kindly explain how a person without legs can position themselves without the use of bedrails.
Thank you!! This is the issue a client of mine with no legs has faced today!! I thought we were supposed to “Treat the patient in front of us” as everyone is not the same!!! The aged care home has said they are banned.
They are definitely banned, but, if the residents is cognitive enough they can sign for approval from the facility, a close family member or POA can also sign for approval..
You’re damned if you do and damned if you don’t.. ???
Totally agree, someone, somewhere will find fault and a way,to make things more difficult than they have to be.
YES! I agree! I looked after a man who had bed rails for around 9 years and relied on them to moved himself around..keeping his own independence and dignity BUT the management took them from him. He was crying as he informed me what had happened and that the management refused to allow him to have them back because of ‘government rules’ or something. I tried but to no avail. The management just said No bedrails anymore. I agree with personalised care. Like you wouldn’t give a resident that climbs, a bedrail.
I also work in aged care and have seen many disadvantages of the ‘fall mattresses’ and low beds than I saw with bed rails. I understand that bed rails can cause problems but this is the bedrails design I feel. The rails could be made with a mesh insert so that legs etc will not get caught with restless residents. I don’t feel they are a restraint as much as low beds and fall mattresses as the resident can still move to the foot of their bed and get up (or down) quite easily…but, with low beds, if they do manage to stand, they are standing on a fall mattress and that is exactly what they can do..fall…as the ground is not sturdy. The bedrails should be only applied to those who are not going to be climbing them, but to save distress/dignity for those who are now continually ending up on the floor, and having to be hoisted back to bed over and over. Some beds are up against the wall on one side..is that not a restraint? Having a low bed so they can’t stand up. ..is that not a restraint? If a resident can not walk..ie..one who is bedridden, how could a safety rail be a restraint? The trip hazards (for staff also) are huge. Tripping over bed exit mats, tripping over fall mattresses in the night, the cords around the beds from air mattresses/bed exit sensor mats etc. Just an example, a resident I assist rolls out of bed and crawls around the floor {Infection control issues) but as soon as staff have him hoisted back into bed, he rolls out again. Staff just have to let him stay on the floor but, he crawled into another resident’s room and woke her in the dark to him crawling around the floor at the end of her bed. That would freak anyone out! This was done in hardly any time and wow, she was scared. What would stop this or slow it down at least? One lousy bedrail. Another example I was so upset about was concerning a woman who had a terrible rash in the area that her pad covers, so we were instructed to leave pad undone by doctor. This woman is bed ridden and cannot stand or move herself but she does end up on floor because she does like to sit up in bed. This day, the woman rolled out of bed, was on the floor naked from the waist down and had been incontinent of faeces. Carers had to wash her and clean her up as she was on the mattress and we needed to hoist her. How undignified this must have been for her. After calling RN to check for injuries, we had to then roll her off the mattress because the hoist can’t be used on top of a mattress. So staff are working on their knees and at floor level, trying to get a sling around her, she was partially under the bed also. Had to raise the bed so we could get to her a little better. Pillows all around the legs of the hoist so she would not be injured. Hoisted her up (which is frightening for some also..but I think the humiliation was overtaking her at that point no matter what we did to comfort her), then placed her back on the bed. Then ob’s taken every 2 hours etc. after this ..and what could have saved all that? ONE LOUSY BED RAIL! As a staff member, how would you feel after doing all that and it taking so much time when other residents are waiting to be attended to, then looking back in and she is on the floor AGAIN!
Well said, totally agree with you. Retired EEN of 48 years in aged care
I am interested to know in what role, precisely, did the author do in aged care. Was she an AIN? An RN? A cook? In other words, is she experienced in the actual day to day care of residents in an aged care facility? Too many times, it seems, those who have never actually done the job are full of ideas as to how it should be done without ever actually experiencing a night shift, or cleaning a soiled bed, or bathing a resident.
One of my main concerns with low beds is dignity. People coming in and out of the rooms and the resident/consumer only seeing feet and ankles if the ‘visitor’ doesn’t bend down to speak. It can be undignified or even frightening if the person is cognitively impaired.
It is classified as a ‘fall’ every time a resident rolls out of their bed onto a crash mat with sensor mat. As you are not supposed to stand the resident up (and it has to be a 2 assist) and settle them back to bed you have to press the emergency call button to safely place them back to bed. Then they crawl out of the bed again and again and again!!!!
The big issue is trying to gain information on why the resident is ending up on the floor in the first place
Is it they are uncomfortable with the bed, I mean if you are sleeping on a mattress that is uncomfortable you certainly won’t want to stay in it!!
Is it they are trying to maintain there independence and wishing to visit the bathroom?!
Is it a disorder or something like post traumatic stress that isn’t being managed correctly
…or just moving around in their sleep, or have dementia and don’t realise what they are doing, or being sat up after a meal and fall/slide to the side then can’t stop themselves, or just roll over and have no support from an air mattress so they roll out etc etc
Mum’s facility claim it isn’t documented as a “fall’ and don’t seem to be able to tell me how often it’s happening. I agree with Evelyn about the loss of dignity and sensory deprivation as unlikely to see more than the sky out the window. I understand there’s entrapment risks etc with rails but is also potential dangers on the floor.
If a person has dementia does a relative need to consent before bedrails are used?
My previous message was about the issues with a low low bed!
I would like to see some residents have the bed similar bed rails like toddlers have. They are made with a soft mesh material with no gaps that you can see out of and cause no injury. Surely someone should have thought of this years ago!!! I have. Obviously it would have to have a railing to support it but you would only have to pad the frame!
I feel a middle ground is best. Those who cant walk have low low beds and those who can still stand and will try to stand regardless should have a bed that is height adjusted to the best height for them to easily stand from. Many people have falls trying to stand from a bed that is too low.
The Standards require that an individual risk assessment be done in each case, but the home Dad is in refuses to do this. They have a blanket “no rails” policy. Our Dad is 97. He has a fused L hip and a withered L leg from a child-hood accident, plus a R hip replacement, and has been non-ambulant for nearly 6 years. he can only sleep on his R side, and tends to sleep close to the R hand side of the bed. He has a king single bed, which goes down low, wedges on the mattress, and sensor mats on the floor. Last July he partially fell out – top half on the floor bottom half in bed. Home refused to install even a single rail, despite giving info from Aged Care Quality and Safety Commission, which makes it clear that rails are quite acceptable in some circumstances. Dad has now had another fall, and still the provider remains intransigent. They will not enter into any discussion, and are clearly in breach of the Charter, and many parts of the Standards, but no-one has power to do anything. Dad is immobile – he can’t even abduct at the hips to cock a leg over if he wanted to – and so a rail can’t be considered a restraint. We have complaints in with AACQSC, but that will take months to resolve anything – and they don’t have the power to enforce anyway. To a former OHS professional, the contrast with OHS provision couldn’t be more stark. They don’t even have a decent Risk Assessment tool. The issues you raise are being raised with us by other people – resident can’t get a drink, visitor can’t hold a resident’s hand, etc.
Why can’t people have a drink or have someone hold their hand?? Are people not allowed in the room?? This sounds awful. Everyone should be allowed to have staff and visitors in their room even if their bed is low down. Surely this can’t be right.
Prayers for a solution. We are in a very similar situation.
My mum keep falling out of bed they won’t put a mat on the floor why
Also she put herself on the floor and lay there all day she has vascular dementia late stages
Lwr. Beds make sense. Resi at least will not fall and break a hip etc. Leading to a probable death due to their age. Incontinence and other excuses minimal to a serious fall. From my 20 year experience in aged care.
I welcome Prof Ibrahim and these so called experts to work a month in aged care on the floor and see what they can do to keep residents safe. Most of these experts just sit in their offices and in order to remain relevant keep coming up with info which is not practical. Staff in aged care have been hammered hard by the opinion of these experts and people in royal commission, most of whom have not set foot in aged care. What cant they work with staff before coming up info which is impractical. Everyone who doesn’t work in aged care is an expert in aged care including hallo care. We have to be careful with restraint but sometimes it makes the resident feel safe. It is like don’t let anyone drive car coz someone had an accident.
I’m 73, have had extensive scoliosis surgery, and normally don’t have any problems. However, when hospitalised I have appreciated having safety rails to prevent me falling when I re-position. Also, the bed rails are a fixture I can pull on when re-positioning.
Mum has been in a Nursing Home since August 2019. Todate she has had a broken nose, bruised ribs, broken leg(in two places) and several gashes on her head and face all from falling out of bed. After each fall I have had meeting with management to get her a bed with rails. Mum is 97 and since the broken leg has been unable to walk. After her last fall out of bed when she was left on the floor for over 2 hours, I insisted she have a bed with rails, or I would remove her from that establishment.
She now has a bed with rails. I have to sign a permission note along with her Dr. every three months. As she can’t get out of bed I don’t consider the rails to be a restraint, and I know that she is safe. She also has vascular dementia. Her falls were caused by either not being put far enough back on the bed or she was trying to reach her buzzer to call the PCW for assistance. She can’t turn over in her bed and always lays on her right hand side.
Linda so sorry to hear about your mum. When she fell was her bed lowered with crash pads? Asking because mum has broken her hip and has dementia and needs to be placed in care. Regards Tania
I have been retired now for nearly 10 year, I worked as a registered nurse. back then this debate was going on. At the RACFs I worked in we always had to do safety assessments, discuss options with doctors and family members (or resident if they could still make their choices) before any action was taken. This was then monitored for 7 days and reviewed monthly by the R.N. and reviewed 3 monthly by all in stakeholders. I worked in a place many years ago when bedrails were in common use, however after coronial inquests found they were dangerous they were removed. One family I dealt with chose to have only a sensor mat in place rather than any form of restraint. It is sad that there has been little progress on this subject.
My Husband has a bed at home with rails and he loves it. In respite he has no rail. And they have to be applied for as they are restraints. Which is ridiculous when how else are they supposed to keep him bed when he can’t walk. I don’t want him to end up on the floor he’s already got a damaged spine. How would they get him up?
I have always encouraged the question, ‘What will this person most likely do tonight – and how can I make this as safe as possible?’
The answers will so often guide good decision-making and documentation of reasons for these decisions.
There are always risks, but it is generally better to set up a ‘more likely to succeed’ transfer situation for an older person who can stand up and will most likely attempt to self-toilet by placing a frame by the bed, perhaps a low level night light, and the bed at a height that facilitates a safe transfer – than to have an almost guaranteed fall when attempting to stand from a too low bed, or a climbing over bedrails fall.
My husband had his bed rails removed and I felt pressured into agreeing to this. He does not move in bed without assistance so the rails were not a problem to him at all. The mats are now put down every night and I take them up when I get there , as I trip over them . The sensor is rarely turned on or, when it is, they forget to turn off.
I don’t think , for my husband, this was the best way to go.
My mother has fallen out of bed twice now. The first time she fractured her hip and the second she fractured her pelvis and humerus. I believe it could have been avoided if side rails would have been up.
I wish people would not generalise. The guidelines require that each case be individually assessed, using info from all involved medical professionals – not just those employed by the provider. For a start, “bed rails” can cover a number of options. In my father’s case just half a rail on one side would have been sufficient. Mats are not preventative – they only tell you if a person has fallen out. In my father’s case, prevention was paramount. Some people who would be quite safe with a bed rail, are placed at risk by being put into a very low bed, from which they can’t get up or out. There should not be any blanket policy!! Individual risk assessment is what’s needed. Sadly it can cost more, so the providers go with a blanket policy, which is illegal.
Yesterday my husband went into respite care. Today we are sitting in the outpatients Dept due to him having a fall out of the bed, with no safety rails. In the last year he has spent a lot of weeks in hospital, with bed rails for his safety. One night in the nursing home he has had 2 falls, from the bed. He cannot walk since he got very ill with covid last year. Having rails on the bed protects him from falls. The alternative with a bed almost on the floor, he wouldn’t be able to stand anyway . Supposedly those mats are supposed to be the protection now. Maybe there should be an assessment on individuals to decide who would benefit from rail safety.
I agreed to my husband having his bed lowered, also being against a wall.
It is a safety issue, I preferred him to have the stability of a wall, with only the one option of falling out of bed. He has Parkinsons disease, and have lots of night movement. His bed is lowered for sleep only.