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According to the Centers for Disease Control & Prevention, "one out of three older adults falls each year, but less than half talk to their healthcare providers about it." Of those seniors who do seek medical attention, some begin looking for long-term care, places outside the home that offer accommodation, medical services and, most importantly safety.
It's a logical course of action: fall, realize that home may not be the healthiest option anymore, and start looking into nursing homes. The numbers bear this logic out: 40% of all nursing home residents cite a serious fall as their main motivator, the primary reason for seeking long-term care.
As loved ones, we expect a nursing home staff to take every precaution, surround our elderly family members with multiple layers of support and protection. But when our expectations aren't met, when we find that certain safety measures haven't been taken, it can be jarring.
In general, bed rails are used far less than most of us imagine, even for those patients who present a serious fall risk. Bed rails, of course, run along the side of a hospital bed, preventing seniors from falling onto the floor at night. And for most of us, that's all we know. Based on that definition, it's perfectly reasonable for us to insist on these 'interventions.' Bed rails are 'safety equipment,' and therefore 'safe,' right?
What we don't know is that bed rails present their own risks, which in some cases, outweigh their potential benefits.
In a report released in 2006, the Food & Drug Administration (FDA) highlighted a newly-recognized danger threatening seniors: "entrapment." " 'Entrapment' describes an event in which a patient / resident is caught, trapped, or entangled in the space in or about the bed rail, mattress, or hospital bed frame." Between 1985 and 2006, the FDA received 691 reports of entrapment. In almost 60% of these reports, patients died because they had been trapped between a bed rail and mattress. In another 17%, residents were seriously injured.
Obviously, bed rails can present an immediate safety risk to some elderly patients. The dangers are particularly high for those residents who have become frail, confused, or restless. Elderly patients with seizure disorders, or those extremely likely to flail during the night, are often placed in beds without rails for good reason.
Bed rails can also have a less-visible adverse effect on nursing home patients. And while they may be able to prevent falls, health regulators recognize that bed rails can increase a patient's sense of isolation. For those seniors who would otherwise be able to leave their beds safely, the FDA considers bed rails an "unnecessary restraint." And legally, nursing homes can actually be held accountable for unnecessarily reducing a senior's independence.
Nursing homes are required by federal regulation to perform risk evaluations for each patient. So what happens when they identify a patient who is at risk of falling?
Because of their inherent safety risks, it's actually a big deal for a nursing home to allow the use of bed rails. First, nursing homes generally try alternative fall-prevention methods. Beds that can be lowered directly to the floor are a good option. They can be left down most of the time, and only raised when a caregiver needs to work. Motion detectors, "bed alarms," can be installed to alert caregivers when a resident nears the edge of their bed. In rare instances, patients may even be legally restrained, in effect "tied to the bed."
When none of these other prevention methods work, the use of bed rails may be warranted.
In 2006, the FDA set up its Hospital Bed Safety Workgroup (HBSW) to study entrapment events and supply industry guidelines. But the HBSW's guidelines are only recommendations; they don't create legally-binding rules. So hospital bed manufacturers are not required to create safer beds, and nursing homes aren't required to purchase beds that follow the Workgroup's guidelines. Still, most do, and many have even upgraded their existing, "legacy," beds to meet the new recommendations.
But dangers still remain. In 2012, the New York Times found that another 550 patients died in entrapment events after the FDA's voluntary guidelines were released in 1996. Several high-profile lawsuits, at least one filed against a nursing home for negligence, have spurred renewed interest in studying the effects, and possible regulation, of bed rails.