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Reductions of Nursing Home Bed Rails and Other Restraints

Over the last few decades there has been a movement to reduce bed rails and other variations of restraints that are used on nursing home residents.  This movement has been growing ever since Congress enacted the Nursing Home Reform Act in 1987.  This law included a prohibition on restraints being used for the purpose of discipline or staff convenience and not for medical purposes.

The goals of the restraints were to improve resident safety in nursing homes.   However they often have the opposite result and lead to more injuries, deaths, and deprive the residents of their dignity and freedom.

Rails can be especially hazardous for residents suffering from dementia. They can fall from greater heights if they attempt to climb over them and sustain more serious injuries (especially head injuries).  There are also issues with entrapment.

“Even when portable bed rails and hospital bed rails are properly designed to reduce the risk of entrapment or falls, are compatible with the bed and mattress, and are used appropriately, they can present a hazard to certain individuals, particularly to people with physical limitations or altered mental status, such as dementia or delirium,” the FDA reports on its website.  The FDA found 531 rail-related deaths occurred from 1985 to 2013 (2013 was the most recent period in that it conducted the analysis).

According to Centers for Medicare & Medicaid Services, Pennsylvania nursing homes have reduced the use of physical restraints such as bedrails or ties to beds or wheelchairs by 97.6 percent from 1996 to 2015.

Even with the current rules and regulations in place and the drastic reduction in the use of restraints in nursing homes the injuries and dangers that result still remain.  The regulations put in place are sometimes ignored or overlooked which can have a harmful effect on the care of nursing home residents.

The FDA highlighted some of the potential risks of bed rails:

  • Strangling, suffocating, bodily injury or death when residents or part of their body are caught between rails or between the bed rails and mattress.
  • More serious injuries from falls when residents climb over rails.
  • Skin bruising, cuts, and scrapes.
  • Inducing agitated behavior when bed rails are used as a restraint.
  • Feeling isolated or unnecessarily restricted.
  • Preventing residents, who are able to get out of bed, from performing routine activities such as going to the bathroom or retrieving something from a closet.