Alternative To Bed Rails For The Elderly
Last year my Mom had a hip replacement at 89, and in the hospital her bed was fitted out with some 3/4 length collapsible bed rails. Since my Mom’s return home from the surgery we have discussed getting some for her bed to help her with sitting up, and not falling from the bed when she is asleep.
But as I delved into the subject, I was very surprised to find that for certain groups of elderly adults bed rails can be very dangerous. This led me to look into the alternatives that we would be able to find for my mom’s bed.
Alternatives to bed rails include adjustable height beds, concave mattresses, wedges and bumpers, crash mats, vertical poles, bed trapezes, bed alarms and other monitoring devices.
Why are bed rails dangerous ?
The FDA reports :-
“Potential risks of bed rails may include-
- Strangling, suffocating, bodily injury or death when patients or part of their body are caught between rails, or between the bed rails and mattress.
- More serious injuries from falls when patients 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 patients, who are able to get out of bed, from performing routine activities such as going to the bathroom or retrieving something from a closet.
The source of the above paragraph is – https://www.fda.gov/medical-devices/hospital-beds/guide-bed-safety-bed-rails-hospitals-nursing-homes-and-home-health-care-facts
Bed rail injury reports
Between the U.S. Consumer Product Safety Commission (Government agency) received reports between January 2003 to December 2013 “of nearly 175 deaths related to adult portable bed rails. In addition, and estimated 39,600 adult portable bed rail injuries were treated in hospital emergency departments from 2003 to 2013. Most of these deaths and injuries occurred with people who are 60 years old and older.”
Source – CPSC.GOV
Between 1985 and January 1st 2009 the US Food and Drug Administration (federal agency of the US department of United States Department of Health and Human Services) received reports of 803 incidents of people in home care settings, hospitals and nursing home residents, who were “caught, trapped, entangled or strangled in beds with rails“. 480 of these people died, 138 had injuries which were not fatal, and 185 people were caught just in time by staff and were not injured.
The majority of the people in the reports were “frail, elderly or confused“.
Source – FDA.GOV
Who are the people at risk with bed rails ?
People suffering with dementia, delirium, conditions of involuntary and uncontrolled muscle movement, physical limitations and frailty are those who are most at risk from bed rails.
How to choose a bed rail alternative ?
Before choosing a bed rail alternative you must firstly decide what your loved one is using it for –
- stopping your loved one from falling out of bed while they are sleeping
- to stop them from slipping from the bed when sitting
- helping to get in and out of bed
- to pull themselves into a better position in the bed
You may get one, or a combination, of the following items to help you with your loved one’s needs.
What are the alternatives to bed rails
Here’s a range of practical alternatives to bed rails which are easily obtained and can also be used in combination with one another to make a safer bed environment, and negate most all risks.
Adjustable height beds
If your loved one is falling out of bed when they are sleeping, an adjustable height bed can help, as you can put it very low to the floor, so that if they roll off the mattress, they aren’t going to go far at all.
Adjustable height beds, can be raised for getting into and out of bed, and for any caregiving which is done on the bed.
If your loved one is rolling out of bed while they are sleeping, a simple solution like wedges/bumpers is concave mattresses.
The mattresses have raised edges which slope down to the flat central part of the mattress, and are there to stop your loved one from rolling off the edge of the bed.
Depending on the mattress you buy the raised edges can come in different heights, so you can choose one which is suitable for your needs.
The difference between these and using wedges is that you can’t just remove the raised edges.
Bed Wedges, Bumpers and Bolsters
Bed Wedges, bumpers and bolsters are all names for the same thing, that is large pieces of foam which are placed on the mattress to raise up the edges, in relation to the center, so a person sleeping can’t fall out of the bed.
They create a sleeping environment which is very similar to the one created by concave mattresses. The only difference being that they can be removed, as and when required, leaving a flat mattress.
Some are placed on the mattress and then covered with the sheet, so they can’t just fall off, and others are attached with velcro to a sheet which is strapped to the bed with belts.
Both types provide raised edges to the bed which stop people from rolling, or falling out of the bed during their sleep.
Where there is no alternative some people place mattresses on either side of the bed as “crash mats” which will soften the impact of rolling out of bed.
Vertical Pole from floor to ceiling
A vertical pole can be near the bed which your loved one can use to sit on the bed and get out of bed.
You will want to secure the pole to make sure it is solid enough. You can buy floor to ceiling poles which have handles on to make it easier to grab ahold of them.
The removable non-permanent poles are known by several different names – “universal floor to ceiling pole/grab bar”, “tension mounted elderly transfer pole”, and “floor to ceiling security pole”.
The non-permanent poles have variable length and are tension mounted. With such a pole you will need to check that it is maintaining its tension over time.
For a permanent pole you will need to put in permanent fixings in the floor and ceiling.
A bed trapeze is a metal frame which is secured to the head of the bed, and from this is suspended a handle, which is usually triangular.
The handle hangs above the head of the person in the bed, and is positioned so that your loved one can reach up, grab the bar, and then reposition themselves while holding onto the trapeze.
If your loved one has a small amount of upper body strength they should be able to do this without have to ask for assistance.
The bed trapeze is also known as – an “over the bed pole”, “over bed pole hoist” and “patient over bed pole helper”.
Bed exit alarms, pressure mats with alarms, motion sensors and pagers, call buttons and pagers, and more, can all be used to let you know when your loved one is starting to to try to get out of bed.
These will allow you to know immediately should there be a problem.
If your loved one is happy to comply, you can get a call button and a pager, so that your elderly parent can call you for help.
I have a long article all about all the different devices you can get for bed monitoring which you can read here. I discuss all the permutations which you need to be consider before you buy anything.
Wireless baby monitors
Intended for babies these work perfectly well for monitoring your parent to see if they are trying to get out of bed.
Baby monitors are particular in that they don’t require the internet or cell phone networks to send you the visual or the audio signals, meaning that there is no fancy set-up required.
There is a sensor with camera placed in the bedroom and the caregiver carries the monitor around the home with them. Just be sure to check the range.
I have an article devoted to different ways of monitoring your elderly loved ones using, amongst other devices, wireless video baby monitors. You can find that article here.
Bed Rail Bumpers
This is obviously not an alternative, but can help to make bed rails safer.
Bed Rail Bumpers are padded covers which are placed over bed rails, and which slip down below the level of the mattress, eliminating some of the risk of entrapment between the mattress and the bed rail – it doesn’t eliminate it totally, and it depends on the user pulling it down as far as it goes. You need to keep checking that it the cover is well pulled down.
***If a mattress is two low in relation to the level of the bed rails, there will still be a space and a risk of entrapment and strangulation. You need to use as high a mattress as possible to reduce any space between the bottom rail and the mattress in which a head may get stuck.***
Posey All in one beds
I have included the Posey beds last as they are really for the most at risk cases, and come at a far greater expense – around $15,000.
Posey beds are meant to be used by people who are at extreme risk of hurting themselves in their beds, or from falling from them.
They are made for hospitals, and are specifically designed to reduce fall risks and to prevent patients from getting trapped inside rails.
The beds are covered with a canopy which is zipped up and has fast release buckles.
Inside the patient has free range of movement and doesn’t need to be restrained. Caregivers can unzip and gain access to the patients at any time.
People who need such a bed are –
- those who cannot absorb the impact of a fall due to a lack of muscle or fat
- people with severe osteoporosis
- sufferers with Parkinson’s, Hutchinson’s and other conditions which may cause involuntary and uncontrolled movements
- people who suffer with impaired sense of position and who risk falls
- people who are on medications which cause altered awareness
- people suffering with impaired balance
- sufferers with dementia
You can find more out about Posey beds here – this is not an affiliate link
Bed rails and their alternatives are not a substitute for proper nighttime monitoring
Bed rails and their alternatives are not meant to be a replacement for frequent monitoring and understanding of your loved one’s nighttime routines.
You need to be checking that everything is okay, and anticipating what may be coming, as our parents will sometimes need to get out of bed.
I have an article which covers 40+ systems for monitoring your parents from afar, and many of which can be used to monitor your parents in bed without any disturbance to their routines – read it here.
What can I do to improve my nighttime monitoring
I have learnt to anticipate with my mom when she is going to need to go to use the toilet, or will want to have a drink.
We actually set the alarm to wake my mom twice a night so that I hear that she is getting out of bed and can help if I am needed.
You will need to determine the reasons for which your loved ones are trying to get out of bed. Are they thirsty, hungry, or in pain ? Or do they need to make a visit to the bathroom.
You can place something to drink, or eat, right by the bed within easy reach, which eliminates getting out of bed.
If your loved one is taking pain medication, you can easily schedule this with them.
If they are able to take medications on their own, you can set set the alarm for the right times.
If your mom, or dad, are not able to take their medication on their own, you just have to schedule it yourself, and got to them at the correct time.
For bathroom visits you can schedule their toileting through the night with them, so they don’t wake up needing to get out of bed by themselves.
If you want your parent to be able to let you know they need help, then purchase a call button with a pager. Your mom or dad, will just have to press the call button and you will receive an alert on the pager.
For cases where you loved one isn’t really cognizant, or just doesn’t like to call for help, you can fit a bed exit alarm or motion sensor which will alert you to your parents movements. You can click here to read my extensive article on bed exit alarms and motion sensors – I explain just about all the available options and what you need to know before you purchase anything.
If you decide to use bed rails here’s what you need to know
Bed rails are not meant to be used to restrain a person in a bed, and should not be used as such.
Bed rail are used for –
- help getting in and out of bed
- changing position in bed
- stopping people falling from the bed
If you have no choice, and you have to use bed rails, here are a few things that you need to know and do –
- check with your doctor whether or not it is advisable for your loved one to have side rails
- make sure that your loved one is not going to try to climb over the side rails, as this can lead to injury
- monitor your loved ones frequently, and try to understand their patterns during the night, so that you may eliminate any potential incidents – such as a drink by their bed if they keep getting up to drink
- if you know that your loved one is going to the bathroom or the kitchen, you can use some kind of device to alert you when they get up, such as a bed exit alarm, pressure pad or motion sensors – I have an extensively researched article on types of bed alarms, pressure mats, motion sensors and monitors which you can read here
- if your loved one is cognizant and will definitely think to use a device such as a call button connected to a paging device, they can let you know when they need help – I have a thoroughly researched article covering those here
- if your loved one is suffering with dementia or another cognitive disorder, and you worry that they may have an incident at any time during the night, you may seriously want to use some form of video monitoring which will alert you to any noise or movement. These devices can be as simple as wireless video baby monitors which are just a live feed and do not record anything (they are generally wireless using radio waves so don’t require any fancy set up) I have an article which you can read about in the article on types of bed alarms, or be a single camera and motion sensor unit which will send you alerts and images on your mobile telephone, which you can read about here in my article on video surveillance for elderly safety – I have another extensively researched article on monitoring your elderly parents for afar which you can read here
- lower the bed as close to the floor as you can
- as well as using the bed rails try getting a concave mattress, or having wedges/bumpers/bolsters that strap to the mattress, or that are under the sheet, so your loved ones can’t get their heads trapped between the mattress and the rail
- if you aren’t using a concave mattress or wedges, you can try to use bed rail bumper covers which will close the gaps in the rails, and if fitted correctly can reduce the risk of entrapment – they need to be pulled below the level of the mattress to eliminate any gap under the rail and above the mattress
- if you are using bed rails on an ordinary mattress you need to do everything you can to eliminate the gap between the side rails and the mattress, to avoid entrapment
- if you are using an ordinary mattress it needs to be a good thick mattress as this should make it easier to reduce any gap between the side rail and the mattress
- for those of you who have parents who may be considered a high risk because of cognitive issues, you will need to do frequent monitoring of them if you are using bed rails
Buying and installing bed rails – what you need to know
- not all bed rails, mattresses and bed frames will fit together
- check with the manufacture that it will fit with your mattress and frame
- make sure that the age, size and weight of your loved one is appropriate and correct for the bed rail
- there should be no gap between the bed rail and the top of the mattress where your loved one can get their head caught
- make sure that the mattress you have will, in time, with compression not become too low and create a gap for entrapment of the head
- be aware that gaps can be created with air and water mattress with movement, so these are not advised
- regularly check for a gap between the mattress and the bed rail which could lead to the entrapment of a head
- always follow the installation instructions by the manufacturer so that you have the proper fit
- regularly check the bed rails to make sure they are not coming loose
- place the rails in a way which discourages your loved one from trying to climb over them to get out of bed i.e. give room to get out of bed without the rail causing your loved one to have to hurdle it – this will avoid a lot of accidents
- get bed rail bumper covers which will help to make the rails safer if fitted correctly
There are a number of different devices which will help to stop our elderly parents falling from their beds while sleeping, and some other devices to help them reposition themselves in the bed, and also to get in and out of the bed.
A combination of one or two pieces of equipment can very adequately cover their needs without having to resort to bed rails. This combined with frequent monitoring, an understanding of your loved one’s nighttime routines and some anticipation on your part, should in most cases be enough to greatly reduce the risk of your loved one falling from their bed.
If you are considering using bed rails it is advisable to check with your loved one’s doctor to make sure that they are suitable in their case, and that you are not putting them at risk.
Lastly remember that bed rails are not meant to be used as a restraint.
I hope that this has been of help. If you want more information you can follow the links below to my related articles.
I’m Gareth and I’m the owner of Looking After Mom and Dad.com
I have been a caregiver for over 10 yrs and share all my tips here.
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