Are Bed Rails Safe in Nursing Homes? Risks, Regulations & More

Bed rails help prevent falls but can also cause injuries if not used properly. Weigh these risks and benefits before getting one for your loved ones.

Bed rails are barriers nursing home facilities use to prevent falls and support residents.

However, growing concerns about bed rail safety have led many nursing homes and hospitals to reconsider their use.

We discovered that bed rails can increase the risk of injuries, including falls, entrapment, and suffocation. But, in some cases, they have even been linked to deaths.

Some nursing homes have banned bed rails completely, while others have implemented new safety measures.

The Purpose of Bed Rails in Nursing Homes

Bed rails are a common sight in many nursing facilities.

They assist residents in mobility, prevent falls and bodily injury, and provide comfort and security.

Bed rails can be a valuable safety tool for nursing facility residents. To explore the best bed rails for seniors, understanding their purpose first is key.

1. Assisting Residents in Mobility

Adult mobility in a nursing home is a major concern.

As seniors age, their mobility declines. This makes it hard for them to move independently — especially in and out of their nursing home beds.

In such situations, bed rails can provide much-needed support and stability to most patients.

Moreover, bed rails help seniors reposition and turn in bed. These can also help reduce the risk of muscle stiffness, pressure sores, other complications, and death.

Bed rails are assistive devices offering additional support to help people maintain mobility.

2. Preventing Falls and Injuries

The Centers for Disease Control and Prevention (CDC) says falls are the leading cause of injury-related death among the elderly.

But, with the bed rails, these falls and injuries can be prevented by providing a barrier that residents cannot easily climb over.

They can help enhance stability, restrict movement, assist with transfers, and provide a sense of security.

Properly understanding different types of bed rails is important for caregivers and doctors because they are responsible for their patient’s safety.

Plus, with the right mattress and bed frame, the patients will surely have firm, reliable hospital beds.

3. Providing Comfort and Security

Bed rails create a protective environment that ensures comfort and helps prevent an elderly patient from getting injured.

A rail or barrier, often with raised foam edges, alongside their bed, can help people feel more secure and relaxed.

Bed rails can provide security and prevent patients from falling off their beds. This is especially helpful for the elderly with mobility challenges in a nursing home.

They can also provide comfort and support for older adults who are feeling restless or agitated.

A pillow or mattress is placed on the bed to ensure maximum comfort and bed controls are provided.

Risks and Concerns

nurse in the bed rails

To weigh if using bed rails is beneficial, you must also know that using them comes with risks and concerns.

It is crucial to understand these safety concerns of bed rails for the elderly to know how you can maximize their potential benefits to your advantage.

1. Entrapment Hazards

Entrapment can occur when a person’s body is caught between the bed rail and the mattress. It can also be between the bed rail and another object — such as a pillow, mattress, or blanket.

Bed rail entrapment hazards lead to serious injury, even death.

This hazard is high for most patients with uncontrolled body movement, disoriented, or dementia.

These individuals may lack awareness of the risks associated with bed rails or be physically injured if they are unnecessarily restricted.

Therefore, it is important to monitor patients frequently to avoid risks of entrapment, falls, or death.

2. Increased Incidence of Falls

According to the National Council on Aging, falls are the leading cause of injury and death among older adults.

Statistics of over 3 million adults 65+ are treated for unintentional fall injuries yearly.

Bed rails can create a false sense of security. Some patients might climb out of bed without considering the risks.

In return, it can lead to falls, especially for unsteady older adults or with balance problems.

To avoid this, ensure the bed rail is properly installed. It should be installed securely against the mattress and should not be wobbly or loose.

3. The Use of Bed Rails as Restraints

While bed rails help in one’s safety, using them as restraints can have harmful physical and psychological effects on the person.

Restraining patients with bed rails can lead to more serious injuries.

Prolonged use of bed rails as restraints can cause pressure ulcers or restrict blood circulation, leading to tissue damage and potential complications.

Preventing patients’ movement increases bedrail injuries by limiting repositioning.Bed rails used as restraints without justification infringe on patient autonomy and rights. It is essential to prioritize patient-centered care and respect their preferences and choices.

Legal and Regulatory Aspects of Bed Rails in Nursing Homes

Bed rails must be used legally and responsibly to protect residents. That’s why guidelines and regulations have been established for a nursing home to follow.

It aims to govern the usage of bed rails and address liability concerns within these healthcare settings.

These ensure that hospitals maintain compliance, avoid risks, and give quality care to their residents.

FDA Guidelines for Bed Rail Usage

The Food and Drug Administration (FDA) is a federal agency that protects public health. They help regulate the safety of food, drugs, medical devices, and other products.

The FDA has issued guidelines for the safe use of any bed rail, especially in hospital beds.

These guidelines help prevent injuries and deaths caused by bed rail entrapment and falls.

FDA General Guidelines Include:

  • Use bed rails cautiously, especially with older adults and individuals with altered mental status, physical limitations, and specific medical conditions.
  • Ensure proper sizing and installation of bed rails to prevent entrapment.
  • Do not rely solely on bed rails as a substitute for supervision.
  • Frequently monitor a patient for signs of skin bruising or bodily injury.
  • See additional guidelines for healthcare hospitals.
  • Make sure to read the patient or resident assessment.

A thorough adult portable bed rail safety released by Food and Drug Administration (FDA) can be accessed through their website.

Ftag Regulations for Nursing Homes

FTAGs stand for Federal Tags.

They are a set of regulatory codes used by the Centers for Medicare and Medicaid Services (CMS).

They also monitor and evaluate the care provided in a nursing home in compliance with federal regulations.

The following tags are relevant to bed rails:

  • F909 Resident Bed – requires nursing facilities to regularly inspect all bed frames, rails, and mattresses.
  • F700 Bed Rails – requires nursing facilities to ensure that bed rails are properly installed and used.
  • F689 Free of Accident Hazards/Supervision/Devices – a nursing home must ensure a safe place and supervise residents as necessary.

Nursing Home Liability Concerns

Nursing homes and hospitals can be held liable for injuries caused by bed rails if they are not properly used.

An 81-year-old man in a nursing home in the United States died from positional asphyxia in October 2021. He was trapped between his mattress and portable bed rails.

Nursing facilities should ensure safety, comply with laws, and address liability concerns. Failure to fulfill this duty can lead to a lawsuit for negligence.

If someone you know has suffered abuse in a nursing home, you can file a legal claim against the facility.

You can contact your state bar association or seek their service online to find an experienced nursing home abuse attorney.The Federal Register also contains more information about bed rail safety standards.

Risk Assessment and Prevention

Nursing home residents are experiencing increased bed rail accidents and injuries. These are due to wrong bed rail use, wrong mattress, or a patient’s agitated behavior.

These are why risk assessment and prevention are important in healthcare settings.

A nursing home can help keep its elderly patient safe and healthy by identifying and mitigating these risks.

Here are three ways to assess risks and prevent them:

Identifying High-Risk Residents

A healthcare team can reduce risk by identifying and addressing the needs of every patient, especially the high-risk residents.

Here are some factors for injuries and adverse events in nursing home residents.

  • Age – older adults have a higher chance of injuries and adverse events.
  • Health conditions – patients with chronic diseases like dementia, heart disease, and diabetes.
  • Medication use – multiple medications increase the chance of adverse drug events.
  • Functional limitation – difficulties performing routine activities (bathing, dressing, toileting).
  • Behavioral problems – wandering, agitation, and aggression.

Care Plan Development and Implementation

Once high-risk patients have been identified, a healthcare worker can develop care plans.

These plans may include modifying the environment, using assistive devices, or providing calming interventions.

For example, a patient with cognitive impairment can benefit from a bed alarm and no bed rails to prevent fatal or nonfatal injury.

This personalized approach ensures that bed rail usage is appropriate and tailored to the patient.

It also reduces the chances of bedrail injuries, accidents, and, worse, death.

Caregiver Training and Supervision

Caregiver training and supervision are essential for effective danger assessment and prevention.

It ensures caregivers have the skills and knowledge to identify and address risks. It is also one way to ensure patients’ safety in their routine activities.

Doing these as part of risk assessment and prevention can help patients by:

  • Identifying and addressing potential hazards.
  • Providing patients with the care they need.
  • Ensuring that caregivers follow proper procedures.
  • Creating a safe and supportive environment.

Supervision ensures that the ongoing assessment and prevention practices are reviewed and improved.

This helps update procedures, identify and mitigate risks, and share best practices with staff members.

Alternatives to Bed Rails

Concerns regarding bed rails’ potential risks and adverse effects have risen. Feds have also warned against improper use of bed rails among elderly patients.

For this reason, exploring alternatives to bed rails is equally important.

1. Low-Height Beds

Low-height beds are a good alternative to bed rails because they provide a similar level of safety without the same risks.

Unlike bed rails that restrict mobility, low-height beds allow patients to move freely within their bed space.

Low-height beds are much lower to the ground. It gives easy access to beds, thus reducing potential risks for patients.

2. Protective Floor Mats

Protective floor mats are also good alternatives to bed rails or assist bars. A bed rail can pose a danger for individuals at risk of falls, potentially leading to death.

Protective floor mats reduce fall-related trauma by cushioning patients who fall out of bed.

3. Movement Monitoring Devices

These devices detect and alert caregivers of significant movements or changes in a person’s position.

This gives you much-needed timely assistance and reduces the need for physical restraints.

Movement monitoring devices use sensors to track the patient’s movements and alert caregivers if the patient is about to fall.

4. The Importance of Person-Centered Care

Person-centered care is superior to having bed rails.

It focuses on individual needs, preferences, and protection without relying on physical restraints. They can help prevent falls without needing bed rails or grab bars.

Person-centered care upholds dignity and respect for all individuals.

Plus, their wishes should be considered when making decisions about their care.

Frequently Asked Questions

An elderly’s safety is important for family members, caregivers, and healthcare professionals.

Therefore our team has gathered these common questions and concerns about using bed rails in nursing facilities.

Why Are Bed Rails Not Commonly Used in Nursing Homes?

Bed rails are not used in a nursing home because they can be dangerous.

Also, the Consumer Product Safety Commission released a recent warning against the dangerous use of bed rails.

A nursing home may breach laws using bed frame side rails instead of adequate monitoring or supervision.

So what they do instead is they focus on other fall prevention measures, such as:

  • Close supervision of patients.
  • Proper medication and pain relief control for patients.
  • Sufficient room lighting.
  • Use of non-slip footwear for the elderly.

Are Bed Rails Considered Restraints in Nursing Homes?

Bed rails are not automatically considered restraints in a nursing home.

It may be classified as physical restraint if intentionally used to restrict a resident’s freedom of movement.

Nonetheless, there are several valid reasons why a nursing home might use bed rails. An example is when they are used to prevent falls, a major hazard for older adults.

When Should Bed Rails Not Be Used in Nursing Homes?

Bed rails should not be used in nursing home beds when they pose a greater risk to the elderly.

Reports by the FDA and the Consumer Product Safety Commission (CPSC) show that bed rails cause severe injuries among patients.

Therefore, it should only be used with the proper assessment based on the guidelines from these agencies.

Bed rails should not be used in a nursing home when they are solely intended to substitute for proper supervision and care.

What Is the Primary Function of Bed Rails in Nursing Homes?

The primary function of bed rails is to prevent falls.

They help prevent falls by providing safety rails that prevent patients from rolling out of bed.

Bed rails are essential for high-risk patients prone to falls, but others must not be unnecessarily restricted.

How Can Nursing Homes Ensure Resident Safety Without the Use of Bed Rails?

A nursing home ensures every patient is safe without using side rails through some fall prevention strategies.

Hospitals can make environmental modifications to reduce making bed rails dangerous. These could include installing nightlights, removing clutter, and keeping bed wheels locked.They may also refer to alternatives that also aim to keep patients safe.


This debate over bed rails’ use in nursing homes will likely continue.

Bed rails can be used but should be limited to situations where the benefits outweigh the risks.

It is important to remember that bed rails are valuable safety tools that should be used with proper assessment and usage guidelines.