Are Bed Rails Allowed in Assisted Living Facilities?

Yes, bed rails are allowed in assisted living facilities as long as they comply with state regulations, facility policies and safety guidelines. Residents must also consent to bed rail use, and strict rules exist concerning the size, need and installation of side rails.

Residents must obtain permission to install bed rails in assisted living facilities. Per federal law, facility staff must obtain resident consent — or agreement from their personal representative — before installing rails. Side rails must only be used as aids, never as restraints; rails longer than half the bed length typically classify as restraints. Additionally, communities should clearly explain the pros and cons to residents. Fitters must follow installation instructions to ensure maximum safety, and individuals must use and maintain rails according to manufacturers’ guidelines. Furthermore, facilities should only approve bed rails if they’ve tried alternatives. Additional state requirements often apply, and some jurisdictions only allow rails with a doctor’s recommendation or prescription.

For example, the Florida Agency for Health Care Administration allows doctor-ordered half-bed rails, as reviewed every six months. Exceptions apply for individuals receiving hospice care. Conversely, the Minnesota Department of Health allows resident choice as long as staff perform full assessments related to physical and cognitive ability, safety and appropriateness, with reviews every 90 days or following a change in condition. Pennsylvania only allows half-rails in assisted living communities if residents can raise and lower them independently and assessments show advantages for safety. Assisted living residents wishing to use safety rails should research state laws and discuss it with their facility. Anyone forced to use rails without consent should contact an elder care lawyer or their local Long-Term Care Ombudsman.

Bed rails can reduce the risk of seniors falling out of bed, aid stability for those self-transferring and assist caregivers when helping residents get in and out of bed. However, devices can also cause serious injury or death, mainly through falls, suffocation and entrapment. Several agencies oversee bed rail safety, and the Consumer Product Safety Commission has rules to prevent vulnerable individuals from getting trapped in portable devices. In light of alternative solutions, the risks of bed rails outweigh the benefits for many older adults.

Per the FDA, many people can stay in bed safely without needing rails. Alternative recommendations from the FDA and National Council on Aging include:

• Lowered beds
• Height-adjustable beds
• Transfer aids
• Floor mats
• Increased supervision
• Medical alert devices
• Bed trapezes (overhead grab devices)
• Raised-edge mattresses
• Pillows

Assisted living staff should also regularly review residents’ personalized care plans, including the need for bed rails.