FAQ: Are Bed Rails Allowed in Assisted Living?

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Bed rails are only partially allowed in California assisted living facilities and are subject to strict regulations. Half-length bed rails that extend from the head of the bed and are used solely for mobility assistance are permitted. However, full-length bed rails are generally prohibited unless the resident is receiving hospice care and the need for the rails is clearly stated in their hospice care plan.

A physical restraint in California is defined as any method, device, or equipment that is attached to or near a resident’s body and restricts movement or access to one’s body, and which the resident cannot remove easily. This includes belts, straps, full-length bed rails, deep chairs that prevent standing, and certain types of wheelchairs or recliners.

Physical restraints are only to be used when absolutely necessary to prevent immediate harm to the resident or others. Their use must follow the failure of less restrictive interventions and be part of a comprehensive care plan developed with input from the resident and their family.

Bed rails may lead to entrapment, entanglement, or falls if residents try to climb over them. They can also limit mobility, cause physical complications like muscle weakness or bedsores, and trigger confusion or agitation, especially in those with dementia.

Although bed rails are sometimes intended to prevent falls, they can increase fall risk if residents attempt to climb over them. Facilities are encouraged to consider safer alternatives such as lower beds, fall mats, or motion sensors.

California Code of Regulations (CCR) Title 22 §72082 outlines the definition and limitations on the use of physical restraints in licensed care settings. It emphasizes that restraints should only be used when necessary and must never violate a resident’s rights to movement and autonomy.

Physical restraints can harm a resident’s sense of autonomy and lead to emotional distress, such as depression, anxiety, or increased confusion. Over time, they may also contribute to cognitive decline, especially in residents with existing impairments.

Prolonged use of restraints may lead to decreased mobility, muscle atrophy, pressure sores, and joint stiffness. These complications can severely affect a resident’s quality of life and physical independence.

Postural supports can become restraints if they unnecessarily restrict movement or are used without proper consent or clinical justification. According to California law, they must not involve tying or limiting the use of a resident’s hands or feet.

Safer alternatives include using lower beds or floor beds, placing fall mats beside the bed, utilizing motion sensors and bed alarms, using foam wedges or bolster pillows, and adjusting beds for easier access. These options can prevent injury while preserving independence.

A thorough fall risk assessment allows caregivers to tailor prevention strategies to each resident’s unique needs, reducing the reliance on physical restraints. This might involve environmental modifications, behavioral monitoring, or additional staffing.

A restraint-free philosophy supports residents’ dignity, autonomy, and mental well-being. California regulations and ethical caregiving practices emphasize alternatives to restraints that focus on compassion and person-centered care.

Even with a request, the use of bed rails must comply with California laws. Only half-length bed rails used for mobility assistance are generally allowed. Full-length rails require specific hospice care documentation and justification.

Staff training is critical in identifying alternatives to restraints and managing behavioral or mobility issues compassionately. Education helps caregivers understand the risks and focus on interventions that support residents’ rights and well-being.

Facilities can promote safety through regular assessments, individualized care plans, environmental modifications, technology-based alerts, and increased supervision. Open communication with families and regular care plan reviews also help meet each resident’s needs without restricting their freedom.