This bed rail purchasing guide discusses what a bed rail is, how it should be used and the factors to consider when buying a bed rail.
What is a Bed Rail and How is a Bed Rail Used?
Bed rails are a piece of safety equipment commonly used by seniors to assist them with getting out of bed. These safety rails allow a senior to take advantage of their upper body strength to pull themselves from a lying down position to a sitting position at the edge of the bed. From there, the railing can be pushed on to help get into a standing position.
Essentially, bed rails are a common transfer aid used to move from one surface to another or to adjust one’s body positioning while in bed. There are some physical and cognitive abilities one must have in order to execute the correct motion and movement for a successful transfer. Therefore, bed rails are not for every senior and their use should be evaluated on a case by case basis to ensure safety concerns are addressed and the device is always being used correctly.
The 4 Types of Bed Rails for Seniors
There are 4 main types of railings available for non-hospital beds.
Adjustable Bed Railing
A fairly popular method of securing a bed rail in place is with elongated tubes that run underneath the mattress and across the bed frame. This type of bed rail is easier to install and is lighter overall compared to a bed rail secured by a platform. However, it may also make one’s sleep less comfortable as the tubing underneath may cause small hills and valleys in the mattress. Some of these railings also have feet that sit on the floor for additional security.
Platform Bed Rails
It is possible to secure a bed rail in place with a large and heavy support base that lies underneath the mattress. The senior’s body weight lies directly on top of the platform base and this holds the device in place so it can be used without it shifting. However, the platform can make a mattress more firm, which can affect sleep quality for some. That said, it can be neatly folded for storage when it is not in use.
Strap Secured Bed Rails
A relatively new type of bed rail exists that is secured to the bed mattress with straps made of fabric. Think of it as a seat belt for your bed rail that helps keep it in place during use. It offers one advantage over other methods of securement in that its users tend to notice no change to the mattress firmness.
Wall Mounted Safety Rail
When a senior tends to weigh more or be considered bariatric, they may require a floor or wall mounted bed rail for extra security. If installed correctly, an obese individual can use the device to safely transfer in and out of bed. Depending on the home setup, this device may only be installed in certain locations as they do need to be attached to studs or a securement mounts. As a result, the bed may need to be relocated or furniture re-arranged slightly to position the bed rail near the bed for the senior to use. The advantage of this device is that it is the best way to ensure the bed rail is secure and will never move during its use. However, floor mounted or bed rails drilled to the wall tend to require more expensive hardware and are more labor intensive to install, which tends to push the installation costs higher.
Summary: Wall mounted grab bars that flip out of the way are great because they can be locked in position to support a bed transfer, or placed aside when not being used.
How To Correctly Install A Senior Bed Rail
Bed rails need to be installed near the head of the bed in order for them to be used effectively. If they were slightly more in the middle of the bed, it could be situated in the area where its user would normally sit before getting up from bed. Thus, it could interfere with a transfer if placed in a more central location of the bed. As well, bed rails should be kept near the headboard to reduce their risk of entrapment or getting one’s limbs stuck between the railing and the mattress. Improper bed rail use has been linked to deaths both among community based seniors and hospital patient populations. For this reason, it is important that one possesses the cognitive capabilities to ensure the railing is used appropriately.
Cognitive and Physical Abilities Required For Safe Bed Rail Use
A multitude of cognitive skills are required to complete a transfer with the support of an assistive aid while maintaining appropriate body mechanics. Some cognitive capacities required for a bed transfer could include:
- The ability to perceive objects in one’s environment such as obstacles in one’s path or handles of a transfer aid
- The capability to understand the proper transferring technique and how to position one’s body to gain enough momentum to start the bed transfer
- Possessing enough insight into one’s physical capabilities and limitations to judge if they are able to complete a transfer on their own or will require assistance from a caregiver
- Understanding all the necessary pre-transfer, transfer and post-transfer steps that need to be followed to ensure safety and being able to put a plan into action
- Having awareness of a bed rail’s purpose, its limitations and how to safely use it
In addition to intact cognitive skills, one must possess the physical strength and endurance to meet the demands placed on the body by a transfer. Some examples of physical traits required could include:
- Good upper body strength with sufficient hand grip power will be needed for the pushing and pulling motion required during a bed rail assisted transfer
- Sufficient trunk and balance control should be present in order to ensure that one does not fall back down into a lying position once seated at the edge of the bed
- Enough lower body strength to be able to stand during the transfer to another surface, or to be able to pivot transfer to a nearby wheelchair
Ways to Reduce Bed Rail Entrapment Risks For Seniors
Getting an upper or lower limb stuck between the bed rail and mattress has been a cause of many injuries and deaths in seniors. Many bed rail manufacturers have modified their products to now include a fabric webbing as a safety feature to reduce this dangerous gap. However, what can be done if one already has a different bed rail model without this safety mechanism or have found the most comfortable bed rails to use do not have a safety guard?
Bed Rail Bumper
One way to mitigate some of the entrapment risk would be to wrap a towel around the bottom of the railing to reduce or eliminate the gap between the mattress and safety railing. Alternatively, one can purchase a bed rail bumper that sits underneath the sheets and on top of the mattress to make a slight bump before the railing gap. This can also be used to keep someone that moves frequently during the night more within the center of the bed, however having one on each side may make getting out of bed more difficult. While most bed bumpers are made of foam that get easily compressed under a senior’s weight, positioning and getting one’s body over top of the bumper can be challenging if one has any decrease in muscle strength, muscle endurance, or balance. It may be required to have a caregiver easily accessible to remove the foam wedge if one has any difficulty transferring with the bed bumper in place.
Of course, the use of assistive devices should not replace caregiver monitoring, especially for seniors at high risk of entrapment or falls.
Bed Rail Alternatives For Seniors Struggling To Get Out of Bed
Not all bed and bedroom setups are able to accommodate the use of a bed rail. In some cases seniors do not find bed rails comfortable or dislike their appearance as the need for assistance is usually associated with aging. That said, the majority of seniors that explore assistive devices beyond a bed rail tend to have greater health problems and difficulty with transfers overall. When any of these situations exist, the following bed rail alternatives may need to be considered:
Bed Rail Ladder
A bed rail ladder is a tear resistant fabric that is usually secured to the bed frame or mattress. This device has a handle on the opposite end that a senior can pull to sit up or adjust their body position while in bed. This device is similar to a bed rail, in that both require a good amount of upper arm strength to change body positions.
Bonus: This device can be easily hidden should any visitors come to the home. Simply place the covers over the bed and the assistive device can no longer be seen.
Security Pole or Transfer Pole
A security pole is a secured metal pole that goes from one’s floor directly to the ceiling above. By pulling with one’s upper body strength on this transfer aid, seniors may find it easier to get up from bed. This equipment can be placed strategically throughout the home to help with transfers from other surfaces. This device is typically secured in place one of two ways: tension or drilled into an anchor, but in some cases can be both.
Much like a bed rail, the effective use of a security pole requires a sufficient amount of upper body strength. There is also upgraded super poles with horizontal support bars to better support bed repositioning and transfers.
The horizontal super bar pivots around a central point of the transfer pole. This can gives seniors more holding positions and grasping options and can support them in a host of positions near the pole. This may be a useful accessory to an already established floor to ceiling pole as it could then be utilized for exercises and to help with bedside personal hygiene tasks.
Tip: One helpful exercise to use with a security pole is to practice one’s sit to stand transfers. The act of rising to a standing position engages several large muscle groups including the back, legs and core. Practicing transfers within grasping distance of a security pole can help someone feel more safe and confident while reducing their risk of falling.
Grab Bars
While it is uncommon that grab bars be used in the bedroom, they are used in some situations. For instance, it is a relatively inexpensive way to have a secured transfer aid able to assist a bariatric senior. This requires the device to be situated close enough to the bed for its use, which may mean less space between the bed and wall for transfer afterwards into a wheelchair or for walking away with a rollator walker. Because of these space constraints, many people tend to opt for other safety equipment to aid with bed transfers when possible.
Sliding Board Transfer
A sliding board is often a wooden plank or some other kind of reinforced material that acts as a bridge between the bed and other surfaces that a senior may need to transfer to. The bridge fills a gap between the two surfaces and allows a senior to slide across the board to transfer to the new surface.
While it may sound easy to slide across one surface, there are many requirements before this device can be used safely. The main three things needed for effective sliding board transfers are:
- Good upper body strength to be able to lift one’s weight while shifting sideways away from the bed or towards it. It is called a sliding board transfer, but lifting one’s body is actually a big component of this transfer as it prevents unwanted friction on the buttocks.
- Good trunk control to be able to control one’s upper body when seated or sliding along the board. There is no back rest to support the upper body, so having good trunk control is required to prevent someone from having a fall by leaning too far forward or backwards.
- Ensure that the height of the bed and the wheelchair or chair are exactly the same height prior to starting a sliding board transfer. If there were a height difference, going up an incline would be extra difficult as one works against gravity. And when going from the bed, chair or wheelchair to a surface that is positioned lower, a senior could gain a dangerous amount of momentum and lose control during the slide. This could lead to a potential fall, injury or even death. Having the height balanced on both ends of the sliding board also helps to avoid unwanted friction on the buttock’s soft tissue. Avoiding this type of pressure can help prevent skin integrity issues or wounds from developing.
Given all these requirements, a sliding board transfer tends to be used only in situations when a senior’s physical abilities are relatively intact and assistance is nearby in case there is trouble.
Bed Transfers For Those That Cannot Assist With Their Own Transfer
Patient Lift
A patient lift is a movable hydraulic device that sits on wheels and lifts a patient from bed to lower them into a nearby wheelchair or chair. This device is expensive to own and requires numerous other accessories such as a patient sling to safely operate. Moreover, because it carries risks of entanglement and falling out during use, it is important to always have two caregivers immediately present during any mechanical patient lift attempt. In case there are any difficulties, additional assistance can be sought more easily if there are two caregivers present.
This equipment can prevent many injuries, however the staff that operate the lift need to be trained on how to safely use the device, which can make the overall use of this device costly. Another disadvantage of a patient lift system is that the floor unit is large and bulky and requires lots of space to maneuver and safely operate.
Tip: A helpful patient lift safety guide has been published by the FDA and should be reviewed prior to considering the use of this transfer device.
| Advantages | Disadvantages |
|---|---|
|
|
Ceiling Lift
Ceiling lifts are similar in function to a traditional patient lift, however their design have been altered to allow for a smoother entrance into the homes of patients and away from hospital settings. A ceiling lift has an electric motor unit that connects to a mounted ceiling track. By controlling the remote, one can easily lower the sling or raise it to transport the senior from the bed to other surfaces within reach of the overhead track. The advantage of this system is that it does not take up any floor space and can travel to any room in the home so long as it has a connected track to that location. This equipment looks more elegant and can easily be swapped out with a new motor unit if a defect occurs. Moreover, this senior safety equipment has its motor unit programmed to slower speeds to ensure lifts are more smooth and safe.
While a ceiling lift is a secure way to easily transport a patient from one room to another, there are some disadvantages to the system:
- They are expensive to purchase and install – Drilling into the ceiling will be required, and door frames may need to be cut or modified to allow the ceiling lift to move throughout the home.
- Caregivers are required to undergo safety training – Caregivers will need to spend time with an occupational therapist, physiotherapist or product representative to obtain the necessary training on how to safely operate the equipment.
- Two caregivers are required for safety purposes – In case there are challenges or it is found the sling may not have been placed correctly, adjustments may need to occur. A second caregiver can provide any necessary support during this complicated transfer.
Additional Knowledge: Patient slings are the piece of equipment that a senior sits inside of during a patient lift. Slings come with a wide array of features and costs are proportional to the slings’ build quality and purpose.
Some common features for modern slings include:
- Special fabric to minimize sliding for patients at risk of pressure ulcers or those who may already have small open wounds.
- Material that can easily be washed to allow them to be used for bath transfers and for patients that may have incontinence issues
- A more porous material that allows greater breathing and minimizes risk of further aggregating or developing a pressure ulcer.