Bed rail safety in long-term care facilities

By Michaun Shetler  |  September 22, 2023  |  All providers

Bed rail usage in long-term care facilities continues to pose risk to individuals who chose to use them. This year, numerous Minnesotans living in long-term care settings have died after becoming trapped in bed rails. The Minnesota Department of Health stated in a February 17, 2023, presentation, “Bed rails and similar assistive devices can be part of an effective and safe plan to support residents. However, these devices create a risk of entanglement and strangulation, and can increase the severity of falls. In addition, these devices can have the effect of being a restraint.”

Some residents and caregivers may wish to use bed rails to help with turning and repositioning, or to increase the sense of safety in bed. However, consideration of risks and alternatives is an important part of making informed decisions about the use of bed rails. Selecting the right equipment and installing it properly are key elements for safety. Further, the facility staff should continue to assess and evaluate the resident and the equipment as well.

Residents and their loved ones can read more about product safety, risks, alternatives, and other resources. Providers can learn more information about bed rail safety from the Minnesota Department of Health.

When the decision has been made to use a bed rail it is important to follow the below steps. 

Common expectations for both types of bed rails include the following:
  1. Resident is assessed for bed rail entrapment risk (cognitive status, physical strength, mobility, history of falls, incontinence and toileting needs, etc.)
  2. Purpose of the bed rail is documented
  3. Bed rail has been determined it is not acting as a restraint
  4. Resident (and when appropriate, family) has been educated regarding the benefits and risks of using the bed rail(s)
  5. Routine physical inspection of the stability, installation, and condition of the bed rail—bed rail is secure and not wobbly and no large gaps are noticeable

Additional documentation requirements for bed rails installed on hospital-style beds include the following:
  • Measurements for Zones 1, 2, 3, and 4 should be documented to verify they meet the dimensional requirements
    • Zone 1—Spaces within the rails (not to exceed 4.75”)
    • Zone 2—Under the bottom of the rail, between the rail supports (not to exceed 4.75 “)
    • Zone 3—Between the rail and the mattress (not to exceed 4.75”)
    • Zone 4—Under the rail at the end of the rail (not to exceed 2 3/8”)
  • Note—if you want to be 100% accurate with these measurements, Care Providers of Minnesota owns two of the FDA approved bed rail measurement kits. The kits are available to rent for 10 days from Care Providers of Minnesota.

Alternative requirements for portable bed rails installed on consumer-style beds include the following:
  1. The facility must determine the make and model of the portable bed rail (you might need to get on your hands and knees and take a picture of the label!)
  2. The facility must document it checked the Consumer Product Safety Commission to verify the specific portable bed rail in use has not been recalled by the CPSC
  3. The facility must verify the portable bed rail was installed/attached according to the manufacturer’s recommendations (you may need to download the instructions for the make and model of portable bed rail in use) 
  4. The facility should visually verify and document the bed rail does not appear to be an entrapment risk, particularly the spaces within the rail and the space between the rail and the mattress (are there areas large enough for a body part to be trapped, is there significant space between the rail and the mattress?)
  5. The facility should include and reference the use of the portable side rail in each assessment conducted (a required assessment element is “assistive devices”)—this includes, when appropriate, the initial assessment and subsequent assessments (change of condition and every 90-days)
  6. If the portable bed rail appears unsafe to use, consider using a negotiated risk agreement, or, in extreme situations, contact MAARC for assistance with adult protection

If you conclude the bed rail in use is not safe for the resident, do the following: 

Offer alternatives, and discuss and offer interventions to mitigate safety risks 
  • Remove the bed rail, or replace with a safer type of bed rail
  • Document your assessment and all interventions discussed, offered, or attempted 
  • If you use a negotiated risk agreement or similar, you must: maintain documentation of the offer of alternatives, implement interventions to mitigate safety risks, and conduct ongoing reassessment for the appropriate use of a bed rail
  • If the family continues to demand that an unsafe bed rail be used, consider contacting MAARC for adult protection services

Care Providers of Minnesota has created audit forms for facilities to use to verify they are in compliance with bed rail documentation and have taken the required steps to help mitigate risks:
  • Side rails on hospital-style beds audit tool
  • Portable side rails installed on consumer-type beds audit tool

Don’t forget that the Office of Ombudsman for Long-Term Care advocates for the health, safety, well-being, and rights of long-term care consumers. They are another great resource and can be reached at 800-657-3591. 


Michaun Shetler
Michaun Shetler  |  Director of Assisted Living  |   mshetler@careproviders.org  |  952-851-2484