Are bed rails a hazard or are they helpful devices in a dementia ward?
I’ve seen horrifying photos recently on Facebook groups of loved ones with bruises and breaks due to falling out of bed. One woman in England wrote about a bed tent that was given to her grandmother to use instead of a restraint. This is a tent that zips up and around a bed and encloses someone inside. An interesting idea, but for someone with dementia, who would be unable to unzip the device, it caused her grandmother to howl in fright when she was enclosed in it.
According to the US Food and Drug Administration, of the 2.5 million hospital and nursing home beds in the US, bed rails injured 803 patients within a 24-year-period, incurring 480 deaths, 138 non-fatal injuries, and 185 staff-rescued incidents.* This data seems outdated, especially as the last year of the survey the FDA conducted was in 2009.
The Nursing Home Abuse Guide says that physical restraints are classified as medical devices and therefore can be used only when a doctor clarifies the medical reason for the restraint, including how and for how long it will be used. Bed rails are categorized as restraints, along with lap trays and wheelchair belts, arm restraints, hand mitts, leg restraints, vests and soft ties, and hook and loop fasteners on clothing. Bed rails and other restraints can apparently only be employed in consultation with the patient. **
The Joint Commission, a non-profit that certifies more than 22,000 health care organizations and programs in the US, has a more nuanced approach. “The determination as to whether or not side rails would be considered a restraint is based on ‘intent.’ Therefore, if the intent of raising the side rails is to prevent a patient from voluntarily getting out of bed or attempting to exit the bed, the side rails would be considered a restraint. If the intent of raising the rails is to prevent the patient from inadvertently falling out of bed, then it is not considered a restraint. Also, if a patient does not have the physical capacity to get out of bed regardless if side rails are raised or not, then the use of side rails is not considered a restraint.”
A bed rail is a metal bar that can be lowered or raised on the side of the bed. These bars can prevent a patient from rolling out of bed and crashing to the floor. They can support a patient in maneuvering into a comfortable sleeping position, and in getting into and out of bed. If, however, the bed frame and mattress are not compatible, a gap can form between them. A frail patient may roll into this gap and then be unable to extricate herself. In extreme cases, this has caused death by asphyxiation. Additionally, a patient can try to get out of bed by rolling over the bar, causing serious injuries when landing on the floor. And if the rails are designed with large spaces between the bars, limbs and heads can become stuck in them.
My mom’s ward here in Israel does use bed rails. And I’m ok with that.
I admit that I had never thought about the potential dangers of bed rails before I started to investigate. I saw them—and still see them—as a preventative measure against injuries and late night wandering. When Mom was living at home, there was no need to use one. Her bed was low to the ground, the floor was carpeted, and Mom was capable of getting into and out of bed by herself. Mom generally slept all night. There were incidents, though, when she left her bed and emptied her bladder in a trash can because she couldn’t find the toilet.
In a dementia care facility, like the one that Mom is in now, the situation is different. At night, there are fewer staff to monitor the patients. Falling out of bed and wandering pose real risks. Mom is not stable on her feet. She needs assistance walking and using the bathroom. What would happen if she got out of bed by herself? As far as we know from talking to the staff on duty, Mom sleeps well at night.
Not all care facilities are equal. Not all staff is kind and compassionate. Should an institution be allowed to decide when and how to use a bed rail? How can you expect someone with Alzheimer’s to understand let alone acquiesce to the use of a bed rail? How much say should a patient’s family have? How do we go about deciding this issue in a way that keeps our loved ones safe?
The woman in England managed to convince the home care manager and specialist nurse to take away the bed tent and provide her grandmother with a floor bed and crash mat, to pad her walls and arrange for a caregiver to check on her every 15 minutes. This will allow her loved one to move around her room as she chooses, providing she does not become agitated. I am proud of this young woman for being a strong advocate for her grandmother.
I suppose I simply closed my eyes to this matter before today. Perhaps there are many more nuanced issues that I am unaware of or unwilling or unable to face. Mom’s care is in the hands of strangers. When we visit, Mom seems well. We can never know what happens when we’re not there, but the times we’ve dropped by unannounced support our feelings that Mom is in good hands.
Now that I’m more informed, I realize that the answer is about knowing our loved one’s needs and abilities and it is also about trust and faith in our fellow human beings.
When our son came home on Friday and decided to cook for himself and some friends, he didn't use all the eggplants he’d bought. I found myself on Sunday morning with his surplus eggplants and the challenge of turning them into something appetizing. Israelis love eggplant. Baked, fried, smoked, roasted. There are more recipes for eggplant than there are people in Israel! I wanted something substantive, a meal all in one. It’s been a long time since I made eggplant Parmesan, so that’s what I did.
Eggplant Parmesan Second to None
When our kids were little, we listened to Jungle Jam and Friends: The Radio Show! on almost every car ride we took. We all loved hearing about Marvy and the RazzleFlabbens, and there were quotes from the show that became everyday utterances in our house. One of them was, “eggplant Parmesan, second to none.” With those few words, I was able to introduce that dish into our household repertoire.
2 medium eggplants, sliced and salted
2 cups bread crumbs
1 tsp granulated garlic
1 tsp paprika
2 cups crushed tomatoes
1 cup tomato paste
1 Tbsp olive oil
2 tsp basil
2 tsp oregano
2 tsp granulated garlic
500 gram / 16 oz container cottage cheese
1 cup yellow cheese
½ cup Parmesan cheese
Salt and pepper to taste
Slice eggplant and place on large flat surface. Sprinkle salt on each slice and let sit for about 20 minutes. (This process brings out the bitterness in the eggplant.) Pat dry, then prepare two bowls, one with egg and the other with bread crumbs. Dip each slice in egg and bread crumbs and place on a baking tray. When all slices are breaded, cook for 20 minutes at 400° F / 200° C or until slices can be pierced easily with a knife. Set aside to cool.
Mix tomato sauce ingredients together. Set aside.
Stir nutmeg, salt and pepper into cottage cheese and add ¼ cup parmesan. Set aside.
In a large baking pan, spread a little tomato sauce, then a layer of eggplant. Next, layer half of the tomato sauce and another layer of eggplant. Spread the cottage cheese mixture on eggplant and additional eggplant layer. Pour on remaining tomato sauce and top with cheese.
Bake at 350° F / 180° C for 30 minutes or until cheese begins to brown.