Hospice Patients Alliance: Consumer Advocacy

When Bed Rails Kill Confused Patients,
Facilities do Not Tell the Family!

A series of articles (by Detroit Free Press staff writers David Zeman and Patricia Montemurri) on nursing home accidents involving confused patients who died while becoming entangled in bed side rails has been printed by the Detroit Free Press in Michigan (2/8/00 - 2/10/00). Headlines report: "When bed rails kill, families go untold" and "Safety rails on beds are potentially fatal." While families and caregivers have serious concerns that patients will fall out of bed, others have concerns that patients will die or seriously injure themselves when getting caught on the side rails. Some patients are quite confused, others are agitated, and this is especially a concern for terminally ill patients who become agitated.

Terminal agitation is one of the common symptoms of the end of life phase. The agitation may be so extreme that patients act completely contrary to their usual personalities. They may scream, get paranoid, imagine that there are dangerous persons or animals attacking them when there are none; they may simply insist on getting up out of bed even though they cannot walk at all, and consequently fall out of bed or fall when they try to walk. Nursing homes have been threatened with lawsuits by families who insist that the bed rails be up at all times, so that their loved one does not fall out of bed. On the other hand, nursing homes have also been threatened with lawsuits by other families who insist that the bed rails not be used, because of their dangers.

It is obvious to those who observed the improvements in infant crib safety where the bars were placed closer together, that similar design changes would help prevent many of the accidents where patients get entangled in the bed siderails. Padding of the side rails would also help, or even making the siderails solid with no spaces to put a hand or arm through, would be helpful.

The real problem is not only bed siderail design, but rather lack of adequate staffing and supervision of the patients. Health care has become a bottom-line business with decisions made based on the best way to save money, not upon what is best for the patients. Over and over again, thousands of patients are denied the care they need based upon their medical condition, because facilities and health care institutions are ruled by for-profit organizations concerned with increasing stockholder dividends. Even in so-called "not-for-profit" run facilities, the same types of decisions are made, again, in order to bolster the bottom line.

Facilities complain about the poor reimbursement from Medicare, Medicaid and so on, yet at the same time top facility administrators and owners are paying themselves hundreds of thousands of dollars per year, and some up to millions of dollars per year. We believe that the "profit" motive has no place in health care when it denies patients the basic care they need. Paying owners and administrators "reasonable" salaries is fine as long as patients get the care they need. And that's the point, what is health care all about? The patients! We in health care exist to serve the patients. The businesses in health care have it backwards: they act and believe that the patients are "sources of revenue" just like a sack of potatoes at the grocery store. Do top administrators "care" about the patients that they deny basic services to? Not a bit.

So, what can we do? If you have a loved one in a facility, whether hospice or nursing home, your presence on site is the best protection your loved one can have. By being there, you can see and observe for yourself what is happening and what your loved one's needs are. The facilities will often NOT tell you the truth if your loved one died while getting caught in the bed siderails. According to the Detroit Free Press article of Feb. 9, 2000, 94 year old Marie Landry died when she became entangled in a bed rail. The facility never told the family. Only when the State cited the facility for the "accident hazard," did the daughter learn that her mother had died unnaturally and unnecessarily.

You may say, "well, she was 94 years old," but this type of accident can easily occur in a 24 year old hospice patient who is terminally agitated or confused. If your loved one has terminal agitation, you need to make sure the rails are padded and that there is adequate supervision to monitor your loved one. Some hospices use "bed alarms" which go off the moment the patient's weight is lifted off the bed, and you know that the patient has gotten up out of bed...hopefully they'll get there before the patient falls!

The Detroit Free Press article stated, "At least five Michigan nursing home residents died in incidents involving bed rails last year [1999]. Bed rail dangers have been a stubborn concern nationwide for years. Since 1985, the U.S. Food and Drug Administration has received reports of 370 bed rail entrapments, 227 people died." And that is the REPORTED number of cases. Most nursing homes do not report these cases, unless they're forced to. In other words, a big coverup occurs. It is more likely that thousands of accidents occur with bedrails each year nationwide. Ask any nursing home nurse.



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