Using Bed Side Rails in Adult Family Homes: There’s a WAC for that!

Adult family home (AFH) residents may use bedside rails if they are assessed as being necessary and the resident can safely use them. Even if an individual has a history of using bedside rails, once that person moves into an AFH, there are necessary steps to take to ensure bed side rail use complies with state regulations as written in WAC Chapter 388-76. In WAC, bedside rails are considered medical devices, which are defined below:

WAC 388-76-10000

“Medical device” as used in this chapter, means any piece of medical equipment used to treat a resident’s assessed need.

(1) A medical device is not always a restraint and should not be used as a restraint;

(2) Some medical devices have considerable safety risks associated with use; and

(3) Examples of medical devices with known safety risks when used are transfer poles, Posey or lap belts, and side rails.

Per WAC 388-76, the following steps must be taken before using bed side rails (or any other medical device) for AFH residents:

  • Resident assessment to determine the need and ability to safely use the bedside rails. (sample bedside rail assessments are available in the AFH Council Document Library).
  • Provide information to the resident/resident representative about safety of using the medical device; A Guide to Bed Safety is an FDA brochure that provides more information about the safety risks and benefits involved with using bedside rails.
  • Update NCP to include description of how bedside rails are used (e.g., helps the resident with bed mobility, transferring in/out of bed, etc.).
  • Ensure the bedside rails are properly installed. (be sure the rails the resident is using are not part of the recalled bed rails listed in Dear Provider Letter #2022-007)

The WACs that describe these requirements are as follows:

WAC 388-76-10650

Medical devices.

(1) The adult family home must not use a medical device with a known safety risk as a restraint or for staff convenience.

(2) Before a medical device with a known safety risk is used by a resident, the home must:

(a) Ensure an assessment has been completed that identifies the resident’s need and ability to safely use the medical device;

(b) Provide the resident and his or her family or legal representative with information about the device’s benefits and safety risks to enable them to make an informed decision about whether to use the device;

(c) Ensure the resident’s negotiated care plan includes how the resident will use the medical device; and

(d) Ensure the medical device is properly installed.

WAC 388-76-10335

Resident Assessment Topics.

(6) Significant known behaviors or symptoms that may cause concern or require special care, including: (a) The need for and use of medical devices;

WAC 388-76-10355

Negotiated Care Plan

(7) If needed, a plan to: (c) Respond to resident’s special needs, including, but not limited to medical devices and related safety plans.

 Creating a plan for the use of bedside rails should be focused on safety and individualized for each resident. Details such as whether one or both sides of the bed will have rails, what time of day they will be used, and how staff will be trained on their proper use should all be included in the assessment and negotiated care plan.

Some providers are caught by surprise when a new resident moves in with a bed that already has side rails, and they were not aware of this prior to admitting the resident. While the resident may want to use the bedside rails right away, they cannot be used in an AFH setting until an assessment showing the need for them is complete. The use of any medical equipment with known safety risks is taken very seriously, and AFH licensors will be on the lookout for all of the requirements and documentation to be in place.

For private paying residents bedside rail assessments may be done by a qualified assessor, not necessarily a specialist such as a Physical or Occupational Therapist.

For Medicaid residents, the HCS case manager who would normally do assessments must use a specific request form (DSHS form 13-906) to implement a process which entails a referral to PT or OT do the bed rail assessment. Because this may take longer than it would if the case manager were to do the assessment themselves, providers should request their case manager initiate the process as soon as possible if there is any chance a Medicaid resident needs bed rails. This detail, in the case of Medicaid residents, about the protocol for getting a bed rail assessment is not in WAC, but it is outlined in HCS Management Bulletin H14-022, dated April 10, 2014.