Bed Rails for Seniors in 2024: Alternatives to Consider

Key Takeaways

• Many portable bed rail brands have recalls due to safety concerns.
• Several alternative bed mobility and safety solutions exist, like foam bumpers, medical alert devices, and adjustable beds.
• If you’re unsure of which mobility or safety methods to choose, consult your doctor or an occupational or physical therapist for appropriate suggestions relevant to your health status and condition.

While bed rails seem like a safe mobility solution for older adults, recent product recalls and federal standards suggest otherwise. The Federal Register reported portable bed railsⓘ A nonpermanent bed rail secured to the side of the bed frame to serve as a mobility aid or to prevent falls from the bed. Also known as side rails, safety rails, and grab bars. were deemed generally unsafe by the U.S. Consumer Product Safety Commission (CPSC) due to more than 79,000 reports of injury and more than 284 deaths dating between 2003 and 2021. ^[1]Safety Standard for Adult Portable Bed Rails. Federal Register. July 21, 2023. Found on the internet at https://unblock.federalregister.gov/ ^[2]Safety Standard for Portable Bed Rails Docket. Consumer Product Safety Commission. Sept. 21, 2022. Found on the internet at https://www.cpsc.gov/s3fs-public/ProposedRuleSafetyStandardforAdultPortableBedRails.pdf?VersionId=Ypa89Iczh13C40Tq7EJRSMDZoatChf1

Ann Kriebel-Gasparro, DNP, president-elect of the Gerontological Advanced Practice Nurses Association, told us how bed rails must adhere to certain standards detailed in ASTM F3186-17: Standard Specification for Adult Portable Bed Rails and Related Products. ^[3]Standard Specification for Adult Portable Bed Rails and Related Products. American Society for Testing and Materials. May 24, 2022. Found on the internet at https://www.astm.org/f3186-17.html Since these standards were published in 2017, the CPSC has issued multiple recalls and warnings against portable bed rails because many brands weren’t upholding these set standards. The CPSC decided to change existing standards, and in the summer of 2023, the final rules were voted into effect to improve and mandate product testing and safety requirements for portable bed rails. ^[4]Record of Commission Action. United States Consumer Product Safety Commission. July 6, 2023. Found on the internet at https://www.cpsc.gov/s3fs-public/RCA-Final-Rule-Safety-Standard-for-Adult-Portable-Bed-Rails.pdf?VersionId=l3bgzIsqr01SeKBYe56AMlHbLPKROHRn ^[1]Safety Standard for Adult Portable Bed Rails. Federal Register. July 21, 2023. Found on the internet at https://unblock.federalregister.gov/

Our Reviews Team has recognized the challenge of choosing an appropriate mobility aid or safety device, which is why we consulted health care professionals for their recommendations on alternative products and safety methods.

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What to consider before shopping for bed rails

Before you purchase a bed rail for yourself or someone you care for, consider the risks. Most injuries or deaths involve entrapment, which is when someone gets caught between the rail’s bars or between the rail and the bed. ^[1]Safety Standard for Adult Portable Bed Rails. Federal Register. July 21, 2023. Found on the internet at https://unblock.federalregister.gov/ ^[2]Safety Standard for Portable Bed Rails Docket. Consumer Product Safety Commission. Sept. 21, 2022. Found on the internet at https://www.cpsc.gov/s3fs-public/ProposedRuleSafetyStandardforAdultPortableBedRails.pdf?VersionId=Ypa89Iczh13C40Tq7EJRSMDZoatChf1 . Injury or death can also occur when people attempt to climb over or through the rails, leading to a fall. ^[5]Clinical Guidance for the Assessment and Implementation of Bed Rails in Hospitals, Long Term Care Facilities, and Home Care Settings. Hospital Bed Safety Workgroup. April 2003. Found on the internet at https://www.fda.gov/media/88765/download?attachment

Between 2021 and 2023, multiple brands’ bed rails have been listed for recall. These brands include:

• Vaunn
• LumaRail
• DeVilbiss
• Essential Medical Supply
• NOVA
• Mobility Transfer Systems

At the time this article was written, our Reviews Team found only two brands without an open recall on their bed rails. These brands are Stander and Able Life, both found in chain retailers like Walmart. Their recall status may have changed since, so check the CPSC for updated information if you are considering purchasing from these brands or others. Even without a recall notice from the federal government, keep in mind that using bed rails comes with risks. “If bed rails are the choice, use covers [over the rails] to prevent the older adult from getting caught between the rails,” said Kriebel-Gasparro. Many bed rail manufacturers have started incorporating covers into their bed rail design for added safety, but you should still use caution as the covers can be removed by the user.

If you do purchase a bed rail, Kriebel-Gasparro recommended making sure it’s installed properly to minimize (but not eliminate) risk. Follow instructions closely and ensure the rail is securely attached to the bed’s frame, fitting snugly against a firm mattress, and not just set in place. And if someone you care for is in a long-term care facility, Kriebel-Gasparro advised making sure a comprehensive assessment and care plan are in place to ensure appropriateness and maximum safety during use.

Regardless of recall status, our Reviews Team cautions buyers against purchasing bed rails as federal safety standards adjust. The FDA has stated that some users may be more vulnerable to entrapment, including those with conditions affecting mobility and cognitive status, as these conditions make it difficult to escape entrapment or ask for help.

The FDA specifically lists the following health concerns as high-risk for bed rail entrapment: ^[6]Recommendations for Consumers and Caregivers about Adult Portable Bed Rails. U.S. Food and Drug Administration. Feb. 27, 2023. Found on the internet at https://www.fda.gov/medical-devices/adult-portable-bed-rail-safety/recommendations-consumers-and-caregivers-about-adult-portable-bed-rails

• Confusion
• Restlessness
• Lack of muscle control
• Alzheimer’s or other forms of dementia
• Parkinson’s disease
• Multiple sclerosis
• Balance disorders
• Stroke
• Low blood pressure

Our Reviews Team recognizes there are benefits to bed rails, although we urge you to weigh them against the physical health risks before purchasing them. While there are many functional benefits to bed rail use, benefits can also be achieved with alternative products, which are detailed later in this article.

Pros of bed rails

• Prevents falls off the bed
• Provides bed mobility assistance
• Decreases caregiver effort
• Relatively low cost
• Adjustable and removable
• Provides a sense of security for users

Cons of bed rails

• Increases the risk of entrapment
• High incidence of injury and death reported
• Not intended for all beds, including many adjustable beds
• Multiple recalls and non-compliant products on the market
• Self-setup leaves room for error and increased injury risk
• May increase worries for caregivers due to recalls and safety issues

Compare bed rail alternatives for seniors in 2024

Table 1 Comparison of bed rail alternatives for seniors

Bed rail alternatives in 2024

If bed rails aren’t a safe option, what is? We consulted Christopher Norman, a board certified geriatric nurse practitioner and holistic nurse in central New York, and Kriebel-Gasparro for alternative mobility and safety solutions for the bed. ^[6]Recommendations for Consumers and Caregivers about Adult Portable Bed Rails. U.S. Food and Drug Administration. Feb. 27, 2023. Found on the internet at https://www.fda.gov/medical-devices/adult-portable-bed-rail-safety/recommendations-consumers-and-caregivers-about-adult-portable-bed-rails Not every alternative is appropriate, so consider discussing your needs with your doctor.

Before investing in products, ask your doctor for an evaluation from a rehabilitation professional, like an occupational or physical therapist. They can help determine the level of assistance you may need at home and recommend products to buy—or to avoid. You may also benefit from working with your rehabilitation professional to rebuild the strength needed to get out of bed safely. They can also provide tips to improve the strategy you use to get out of your bed, simplifying it by breaking down each of your movements into a step-by-step approach. In turn, you’ll reduce your fall risk, feel more confident in your movements, and improve your independence.

Explore Falls Free CheckUp for more on how to protect yourself and the ones you care for against fall-related injuries.

Adjustable beds

All adjustable beds offer head elevation, which raises your upper body into a seated position and makes it easier to get out of bed. This option is most appropriate for people who feel safe turning their bodies toward the edge of the bed and standing independently, but want assistance with raising themselves up from a lying to a seated position. Most adjustable bases offer adjustable leg heights so you can set the base to a height that feels safe to stand up from. But it’s important to note that most adjustable bases don’t have controls to elevate or lower the entire bed height on demand. If adjustable height is a feature you want in a bed, a hospital bed may be a better investment.

Adjustable beds often offer other features that support safer mobility. The Saatva Adjustable Base Plus ($1,500) has under-bed lighting to illuminate the floor around your bed at night, so you’re less likely to trip while walking through your bedroom. It also offers wall-alignment, which shifts the adjustable base backwards as the head of the bed elevates, keeping you within reach of your nightstand.

Medical alert systems

If you’re independent in your mobility but would like peace of mind knowing assistance is within reach, a medical alert system is a good choice. These systems are connected to 24/7 monitoring centers, where people are available to dispatch help as needed. Depending on the medical alert system, you can contact the monitoring center by either pressing a button or talking to the voice-activated device. Some systems have fall detection, which automatically contacts the monitoring center if it detects a fall.

Our Reviews Team recommends a voice-activated medical alert system for bedroom safety. GetSafe and Aloe Care Health (both starting at $30 per month) use a wall-mounted device to pick up your voice anywhere in the room if you need help.

Wearable devices are great on-the-go solutions, but they can be problematic to wear while sleeping. Necklace-style devices worn around the neck can create a strangling hazard if worn to bed, and wearable devices with push buttons can accidentally alert the monitoring center when you toss and turn at night. These devices can still provide overnight protection, though, if they are kept within reach on a bedside table.

Floor mats

Floor mats can provide a level of protection from injury without the risk of entrapment. According to the Veterans Health Administration (VHA), this option is best if you have a caregiver who can place the mat while you’re sleeping and remove it before you get up in the morning, since its raised, soft surface can create a fall risk for older adults with balance and mobility issues. ^[7]Floor Mat Resource and Implementation Guide. Veterans Health Administration National Center for Patient Safety. April 24, 2014. Found on the internet at https://www.patientsafety.va.gov/docs/fallstoolkit14/floor_mat_guide_042114v2.pdf The FDA suggests pairing a floor mat with an adjustable height bed, so the caregiver can lower the bed to further reduce injury if the user falls off the bed. ^[5]Clinical Guidance for the Assessment and Implementation of Bed Rails in Hospitals, Long Term Care Facilities, and Home Care Settings. Hospital Bed Safety Workgroup. April 2003. Found on the internet at https://www.fda.gov/media/88765/download?attachment

Floor mats are placed on the floor during the night, but should be moved away during the day to avoid tripping.

The VHA recommends purchasing a floor mat that extends past the head of the bed (approximately 70 inches long) and is at least 44 inches wide for adequate protection. Additional padding on surrounding furniture, like the nightstand, might be a good idea to prevent injury from a fall against the corners or edges. Caregivers may also benefit from the placement of glow-in-the-dark tape around the edges of the floor mat to prevent tripping during nighttime check-ins. ^[7]Floor Mat Resource and Implementation Guide. Veterans Health Administration National Center for Patient Safety. April 24, 2014. Found on the internet at https://www.patientsafety.va.gov/docs/fallstoolkit14/floor_mat_guide_042114v2.pdf

It can be difficult to find floor mats that meet the suggested 44-inch width. We found one available for purchase online called the Posey Floor Cushion (MPN # 6025), which you can order through Divine Medical for $312.49 (at the time of publishing, it was on sale for $231.47). Most brands offer widths up to 38 inches, like the foldaway Secure Beveled Edge Fall Mat ($139.99).

Bed trapezes

Freestanding or bed-mounted trapeze bars provide similar bed mobility assistance to rails, allowing you to pull yourself into a sitting position. This option is best for people with good upper body strength. Those with shoulder injuries or less upper body strength should avoid this option.

Bed-mounted trapezes have lower weight limits than freestanding trapezes, and many models must attach to a sturdy bed frame, or to a headboard or footboard fixed securely to the bed frame. They’re most compatible with a hospital bed, which is sturdy enough to accommodate the product. Freestanding trapezes are more costly, but you get a sturdy frame with feet that fit under most under-bed spaces.

Price varies depending on the manufacturer, retailer, size of the equipment, and weight limit. Trapeze bars for beds can be purchased from online medical product distributors like The Betty Mills Company, which sells a Medline trapeze bar with a 250 lb weight capacity for $97.98, and from online retailers like Amazon, which sells a Graham-Field trapeze bar with a 250 lb weight capacity for $120.13. Both can be either attached to a bed frame or stand, but the stands are optional add-ons. The cost for a higher weight capacity trapeze bar is much higher. An all-in-one trapeze bar stand with a 650 lb weight capacity from Drive Medical is $1,396.38.

Bolsters and roll guards

Bed rails are often used to guard against falls off the bed, but there are similar solutions with less entrapment risk. Placed around the edges of the bed, bolsters and roll guards offer a perimeter reminder to prevent the sleeper from getting too close to the edge of the bed.

Some bumpers secure to the bed’s frame using straps, although they can be bulky and uncomfortable. Smaller foam bumpers, like roll guards, are popular alternatives. They’re small enough to tuck underneath your fitted mattress cover and other bedding, but large enough to provide a perimeter reminder. Small roll guards and bumpers are not always recommended because they’re small and soft enough to squish under body weight, which isn’t protective against falls.

Banbaloo offers a roll guard for beds for $36.99 on Amazon, although some users left negative reviews, saying the roll guard isn’t strong enough to protect high-risk individuals from falls because of its small size and soft quality. Roll guards may also make getting out of bed more difficult for some users, since they would need to lift their body over the roll. Remember to ask a health care professional for recommendations based on your unique needs.

Concave mattresses

Similar to bolsters and roll guards, concave mattresses and mattress covers offer perimeter protection. This option has built-in raised edges that don’t shift, creating a caved-in center to prevent accidentally rolling off the bed and replacing the need for a bed rail. The nylon Defined Perimeter Mattress Cover from Drive Medical is a good example and is pictured below. It’s designed to be placed over a mattress like a fitted sheet, and it has an open, flat section between the raised edges to make it easier for the user to get into and out of bed. Defined perimeter mattress covers are often used with hospital beds and best fit twin XL mattresses. You can purchase them through online medical retailers like Vitality Medical, starting at $157.71.

Not all mattresses or mattress covers with built-in bolsters have openings for the user to safely enter and exit the bed. While concave mattresses provide a more secure perimeter for the sleeper, they can also make it harder to get in or out of bed independently. This option is most appropriate for those with caregivers who can help them to transfer in and out of bed.

As you search for ways to improve bedroom safety, consider the firmness of your mattress. Some soft memory foam mattresses don’t offer good edge support, which is a supportive rim around the mattress’ perimeter to prevent you from rolling off the bed. If your mattress does not offer good edge support and you’re scared of rolling off the bed at night, exchanging your mattress for a firmer mattress option could better support added bolsters and roll guards.

Hospital Beds

Hospital beds come with head, foot, and height adjustability, as well as permanent bed rails, creating a sleeping environment with less risk of entrapment. Unlike portable bed rails, hospital beds and their permanent bed rails are regulated by the FDA and could be eligible for Medicare coverage, according to Kriebel-Gasparro. Your doctor will need to write a prescription for a hospital bed to justify the medical need for it and to potentially qualify for coverage under Medicare Part B or Medicare Advantage as durable medical equipment. ^[8]Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment. U.S. Food and Drug Administration. March 2006. Found on the internet at https://www.fda.gov/regulatory-information/search-fda-guidance-documents/hospital-bed-system-dimensional-and-assessment-guidance-reduce-entrapment ^[9]Bed Rail Safety Activities. U.S. Food and Drug Administration. Feb. 27, 2023. Found on the internet at https://www.fda.gov/medical-devices/adult-portable-bed-rail-safety/bed-rail-safety-activities#:~:text=The%20FDA%20oversees%20adult%20portable,product%20problems%20to%20the%20FDA ^[10]Does Medicare Cover Bed Rails? Medicare. Found on the internet at https://www.medicare.org/articles/does-medicare-cover-bed-rails/

Hospital beds are relatively expensive compared to other alternatives. For example, the Lynacare Hospital Bed from HomeCare Hospital Beds starts at $2,699. But if you qualify for insurance coverage, it could be a safe and viable option for older adults with mobility needs. A hospital bed can be an easier option for caregivers because they can roll it away from walls for patient care or to adjust the height to set up transfers.

Bed alarms

Bed alarms are often used in place of restraint systems like bed rails to protect people with dementia and other cognitive limitations, who may not be able to verbalize when they’ve fallen out of bed or remember that they need help getting out of bed. “Bed alarms are placed under the mattress, which will go off when the person gets out of bed,” said Kriebel-Gasparro. Some floor mats with built-in alarms will also alert the caregiver when it detects weight.

Bed rails should never be considered for restraints in any setting, said Norman. Kriebel-Gasparro agreed. She told us that portable bed rails are not a substitute for proper monitoring, especially for those with dementia or confusion who may try to leave the bed and get trapped in the rails or injured due to their placement. ^[11]Safety Concerns about Adult Portable Bed Rails. U.S. Food and Drug Administration. Feb. 27, 2023. Found on the internet at https://www.fda.gov/medical-devices/adult-portable-bed-rail-safety/safety-concerns-about-adult-portable-bed-rails

But Norman told us that bed and floor alarms aren’t always the best choice, either. “They often create more chaos and noise in a situation where someone might already be restless,” he said.

Those who would benefit from this product are also at highest risk of disorientation and agitation, which could be triggered by the alarm sound. “I advise people to think about why they want to keep a person confined to a bed. If the person wants to move, find out why. Is the person in pain, or do they need to use the bathroom? What is the person looking for by trying to get out of bed? When you can meet and anticipate these needs, restraint often becomes less urgent,” said Norman.

If you choose to purchase a bed alarm, Lunderg is a popular and well-reviewed brand that can be found on Amazon for $124.95. You get a weight-sensitive alarm pad, which fits across the bed to detect movement at the edges of the bed, and a linked pager with batteries included.

Bottom line

“Adult portable bed rails are not for everyone, nor every situation,” cautioned Kriebel-Gasparro, “Even when portable bed rails are properly designed to reduce the risk of entrapment or falls, and used appropriately, they can present a hazard to certain individuals, especially to those with physical limitations or altered mental status, such as dementia or delirium.”

Instead, consider less risky alternatives, like adjustable beds, medical alert systems, and cushioned floor mats. If you’re unsure what type of mobility aid is most appropriate, ask your doctor for guidance or seek a referral to an occupational or physical therapist who can evaluate your needs and make recommendations. You may also benefit from ongoing treatment from an occupational or physical therapist to improve your strength for bed mobility, which will also improve your bedroom safety and reduce your risk of falls.

Additional sleep resources

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Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources

1. Federal Register. Safety Standard for Adult Portable Bed Rails. July 21, 2023. Found on the internet at https://unblock.federalregister.gov/
2. Consumer Product Safety Commission. Safety Standard for Portable Bed Rails Docket. Sept. 21, 2022. Found on the internet at https://www.cpsc.gov/s3fs-public/ProposedRuleSafetyStandardforAdultPortableBedRails.pdf?VersionId=Ypa89Iczh13C40Tq7EJRSMDZoatChf1
3. American Society for Testing and Materials. Standard Specification for Adult Portable Bed Rails and Related Products. May 24, 2022. Found on the internet at https://www.astm.org/f3186-17.html
4. United States Consumer Product Safety Commission.Record of Commission Action. July 6, 2023. Found on the internet at https://www.cpsc.gov/s3fs-public/RCA-Final-Rule-Safety-Standard-for-Adult-Portable-Bed-Rails.pdf
5. Hospital Bed Safety Workgroup.Clinical Guidance for the Assessment and Implementation of Bed Rails in Hospitals, Long Term Care Facilities, and Home Care Settings. April 2003. Found on the internet at https://www.fda.gov/media/88765/download?attachment
6. U.S. Food and Drug Administration. Recommendations for Consumers and Caregivers about Adult Portable Bed Rails. Feb. 27, 2023. Found on the internet at https://www.fda.gov/medical-devices/adult-portable-bed-rail-safety/recommendations-consumers-and-caregivers-about-adult-portable-bed-rails
7. Veterans Health Administration National Center for Patient Safety.Floor Mat Resource and Implementation Guide. April 24, 2014. Found on the internet at https://www.patientsafety.va.gov/docs/fallstoolkit14/floor_mat_guide_042114v2.pdf
8. U.S. Food and Drug Administration. Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment. March 2006. Found on the internet at https://www.fda.gov/regulatory-information/search-fda-guidance-documents/hospital-bed-system-dimensional-and-assessment-guidance-reduce-entrapment
9. U.S. Food and Drug Administration. Bed Rail Safety Activities. Feb. 27, 2023. Found on the internet at https://www.fda.gov/medical-devices/adult-portable-bed-rail-safety/bed-rail-safety-activities
10. Medicare.org. Does Medicare Cover Bed Rails? Found on the internet at https://www.medicare.org/articles/does-medicare-cover-bed-rails/
11. U.S. Food and Drug Administration. Safety Concerns about Adult Portable Bed Rails. Feb. 27, 2023. Found on the internet at https://www.fda.gov/medical-devices/adult-portable-bed-rail-safety/safety-concerns-about-adult-portable-bed-rails