Bed rails, bed levers and profiling beds for an older parent

Watch your parent get into bed and out of it once or twice, if they will let you, and notice where it gets hard. Some people can sit up but cannot swing their legs round. Others reach the edge and cannot push up to stand, because the bed is too low or the mattress too soft. Some manage in the daytime and struggle at night, when they are stiff or half asleep. Each points to a different step on the ladder above.

If the worry is that your parent will roll out of bed, ask first whether it has happened, and how. A person who slides out while trying to get up is having trouble getting up, and a rail will not help them; it may make things worse, because they will try to get over it. A person who rolls out while fast asleep, and stays put once awake, is the case rails were designed for.

If getting about the house is harder generally, the mobility and falls care guide covers what helps beyond the bedroom, and walking aids and how to choose goes through frames and sticks.

The MHRA guidance, Bed rails: management and safe use, was last updated on 30 August 2023. The same day it issued a National Patient Safety Alert covering medical beds, bed rails and bed grab handles. Between January 2018 and December 2022 it received 18 reports of deaths and 54 reports of serious injuries involving this equipment. The guidance says the most serious incidents involved a head, neck or chest becoming trapped, or a fall, and that most happened in community settings such as nursing homes and people's own homes.

The guidance names the people who are at greater risk of being trapped. They include people who are confused, agitated or have delirium, people with dementia or a learning disability, people with involuntary or repetitive movements, people who are very small or very large, and people who are sedated or drift in and out of consciousness. It also says rails must not be used as a restraint, and that for someone whose condition makes them move erratically they can increase the risk of a fall rather than reduce it.

What the guidance asks for before a rail is usedSection titled What%20the%20guidance%20asks%20for%20before%20a%20rail%20is%20used

A risk assessment comes first, and it is repeated when your parent's condition changes or the bed, mattress or rail is replaced. It asks whether your parent is likely to fall from bed, whether they would try to climb over a rail, what they think about having one, and whether something else would do the job. The reasons should be written down and shared with the family.

The rail, the bed and the mattress have to work together. A rail made for one bed can leave dangerous gaps on another, and a softer, thicker or air mattress changes both the gaps and the height of the rail. The guidance warns that rails sold for divan beds are mostly the add-on type, not made for any one bed or mattress, and that rails should not be fitted to wooden or metal bedsteads they were not designed for.

Bed levers carry a risk tooSection titled Bed%20levers%20carry%20a%20risk%20too

A bed lever, also sold as a bed grab handle or bed stick, is a handle fixed to the side of the bed, usually with a frame that goes under the mattress. The MHRA describes these as aids to help someone move in bed and get in and out of it, not as a way to stop a fall, and says they should not be used as an alternative to bed rails. It has also had reports of deaths from people becoming trapped in grab handles. Check that the lever is made for that type of bed, that it does not move when your parent pulls on it, and that there is no gap between the lever and the mattress that a neck or head could slip into. Check again after any change, such as a new mattress. Problems with any medical device can be reported to the MHRA through the Yellow Card scheme.

1. 1

   Ask for an assessment

   Free

   Ring adult social services at your parent's council and ask for a needs assessment or an occupational therapy assessment, or ask their GP to refer them. If a district nurse already visits, ask the nurse. Say plainly what is going wrong: getting up, getting into bed, or a fear of rolling out.
2. 2

   Someone visits and watches

   At home

   An occupational therapist, or a nurse for nursing equipment, sees your parent get in and out of bed, looks at the bed and the room, and asks about nights. This is where a risk assessment for rails is done, if rails are being considered.
3. 3

   The equipment is delivered and fitted

   On loan

   Equipment is loaned free for as long as it is needed. In England a council cannot charge for aids, or for minor adaptations that cost £1,000 or less, for someone it is supporting under the Care Act.
4. 4

   It is reviewed when things change

   Later

   If your parent loses weight, the mattress changes or their health changes, ask for the equipment to be looked at again. When it is no longer needed, the service collects it.

The rule that equipment is free sits in the Care and Support (Charging and Assessment of Resources) Regulations 2014, and the NHS page on household gadgets and equipment says the same thing in plainer words: equipment and small adaptations are provided free if your parent is assessed as needing them. You can apply for a needs assessment on gov.uk, which finds your parent's council from their postcode. The assessment itself is free and does not depend on their savings. Local authority funding explains what else the same assessment can open up.

Waiting times for an occupational therapist vary between councils. If your parent is in hospital, ask the ward before discharge, because equipment can be arranged so that it is there when they get home; hospital discharge explained covers who to ask. If they need help with standing and moving that goes beyond a lever, such as a hoist or a second person, transfers, hoists and two carers goes through that equipment and how it is arranged. Bigger changes to the house, such as a downstairs bedroom, go through a Disabled Facilities Grant instead.

Citizens Advice has a template letter to cancel goods bought at home. Goods made to your own specification can be excluded, so ask before ordering anything made to measure.

We do not recommend brands. For independent views on particular beds and the questions to ask, Which? has a guide to buying an adjustable bed, and Living Made Easy lists bedroom equipment and what it is for. The British Healthcare Trades Association has a code of practice its member companies sign up to, so it is worth asking a seller whether they are a member. We have not found two published, dated price guides for this equipment, so we do not quote prices here; compare written quotes instead.

Getting up in the morning and getting into bed at night are the two times of day where help with moving matters most, so it can make sense to start with a visit at one end of the day or both. A carer who comes every day also notices when moving gets harder, which is worth passing to the occupational therapist. How many visits a week your parent needs helps you work out the hours.

Nights are different. A fall at night can happen on the way to the toilet in the dark, and a rail does not stop a person who has decided to get up. Night care for falls and toilet trips explains what a night carer does about it, and overnight care sets out the difference between sleeping and waking nights. When you are ready to look, you can search for carers near you and compare their rates, and message the ones who help with mornings, evenings or nights.

PrimeCarers is an introductory service, not a care agency. Carers are self-employed and set their own rates. Before a carer appears on PrimeCarers we check their ID and right to work, they hold an enhanced DBS check (or PVG in Scotland, Access NI in Northern Ireland) issued within the last 2 years, and they have an online interview. For visits booked through PrimeCarers, insurance is arranged where the carer does not have their own cover, subject to the policy terms. We do not check qualifications, training or references, and the reviews and references on a profile are not verified by us, so ask a carer directly about moving and handling and how they have helped people in and out of bed before.