Is an enclosure bed considered a restraint? Understanding the Rules for Senior Care

Oct 29, 2025 4 min read •

senior care Patient Safety

According to regulatory bodies like The Joint Commission, an enclosure bed is generally considered a form of physical restraint because it prevents a person from exiting the bed freely. Understanding this classification is crucial for anyone involved in senior care, especially regarding the critical question, Is an enclosure bed considered a restraint?

Quick Summary

Yes, an enclosure bed is considered a physical restraint by most healthcare regulatory bodies because it restricts a patient's voluntary movement and ability to exit the bed. Its use is subject to strict rules and protocols, including physician's orders and patient assessment, and is generally reserved for specific safety purposes after less restrictive options have failed.

Key Points

Considered a Restraint: Yes, an enclosure bed is legally and clinically considered a restraint because it restricts a patient's freedom of movement and ability to exit the bed freely.
Regulatory Oversight: The use of enclosure beds is governed by strict regulations from bodies like The Joint Commission, requiring specific protocols and authorization.
Requires Physician's Order: Like all restraints, an enclosure bed can only be used with a provider's order, which must be renewed periodically.
Less Restrictive Alternative: Enclosure beds are often considered a less restrictive option than more traditional physical restraints, such as vests or limb holders.
Focus on Alternatives: Before using an enclosure bed, healthcare providers should explore all less restrictive alternatives, like bed alarms, distraction techniques, or environmental modifications.
Documentation is Crucial: The decision-making process, including patient assessments and monitoring, must be meticulously documented to ensure patient safety and regulatory compliance.

Defining What Constitutes a Restraint

In the realm of healthcare, a physical restraint is broadly defined as any manual method or physical device that restricts a person’s movement, access to their body, or freedom of action. This includes traditional restraints like vests or limb holders, but also encompasses less obvious methods. The key is whether the device or method limits a person's ability to move freely or exit a specific area, like a bed, voluntarily. For an enclosure bed, which uses a mesh tent or canopy system, the purpose is to create a safe, protective environment, but the effect of confining the patient means it falls under this classification.

Enclosure Beds vs. Other Restraints

While an enclosure bed is categorized as a restraint, it is often seen as a less restrictive alternative to more severe options. This distinction is important for clinical decisions. The bed provides a protected space, which can have a calming effect on agitated or confused patients, as opposed to the potential for increased anxiety or injury that might come with other physical restraints. It is important to note that the appropriateness of the device depends entirely on the patient's individual needs and behaviors.

Comparison of Restraint Types


Restraint Type	Description	Restrictiveness Level	Common Indications
Enclosure Bed	Mesh canopy system placed over a standard bed to prevent exit.	Less Restrictive	Fall prevention, agitation due to dementia, wandering behavior.
Limb Holders	Cuffs or devices to secure arms or legs to the bed.	Highly Restrictive	Preventing disruption of medical lines (IVs, feeding tubes) or self-harm.
Vest Restraints	Sleeveless garment-style device to prevent exit from bed or chair.	Highly Restrictive	Preventing unassisted exits; risk of suffocation if misused.
Bed Rails (4 rails up)	Raising all four side rails on a bed.	Situationally Restrictive	Prevents patient from getting out of bed; considered a restraint if the patient is able to get up but is prevented from doing so.

Regulations and Protocols for Use

Because enclosure beds are classified as restraints, their use is governed by strict regulations and requires a comprehensive, documented process. This is to protect the patient's rights and ensure their safety. Key requirements often include:

Physician's Order: A qualified provider must order the use of the enclosure bed, and this order must be renewed at regular intervals (often every 24 hours). The order must specify the duration and circumstances for use.
Comprehensive Assessment: Before use, the patient's medical and behavioral history must be assessed to determine if an enclosure bed is the most appropriate and least restrictive intervention. This includes evaluating the risks versus the benefits for that specific individual.
Exploration of Alternatives: Clinicians must first attempt less restrictive interventions, such as adjusting medication, providing distraction (activity aprons, fidget aids), or using bed alarms, before resorting to an enclosure bed.
Patient and Family Education: The clinical team must explain the reason for the enclosure bed to the patient (if possible) and their family, detailing its function and how it contributes to the patient's safety plan.
Regular Monitoring and Documentation: Staff must frequently check on the patient, documenting their response to the enclosure bed, ensuring their needs (e.g., toileting, nutrition, hydration) are met, and ensuring the bed is used correctly.

Ethical and Safety Considerations

The use of any restraint, including an enclosure bed, carries significant ethical considerations. The primary goal is always to balance a patient's right to freedom of movement with their safety and well-being. Potential risks associated with restraints include increased agitation, anxiety, loss of dignity, and, in some cases, risk of entrapment or injury if not used properly. Furthermore, the calming effect can be beneficial, but it must be weighed against the psychological impact of feeling confined.

For some patients, particularly those with a history of claustrophobia or combative behavior, an enclosure bed may not be an appropriate choice. It is imperative that healthcare teams work with family members and caregivers to make an informed decision that respects the individual's history and preferences while ensuring their physical safety.

The Role of Restraint Alternatives

Before considering an enclosure bed, a facility should exhaust all reasonable alternatives to restraints. These alternatives focus on addressing the root cause of the patient's behavior, rather than simply confining them. A truly patient-centered approach involves investigating the reasons behind behaviors like trying to exit the bed or agitation.

Alternatives to Consider

Environmental Adjustments: Ensure the patient's room is calm and familiar. Use nightlights to reduce confusion and rearrange furniture to create a safer space. Addressing pain, thirst, or other physical needs can also de-escalate agitation.
Personalized Care Plans: Develop a care plan that incorporates the patient's routines and preferences. This might include structured activities, favorite music, or simple, clear communication techniques to redirect behavior.
Distraction and Redirection: Use diversionary tools like activity aprons or sensory aids. Gentle redirection and verbal communication can often calm a patient who is attempting to get out of bed.
Bed and Chair Alarms: These non-restraining alarms alert staff when a patient attempts to exit a bed or chair, allowing for timely intervention before a fall occurs. However, overuse or misuse can sometimes agitate patients further.

Conclusion: Navigating a Complex Issue

Yes, an enclosure bed is considered a restraint, but its use is not a simple matter of a yes-or-no answer. It represents a complex balance between patient safety, freedom, and ethical considerations. While categorized as a restraint by regulatory bodies, it is often a less restrictive option than traditional physical restraints. For caregivers and families navigating this decision, it is essential to understand the regulations, participate in the patient's assessment, and be a vocal advocate for trying all less restrictive alternatives first. This ensures the chosen intervention provides maximum safety while preserving the patient's dignity and quality of life.

For more information on patient safety, review guidelines from the Food and Drug Administration regarding bed safety.

Frequently Asked Questions

An enclosure bed is classified as a restraint because it uses a physical device (the canopy or mesh tent) to immobilize or limit a patient's ability to freely exit the bed, regardless of the device's intent.

While enclosure beds are not routine, they are used in specific situations, particularly for patients with cognitive impairments like dementia, who are at high risk for falls or self-harm due to impulsive behavior.

Both can be restraints. An enclosure bed is designed specifically to prevent exit, whereas bed rails are considered a restraint only if they prevent a patient who is capable of exiting the bed from doing so. The context and patient's ability are key.

Alternatives include individualized care plans, environmental adjustments to reduce hazards, bed alarms to alert staff of exit attempts, and diversionary techniques to calm and redirect agitated patients.

Family members can discuss the possibility with the healthcare team. However, the decision must be made by a qualified provider based on a comprehensive patient assessment and after less restrictive options have been tried.

Risks include potential patient agitation, anxiety, psychological distress from feeling confined, and a small risk of entrapment or injury if not used properly. The benefits must always be weighed against these risks.

The duration is determined by the provider's order and the patient's care plan. The order must be regularly reviewed and renewed (typically every 24 hours), and the bed should be discontinued as soon as the patient's behavior improves.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.