Protocol for Approving Bed Placements in
Nursing Home Residents’ Rooms

By statute (s. 400.23(2)(a), F.S.), the Agency for Health Care Administration may enforce the special occupancy provisions of the Florida Building Code and the Florida Fire Prevention Code when performing any inspections of nursing facilities. The requirement for a bed in a bedroom to be located 3 feet from another bed or wall is contained in the Florida Building Code, Chapter 4, Special Occupancy, Section 420.3.2.2. Because the previous rule, Chapter 59A-4, exempted facilities constructed before July 7, 1970 from the requirement, only those facilities are not required to meet this standard. The Agency follows the Florida Building Code and Fire Prevention Code since, to do otherwise, implies unnecessary risk to the residents and patients in health care facilities.

The Agency concurs in the belief that bed placements in nursing facilities’ resident rooms should take into account resident needs and preferences as determined through the care planning process. However, such resident considerations must be consistent with the requirements of safety and hazard- free access to elements required by the Florida Building Code and must assure compliance with federal regulations regarding resident freedom of movement, the best interests of the resident based upon his/her comprehensive assessment, and ability to promote well being and provide safe care to residents. To merge these considerations into one policy for oversight and enforcement of safety requirements, the following protocol will apply.

As permitted by the Florida Building Code in Section 103.7, Alternative Materials and Methods, an alternate bed configuration, which will permit a bed to be placed against a wall, will be considered in a nursing home facility under the following circumstances when a request for equivalency has been requested and approved by the Agency:

Requirements for the physical plant:

1. The facility must maintain a facility log available to the survey team identifying the instances where residents have requested the relocation of furniture within their rooms and where the facility has responded to those requests in assessing the alternate location of furniture within the room is not inconsistent with resident safety or movement or the compromising of identified Life Safety Code requirements. This log shall also indicate that staff have care planned the residents’ ability to engage in the revised environment with specific and detailed instructions in the plan of care identifying any alteration in care necessitated by the relocated furniture.
The facility shall provide a dimensioned floor plan of the resident bedroom with the following items identified: The new location of all furniture in the room with dimensions shown between the bed(s) and the bed(s) and the walls. This must be referenced in the resident’s plan of care and specifically reviewed no less often than quarterly.
The location(s) of the nurse call activation device(s). The nurse call activation device must be accessible to the resident lying in the normal position in the bed without creating a hazard to the resident. The nurse call cable cannot lie on the floor or be draped across the resident’s bed. It must not be a tripping hazard for the resident or caregivers.
The location of the electrical receptacles shall not be compromised by placing the bed against the wall. If additional electrical receptacles are required in the room, then they shall be installed by a licensed electrician only. There must be one electrical receptacle accessible dedicated for resident use accessible at each side of the bed. This may mean that, in some cases, an additional electrical receptacle may have to be added. All electrical receptacles that are not made conveniently accessible by the new bed position against the wall must be covered with a permanent cover plate or removed. One receptacle may be at the foot of the bed and the other at the accessible side of the bed. Both beds may share the existing electrical receptacle located between the beds.
The cubicle curtain to maintain resident privacy must be relocated if necessary to meet the new bed placements. In semi-private rooms, the cubicle curtain may not block the entrance to the toilet room for the other resident when the curtain is closed.
Residents must have opportunity to access an over bed reading light consistent with the location required under the standard room configuration. Any comparable lighting device of the resident’s choosing, such as a floor or table lamp, can be utilized for reading.
If there is a window or through-wall heating/air conditioning unit in the room, provide the dimensioned projection of the unit into the room. The bed relocation must not block this unit for air distribution to the room or restrict access to the side of the bed away from the wall.

The location of any fixed equipment in the room must not create an encumbrance to the resident or obstruct access or use of any element required by the Florida Building Code.
Residents’ personal furniture placed in the room is permitted so long as it does not obstruct access to or create an encumbrance for either resident in the room.
Written approval for the alternated bed configuration from the Office of Plans and Construction must be maintained on file in the facility.

Requirements for the resident:

The resident or his/her legally responsible party has requested placement of the bed against the wall and this request does not interfere with care required for the resident’s roommate and approval by the interdisciplinary care plan team are documented in the resident’s care plan file.
The resident is able to self transfer. The resident’s choice to move their room furniture must not be contraindicated by the clinical staff’s assessment of the resident or by any orders from the attending physician.
Placement of the bed against the wall must not serve as a resident restraint.

Observation and documentation:

Alternate bed configurations will be observed during routine survey
processes to determine that they do not present hazardous conditions for
residents so placed.
2. If an alternate bed configuration is used, survey staff will confirm approval
from the Office of Plans and Construction if the resident is part of the survey sample.
For residents included in the survey sample, survey staff shall review the
resident care plan files to ensure documentation of residents’ requests for
alternate bed configurations are present, physicians’ orders are present
for any restraints, and residents so placed are not being restrained by
virtue of the alternate bed configuration.