The concern is in this state she's at increased risk of falling if she gets up while the aid is asleep. I was thinking now might be a good time to transition to the hospital bed and use rails to discourage getting up alone. is this the right solution or is there a better one. Getting two aides is not in the budget
I agree with the others here, no to the hospital bed. There have been cases where elders have broken their leg when it was caught it in the railing, or choking themselves when their head went through the railing.
It might be time to consider Memory Care or a nursing home, where professionals can help out. If your Mom can't budget Memory Care, then check with Medicaid (different from Medicare) to see is she can quality for a nursing home, and Medicaid helps with the cost of the nursing home.
Where does the aide sleep? Is she hired for just night time? If so, she should be able to hear Mom get out of bed. If she has a separate room, get a baby monitor. I live in a split level. My Moms room was on the lower floor and I was at the top of the house. I had a baby monitor so I could hear her when she was up and around. Have you tried having a commode in her room?
This is another reason why restraints are not allowed anymore. They make the staff feel that the patient is safer being restrained and won't get into trouble. Believe me, a lot of the patients can get into all sorts of trouble if restraints are used.
Falls and injuries will happen at home or in an excellent facility. You just have to try to prevent them if possible.