Pressure Ulcers

Pressure ulcers, sometimes referred to as “bedsores” or decubitus ulcers are a big sign of potential neglect in a nursing home or other care facility.  Many people are not aware that bedsores can be prevented and are often times the result of neglect and abuse. Unfortunately, the elderly and other people less able to care for themselves fall victim to pressure ulcers.  When a nursing home is understaffed and is unable or unwilling to take care of their residents like they should, this can lead to neglect and injury to the nursing home residents.

A pressure ulcer or bedsore is an area of skin that has become damaged due to prolonged pressure because they are not moving around or contact with moisture.  They are called bedsores because they occur when someone has been left neglected in the bed too long.   Nursing home residents become at risk for pressure ulcers when they are bed or wheelchair bound and/or when they have decreased mobility, bad circulation, diabetes and other medical conditions.

There are many different stages of bedsores, ranging from a Stage I to a Stage IV, depending on the severity of the bedsore:

  • Stage I: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk)
  • Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
  • Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible directly palpable.
  • Stage IV: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.
  • Unstageable: Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.

Under most circumstances, bedsores should not occur.  Bedsores develop when a resident is left lying in the same position too long or left lying in a wet diaper too long.

How can bedsores be prevented? When a resident is admitted to a nursing home they should be fully assessed by the nursing staff to determine if they are at risk for bedsores.  Depending on their risk level, a plan must be put in place to prevent the resident from developing skin breakdown.  Simple precautions can be used to prevent skin breakdown:

  • turning and repositioning
  • using pads and wedges
  • special mattresses that keep pressure off the problem areas
  • use of heel floats and other assistive devices
  • frequent monitoring for skin breakdown
  • keeping the residents free from moisture
  • changing wet diapers often if the resident is incontinent

If the nursing home is understaffed or the staff is undertrained, they may not be taking appropriate care of the residents, leading to skin breakdown.

It doesn’t stop with just a painful pressure ulcer.  These wounds most often lead to other complications, which is why prevention of the bedsore is important.  Once a bedsore develops, it can be a lengthy painful process to heal, if it can be healed at all.  Different ointments and dressings are typically used to aid in the healing process.  Sometimes the wounds must be debrided surgically to remove any dead and infected tissue.  If not treated appropriately, bedsores often lead to serious infection, amputations and even death.

Claims against the nursing home can be based on allowing the bedsores to develop, but they can also be based on failing to appropriately treat the bedsores or obtain the necessary medical treatment after they develop.  A case for wrongful death can be filed if the resident’s death is related to the development of a bedsore.  If you know someone who has suffered from a bedsore at a nursing home, you should contact an experienced nursing home attorney to investigate a potential lawsuit against the nursing home.

When we place loved ones in a nursing home or other facility, we do so believing the facility will take good care of our loved one and watch over them.  It often comes as a shock when people learn that their family and loved ones have been injured and mistreated due to poor care or abuse by the very ones who are supposed to be watching over them.  Abuse and neglect, even minor neglect, can cause a rapid deterioration in a resident’s health and lead to depression, illness and even death.  It is important for friends and family members to report suspected abuse and neglect before an unfortunate outcome occurs.  The aging population is increasing rapidly and it is important to address the patterns of abuse and neglect occurring in the nursing home industry.  At Wagner Hughes, LLC, we fight to get justice for past abuse and neglect and work to make nursing homes better for current and future nursing home residents.  If you or a loved one has suffered an injury as a result of nursing home pressure ulcers, call Wagner Hughes, LLC for a free consultation at (404) 900-6979.