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Bedsores In Nursing Homes & Assisted Living Facilities

Bedsores—also known as pressure ulcers, decubitus ulcers, and pressure sores—are all-too common among residents of nursing homes and assisted living facilities. Common, and also potentially dangerous. Those bedsores might also be signs of neglect.

What Causes Bedsores?

Bedsores are injuries to the skin and underlying tissue caused by prolonged pressure or friction on a particular part of the body. Elderly people with mobility issues are at increased risk for developing bedsores due to their age, thinner skin, and lack of mobility. Individuals confined to a wheelchair are also at increased risk of developing bedsores. Dehydration and malnutrition, as well as extended exposure to moisture, such as urine or feces, also increase the likelihood of developing bedsores.

People at increased risk of developing bedsores include:

  • Those who use a wheelchair or are bedridden
  • Older adults
  • Those who can’t move certain parts of their body without help
  • People with a disease affecting blood flow, such as diabetes or vascular disease
  • People with Alzheimer’s disease
  • Those who can’t control their bladder or bowels
  • People with fragile skin
  • People who are malnourished

Where Do Bedsores Form?

Bedsores typically form on bony or protruding areas of the body with less tissue to act as padding under the skin. For people confined to their bed, bedsores most often develop on:

  • The back or sides of their head
  • Their shoulder blades
  • Their hips, lower back, or tailbone
  • Their heels, ankles, or behind their knees

In people who use wheelchairs, pressure sores often form on:

  • The backs of their arms or legs where they rest against the wheelchair.
  • Their shoulder blades and spine
  • Their tailbone or buttocks

Symptoms of Bedsores

The warning signs and symptoms of bedsores are:

  • Tender areas on the body
  • An area of skin that feels warmer or cooler than other areas
  • Unusual changes of skin color or texture
  • Swelling
  • An actual sore

Bedsores can develop over hours or days. They are categorized and described based on their depth and severity, among other characteristics. The degree of damage to the skin and tissue ranges from changes in skin color to severe injuries involving the skin, underlying tissue, and bone.

Bedsores are categorized in four stages of development.

Stage 1: Stage 1 is the mildest. Bedsores in stage 1 only affect the upper layer of skin. Symptoms of a stage 1 bedsore may include burning, pain, or itching. The area may also feel different than the surrounding skin—it may be firmer or softer, warmer or cooler.

Stage 2: When the sore digs deeper into the skin, it becomes a Stage 2 bedsore. At Stage 2, the skin is broken; it is an open wound and may look like a pus-filled blister. The area is swollen, red, and warm. Stage 2 bedsores are painful.

Stage 3: Stage 3 bedsores occur when the sore has gone through a second layer of skin into the fatty tissue. A Stage 3 bedsore looks like a crater and may have an unpleasant smell. The tissue around the sore will be black if that tissue has died.

Stage 4: Stage 4 bedsores are the most serious. They are big and deep and may affect muscles and ligaments. The skin has turned black and shows obvious signs of infection, including reddened edges, pus draining, a foul smell, and heat. Tendons, muscles, and bone may be visible in the wound.

Medical personnel may categorize even more severe bedsores using two other terms—unstageable bedsores and bedsores with suspected deep tissue injury.

Unstageable: An unstageable bedsore is one where the bottom of the sore can’t be seen, so it’s not possible to tell how deep it is until a doctor cleans it out.

Suspected Deep Tissue Injury (SDTI): Doctors refer to a bedsore as SDTI when the surface of the skin makes it appear as a stage 1 or 2 bedsore, but under the surface the bedsore is, in fact, a Stage 3 or 4 bedsore.

Are Bedsores a Sign of Neglect?

Bedsores occur when a person spends too much time in one position. They are avoidable if caregivers frequently reposition people with limited mobility. And if a bedsore is found early, it can be treated and will heal fairly quickly.

When a person living in a nursing home or assisted-care facility develops bedsores, it may very well be a sign of neglect. Caregivers should be expected to reposition their patients frequently to prevent bedsores. Caregivers also should be trained to examine their charges for signs of bedsores, so that if a bedsore starts to develop, it can be treated immediately and does not become a serious or dangerous wound. And, of course, staffing in the nursing home or assisted-living facility should be sufficient to adequately care for the residents, including keeping them clean and monitoring their eating to ensure they are adequately nourished.

If you have a family member or loved one living in a nursing home or assisted-living facility who has developed bedsores and want to consult a nursing home abuse lawyer to discuss their situation, contact us for a free consultation.

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