When Are Bedsores Evidence of Nursing Home Neglect?

Older man is uncomfortable in a hospital bedBedsores are also known as pressure sores, pressure ulcers, and decubitus ulcers. They form when there is unrelieved pressure on the skin—especially when an individual is sedentary, wheelchair-bound, or bed-bound. The pressure put on the skin can interfere with circulation, which deprives skin of oxygen and nutrients. These painful skin lesions can develop quickly, can be difficult to get rid of, and can be very dangerous.

Identifying Bedsores

Not all bedsores are the same. Bedsores develop in the following stages:

  • Stage I: Non-blanchable erythema of intact skin. Stage 1 bedsores may present as red skin that might itch, hurt, or feel warm to the touch. This may appear differently in darker pigmented skin. Changes in sensation, temperature or firmness may precede any visual changes. These bedsores may heal on their own if pressure is relieved from the spot.
     
  • Stage II: Partial-thickness skin loss with exposed dermis. This is described as a viable wound bed—a moist pink or red area. This can also include wounds that present as an intact or ruptured serum-filled blister. Neither fat nor the deeper tissue layers are visible. There is no granulation tissue, slough, or eschar present. The sore is open and the skin around it may be discolored. If the person is otherwise in good health, Stage II bedsores that are treated promptly may heal quickly.
     
  • Stage III: Full thickness skin loss. This is described as full thickness loss of skin in which the fat is visible in the ulcer and granulation tissue and rolled wound edges are often present. Slough and eschar may be visible. The depth of the wound can vary by location of the wound on the body. Some wounds, however, may be deep. Tunneling can occur, but muscle, fascia, tendon, ligament, cartilage, and bone are not exposed. These wounds can be described as unstageable if slough or eschar is obscuring the extent of the tissue loss. These bedsores effect not only the outer layer of skin, but all layers of skin down to the muscle. The skin tissue may be permanently harmed.
     
  • Stage IV: Full thickness skin and tissue loss. Full thickness skin and tissue loss with exposed or directly palpable muscle, fascia, tendon, ligament, cartilage, or bone. These wounds may include tunneling and rolled edges. Depth can vary by location. These wounds can be described as unstageable if slough or eschar is obscuring the extent of the tissue loss. At this advanced stage, bedsores impact not only the skin but may also impact the muscle, bone, tendons, and joints. Stage IV bedsores can be fatal.
     
  • Unstageable pressure injury: At least a Stage III or IV wound in which slough or eschar is obscuring the extent of the tissue loss.
     
  • Deep tissue pressure injury: Typically described as a dark wound bed or blood-filled blister scenario. These wounds may appear deep red, maroon, or purple. They are often preceded by pain and temperature changes in the localized area. Like Stage I to IV wounds, these injuries can be caused by intense or prolonged pressure or shear force (or a combination of these factors) to an area with a muscle–bone interface.

When a person is bed-bound, pressure sores can occur in any of these areas:

  • The back or sides of her head
  • The rims of her ears
  • The shoulders or shoulder blades
  • The hipbones, lower back, or tailbone
  • The backs or sides of her knees, heels, ankles, and toes

If the person uses a wheelchair, he is most likely to develop a pressure sore on…

  • The tailbone or buttocks
  • The shoulder blades and spine
  • The back of his arms and legs where he rests against the chair

All of these bedsores are painful and can lead to further complications, such as infections.

How Bedsores Form

Nursing homes often defend claims of negligence by arguing that the bedsores were not preventable or that the bedsores are actually deep tissue injuries sustained long before the patient was ever in their facilities and that they just now, by chance, have come to the surface of the skin to be seen. Most of the time this is just not true.

More often than not, pressure ulcers or bed sores that develop or appear in a nursing home or hospital are the result of negligent care.

The most likely victims of bedsores are people who have medical conditions that limit their ability to change position, that make it necessary for them to use wheelchairs, or that confine them to bed for extended periods of time. Some specific factors that make bedsores more likely include:

  • Lack of movement. The biggest contributing factor of bedsores is an inability to move. Residents who can shift their own weight or move their arms and legs can relieve pressure on the skin themselves. Those who can’t suffer a lack of blood flow to these areas, promoting injuries.
     
  • Moisture. Moist skin encourages bedsores, so extra care must be taken to keep residents dry. Staff members must make sure that those who are unable to move are dried thoroughly after bathing and that adult diapers are changed promptly.
     
  • Sensory loss. Some residents are able to move but are unable to feel some parts of their bodies (such as their feet or legs). If they cannot feel the discomfort or pain of prolonged pressure, they will not shift to correct long-standing pressure.
     
  • Poor circulation. Bedsores can develop easily in patients who have poor blood flow to their extremities, including those with diabetes or those with edema in their legs.
     
  • Poor nutritionGood nutrition is important for preventing bedsores. Elderly people are more likely to have fragile skin, which needs vitamins and protein to remain strong.

While these factors make bedsores more likely, nursing home staff can take reasonable steps to prevent bedsores from developing.

How Nursing Home Staff Can Prevent Bedsores

Bedsore prevention starts as soon as a resident moves into a nursing home. Nursing home staff should assess a new resident’s skin condition within the first week or so of admission.

There are several different bedsore assessments available for nursing home staff to use to assess a nursing home resident’s risk of developing a bedsore. For example, nursing home staff may complete:

  • A comprehensive skin assessment.
  • The Braden Scale for Predicting Pressure Sore Risk.
  • The Norton Scale.
  • Another bedsore risk assessment tool.

These assessments can provide specific information that is useful in protecting the nursing home resident from painful and potentially deadly bedsores.

After the initial assessment is done, nursing home staff must take further action to prevent bedsores. Specifically, staff members may…

  • Develop and implement a plan to prevent bedsores based on the assessment.
  • Regularly check on patients.
  • Reassess the need to complete a bedsore assessment periodically or after any significant change in the resident.
  • Adapt the bedsore prevention plan as needed.
  • Get the patient immediate medical attention when a bedsore is detected.
  • Train staff on recognizing the signs of bedsores and properly treating this condition.

Unfortunately, not all nursing home staff take these important precautions.

What Goes Wrong?

Nursing home staff may be liable for bedsores if they do not act with reasonable care to prevent them. Some of the ways this could happen are if:

  • The recommendations from the bedsore assessment were not implemented. It is not enough to do an assessment. In order for the assessment to be of any value, its recommendations must be put into effect.
     
  • The results of the bedsore assessment were not consistent with the resident’s true medical condition and risk of bedsores. If the bedsore assessment was not completed correctly, then the recommendations from the bedsore assessment will be of little use.
     
  • The resident’s medical condition or medications had changed since the assessment was first completed. It may have been important for another assessment to be done.
     
  • Nursing home staff failed to check on the resident frequently enough and thoroughly enough to prevent a bedsore injury.

The results can be catastrophic.

Why Bedsores Are Dangerous

There are serious complications that can develop when bedsores are not properly treated, including…

  • Cellulitis: This is infection in the skin’s connective tissue, which can lead to severe pain, swelling, and redness. Cellulitis can also lead to life-threatening complications, including sepsis and meningitis.
     
  • Sepsis: Sepsis occurs when bacteria spread rapidly through the bloodstream to other parts of the body, potentially leading to organ failure and death. Sepsis is one of the biggest dangers of an advanced pressure sore.
     
  • Cancer: Squamous cell carcinoma is a type of cancer which can develop when chronic wounds don’t heal.
     
  • Infection in joints or bones: Infections in the joints can lead to cartilage and tissue damage, while infections in the bones can reduce the functioning of joints and limbs. Joint infections (septic or infectious arthritis) can damage cartilage and tissue, whereas bone infections (osteomyelitis) can reduce the function of one’s joints and limbs.

If you notice any potential sign of a bedsore such as broken skin, open sores or signs of infection such as fever, a bad smell, or heat or redness in a localized area of the body, then it is important to get immediate medical help for your loved one. Prompt treatment could prevent the types of complications described above.

What to Do If You Think Nursing Home Neglect Caused Your Loved One’s Bedsore

Bedsores may be prevented with proper care—and if your loved one sustained a bedsore in a Kentucky nursing home, you may have a case for negligence.

Nursing home may try to argue that bedsores were not caused by staff negligence but rather because the resident had a health complication, the resident was not complaint in treatment of the bedsores, or the resident came to the facility with a pre-existing bedsore. This is why you need strong legal representation working on your side.

You are not powerless against nursing home neglect. You have the right to:

  • Find out exactly what happened. You have the right to know who was really responsible for your loved one’s injury or death.
     
  • Talk to a lawyer. Together, you and your lawyer can seek to hold the nursing home accountable for your loved one’s injury or death.

How you proceed now is up to you. If you would like to speak with our experienced nursing home injury lawyers about your options, please start a live chat with us today. We would be pleased to provide you with a free, no obligation consultation about your legal rights and possible recovery.
 

 

Matthew L. White
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Founder & Partner of Louisville Personal Injury Law Firm Gray & White Law