Bedsores are also called pressure sores, pressure ulcers, or pressure injuries. They can be a serious concern for nursing home residents with limited mobility.
Not every bedsore means neglect occurred. However, a new or worsening pressure injury can raise questions about the care a resident is receiving.
Nursing home bedsore neglect may occur when a facility fails to recognize a resident’s risk. It may also happen when staff do not reposition the resident, monitor the skin, provide proper nutrition and hydration, or respond when a sore begins to develop.
For families, the key question is not simply whether a bedsore exists. The issue is whether the nursing home recognized the risk and took reasonable steps to prevent the injury. It also matters whether staff identified the sore early and provided proper treatment.
What Causes Bedsores in Nursing Home Residents?
Pressure injuries develop when prolonged pressure reduces blood flow to the skin and tissue beneath it. They often form where bones are close to the skin.
Common areas include the heels, ankles, hips, elbows, shoulder blades, back, and tailbone.
Residents who spend long periods in a bed or wheelchair are especially at risk. Other factors can also increase the risk. These include limited mobility, fragile skin, poor circulation, poor nutrition, dehydration, incontinence, and certain medical conditions.
Many nursing home residents cannot reposition themselves without help. They may rely on staff to relieve pressure and protect their skin.
What Are the Stages of Bedsores?
Pressure injuries are classified by how deep they are and how much tissue damage has occurred.
Stage 1: The skin is still intact. However, it may show lasting discoloration or other signs of pressure damage.
Stage 2: The skin is partly broken down. The area may look like an open sore or blister.
Stage 3: The injury extends into deeper tissue. Body fat may be visible.
Stage 4: The wound extends deeply into the tissue. Muscle, tendon, or bone may be exposed or damaged.
Some pressure injuries are considered unstageable. This happens when damaged tissue covers the wound and makes it hard to tell how deep it is.
A deep tissue pressure injury can also develop below the skin. The full extent of the damage may not be visible right away.
More serious pressure injuries can be hard to treat. They may also take a long time to heal.
Pressure sores can also lead to infections and other medical complications. MedlinePlus notes that severe pressure injuries can be harder to heal and may cause serious infections.
Are Bedsores Always a Sign of Nursing Home Neglect?
No. A bedsore by itself does not prove nursing home neglect.
Some residents have health conditions or other risk factors that make pressure injuries hard to prevent. This can happen even when proper care is being provided. CMS recognizes that some nursing home residents may still develop pressure injuries despite appropriate preventive care.
Even so, nursing homes have important responsibilities when caring for residents who are at risk.
Federal standards require Medicare and Medicaid-certified nursing homes to provide care that follows professional standards. This includes taking steps to prevent pressure injuries when possible.
Facilities must also provide proper treatment when a pressure injury develops. That includes promoting healing, preventing infection, and helping prevent additional sores.
This makes the circumstances around the bedsore important.
Families may have reason to ask more questions if a serious pressure injury appears unexpectedly. Concerns may also arise if an existing wound gets worse or staff cannot clearly explain what happened.
It is also important to ask what treatment is being provided and what steps are being taken to prevent further injury.
How Should Nursing Homes Help Prevent Bedsores?
Preventing pressure injuries begins with identifying residents who are at risk and developing an appropriate care plan.
Depending on the resident’s individual needs, preventive care may include:
- Regularly repositioning residents who cannot move independently
- Using pressure-relieving mattresses, cushions, heel protectors, or other appropriate equipment
- Checking the skin for redness, discoloration, breakdown, or other early warning signs
- Keeping skin and bedding clean and dry
- Properly managing moisture and incontinence
- Providing adequate nutrition and hydration
- Following physician and wound care instructions
- Documenting the condition of existing pressure injuries and changes in the resident’s condition
- Responding promptly when a pressure injury develops or begins to worsen
There is not one repositioning schedule that is appropriate for every nursing home resident. Preventive care should be based on the resident’s condition, mobility, skin integrity, risk factors, and individualized care plan.
When Can a Bedsore Raise Concerns About Neglect?
A pressure injury may warrant closer investigation when there are signs that basic preventive or wound care measures were missed.
For example, concerns may arise if a resident who depends on staff for movement is routinely left in the same position for extended periods. Families may also notice that bedding or clothing is repeatedly wet or soiled, that a wound is becoming larger or deeper, or that staff members appear unaware that a pressure injury exists.
CMS guidance for nursing home surveyors specifically examines whether facilities identify residents at risk for pressure injuries, evaluate existing wounds, develop appropriate care plans, and consistently implement interventions intended to prevent or heal them.
The existence of a Stage 3 or Stage 4 pressure injury does not automatically establish negligence. However, a severe or worsening injury can make it especially important to review the resident’s medical records, care plan, repositioning records, wound assessments, nutrition records, and other documentation to understand what happened.
What Should Families Do If They Discover a Bedsore?
If you discover that a loved one has developed a pressure injury in a nursing home, ask questions.
Find out when the wound was first identified, what stage it is, what treatment has been ordered, and what steps are being taken to prevent it from worsening. Ask whether a physician or wound care specialist has evaluated the resident.
It can also be helpful to document what you observe. Photographs taken over time, notes about conversations with staff, changes in your loved one’s condition, and copies of available medical information may become important if questions later arise about the care that was provided.
Most importantly, serious or worsening pressure injuries require medical attention. Signs of infection can include drainage, foul odor, redness, warmth, swelling, increased pain, or fever.
How Can You Report Nursing Home Neglect in Ohio or Michigan?
If you are concerned that a nursing home resident is not receiving appropriate care, you may report the concern to the agency responsible for overseeing nursing homes in that state.
Reporting Nursing Home Concerns in Ohio
In Ohio, complaints involving nursing home care can be submitted to the Ohio Department of Health Bureau of Survey and Certification. Complaints may be filed through the department’s online complaint system and may be submitted anonymously. However, filing anonymously may prevent the department from contacting you for additional information or notifying you of the investigation results.
Residents and families can also contact the Ohio Long-Term Care Ombudsman Program at 1-800-282-1206. The program advocates for people receiving long-term care and can help address concerns involving a resident’s health, safety, welfare, or rights.
Reporting Nursing Home Concerns in Michigan
In Michigan, complaints involving nursing homes and skilled nursing facilities can be filed with the Michigan Department of Licensing and Regulatory Affairs Bureau of Survey and Certification. Complaints can be submitted online or by calling the state’s complaint hotline at 1-800-882-6006.
Michigan residents and families can also contact the Michigan Long Term Care Ombudsman Program at 1-866-485-9393 for assistance with concerns involving nursing home care and residents’ rights.
Filing a complaint with a state agency or contacting an ombudsman is separate from pursuing a legal claim. A regulatory investigation focuses on whether the facility complied with applicable care requirements. A legal claim may examine whether negligent care caused or contributed to a resident’s injury and resulting damages.
What If You Suspect Nursing Home Bedsore Neglect?
If your loved one developed a serious bedsore while living in a nursing home, the injury alone may not tell you whether neglect occurred. Understanding the resident’s risk factors, care plan, treatment, medical records, and the progression of the wound can help determine whether appropriate care was provided.
If you are concerned about bedsores or another serious injury involving a nursing home resident, contact Gallon, Takacs & Boissoneault for a free consultation at 419-843-6663.
Serving clients throughout Northwest Ohio and Southeast Michigan.
Michael Bell, is Partner and Personal Injury Attorney at GT&B since 2007. His entire career has been committed to protecting the rights of those injured through no fault of their own. Mike concentrates his practice in the areas of car wrecks, trucking accidents, medical negligence, wrongful death, birth injuries, defective products, nursing home abuse & neglect, dog bites, construction accidents and slip & falls.
