Bed Sores, Pressure Sores, Decubitus Ulcer

One of the most common (and most preventable) forms of neglect that happens in nursing homes is the development of bed sores (also known as pressure sores and decubitus ulcers). Just because bed sores are common, though, does not mean that they are not serious. In fact, bed sores are one of the most serious dangers faced by nursing home residents.

What are the causes of bed sores?

Nursing homes are required to have policies and procedures in place that identify the treatment they are to give residents to prevent and treat bed sores. Typically, the problem is not the quality of the policy, but the quality of the people responsible for implementing the policy. In most cases, nursing home residents develop bed sores because there is a staffing problem at the nursing home. The staffing problem can range from the number of staff members available to care for residents or the training staff members receive. The lack of quality and quantity in the staff is most often a by-product of corporate or individual nursing home owners pulling so much money out of the facility that it does not have enough money left over to have enough sufficiently trained employees available to give quality care. The goal of Nursing Home Justice Associates is to be the voice of nursing home residents in Maryland who have suffered from bed sores as a result of negligence in nursing homes that results in painful and debilitating bed sores.

How do bed sores develop?

Bed sores commonly develop on the bony areas of the body when there is continuous pressure. Areas most at risk for bed sores are the coccyx (the area around the buttocks), hips, shoulder blades and heels, although other areas with unrelieved pressure are at risk as well. Bed sores are most likely to develop when an immobile nursing home resident is left in the same position for long periods of time. If the nursing home staff fails to consistently turn and reposition a resident to relieve pressure on these at risk areas, the resident will likely develop a bed sore.

Cleanliness is also a key factor in preventing and worsening of bed sores as well. Imagine a resident who is incontinent, which means that she is physically unable to control her bowels or bladder. Keeping residents clean and dry after an incontinent episode should be a top priority at a nursing home, however all too often, because the staffing levels are so low at nursing homes residents are forced to lie in her own feces and urine for hours and hours. Not only is this undignified for the resident, it is unhealthy. The acidity of the urine tends to break down the skin. When the skin is open, the urine and feces has a pathway into the blood stream that will often lead to infection. Once a bed sore becomes infected, the resident is in grave danger of developing a systemic infection throughout her body known as sepsis. Sepsis is very difficult to treat and often results in death.

Another key factor in the prevention and worsening of bed sores is hydration and nutrition. When a nursing home is understaffed or the staff is poorly trained, some of the most basic necessities of life are overlooked. For example, many immobile residents rely entirely upon the nursing home staff for the most basic of care, including giving them a drink of water or assisting with meals. When residents are not given the assistance they need, they do not get enough food or water, making them at risk for becoming dehydrated and malnourished. Dehydration and malnourishment weaken the body. When a resident becomes dehydrated, their skin becomes less supple and more brittle, making it more prone to the development of bed sores. A person who is malnourished has less fat and muscle, making it easier for bed sores to develop and to worsen at a faster rate.

How are bed sores diagnosed?

Bed sores are classified according to stages with each stage of a bed sore representing a greater degree of tissue and skin damage than the stage before it. Bed sores do not take very long to develop and they can become a serious problem very quickly if they are not met with immediate and aggressive treatment.

In February 2007, The National Pressure Ulcer Advisory Panel redefined the four stages of pressure ulcers. Below are pictures that demonstrate the four stages of pressure sores:

Stage 1:

 

Skin that is intact but has non-blanchable redness that is typically localized to a specific area, usually over a bony prominence. Skin with dark pigments may not show visible signs of blanching and its color could be different in the areas surrounding it.

Stage 2:

Skin that presents with a partial thickness loss of dermis with a shallow open wound with a red pink bed without slough. This sometimes also presents intact or as an open or ruptured fluid filled blister.

Stage 3:

Skin tissue has full thickness loss. The wound is open where subcutaneous fat is visible, however bone, muscle and tendon are not visible. While slough may be present it may not be to the point of obscuring the wound depth. The wound may have undermining or tunneling.

Stage 4:

 

Wound is deep with full thickness tissue loss. Muscle, tendon and bone are visible. Eschar and slough may be present on top of the wound while undermining and tunneling are often present around the wound and under the intact skin.

While each of these people were likely compromised either mentally or physically, they were accepted by a nursing home who promised that they could provide the care and treatment each needed. Far too often this care is not given because an individual or corporate owner of the nursing home made a choice to slash the nursing home budget in an effort to increase the bank account of those who own the nursing home company.

What should nursing homes be doing to prevent bed sores?

Without question, bed sores are easier to prevent than they are to treat. Nursing homes should be using the many practices at their disposal to prevent bed sores from developing and to stop existing bed sore from worsening. For example:

1. Residents should be well fed and well hydrated.
2. Residents should be kept clean and dry.
3. Residents who are unable to reposition themselves should be turned and repositioned at least every two hours. Some residents may require more frequent repositioning.
4. Residents who are at risk for bed sores should have special mattresses that help reduce pressure to the areas of the body most at risk.
5. Residents who use orthopedic devices, such as braces, should be given clothes or a protective pad to keep it from rubbing on the resident’s skin
6. Nursing homes must have enough employees to meet the needs of each and every resident at the facility and should be appropriately trained in how to prevent bed sores and treat residents who have existing bed sores.
7. Nursing homes must prepare an appropriate care plan for each resident who is at risk for bed sores or who has existing bedsores. The facility employees must know and follow the care plan for each resident.
8. Nursing homes who have residents with bed sores must measure the bed sores weekly, or even more often and make observations such as drainage, odor and the appearance of surrounding tissue in the resident’s medical record. This is done so that doctors and nurses can know how to better treat the wound.

If your loved one suffers from bed sores in a nursing home, we can help.

Our attorneys have been successful in resolving cases favorable to our clients and their families where nursing homes, through their owners and related corporations have allowed residents to develop bed sores. If a family member or loved one has suffered from one or more bed sores while under the care of a Maryland nursing home, contact Nursing Home Justice Associates at 1-410-825-ABUSE (2287) to learn more about your legal rights.

Nursing Home Justice…..It’s What We Do.

 

Other Injuries Suffered By Nursing Home Residents:

Bed Sores, Pressure Sores, Decubitus Ulcer

Burns

Choking

Clogged Breathing Tubes

Falls

Malnutrition & Dehydration

Medication Errors

Physical Abuse

Restraints & Bedrails

Sepsis/Infection

Sexual Abuse

Wandering & Elopement