Bedsores, medically known as pressure ulcers or decubitus ulcers, are among the most common and preventable injuries in nursing homes. These wounds develop when sustained pressure cuts off blood flow to skin and tissue, typically in residents who cannot reposition themselves. Because bedsores are almost always preventable with basic nursing care, their presence in nursing home residents strongly suggests neglect.
How Bedsores Develop
Pressure ulcers form when the body's weight compresses tissue against a surface for extended periods. Bony prominences including the tailbone, heels, hips, and shoulder blades are most vulnerable because skin and tissue are thin over bone. Immobile residents who remain in the same position for hours experience tissue death as blood flow is blocked to these areas.
Moisture from incontinence, perspiration, or wound drainage accelerates skin breakdown. Residents left in soiled briefs or damp bedding experience maceration that weakens skin and increases pressure ulcer risk. Proper incontinence care is essential to preventing bedsores, making moisture-related wounds evidence of multiple care failures.
Friction and shearing forces contribute to pressure ulcer development. Dragging residents across sheets rather than lifting properly, or allowing residents to slide down in beds or chairs, creates friction that damages skin. These injuries indicate staff are using improper transfer techniques or not repositioning residents correctly.
Stages of Pressure Ulcers
Stage 1 pressure ulcers present as non-blanchable redness on intact skin. When pressed, the skin does not temporarily lighten as healthy skin would. These early wounds are warning signs that should trigger immediate intervention to prevent progression. Stage 1 ulcers can heal quickly with proper pressure relief and care.
Stage 2 ulcers involve partial-thickness skin loss with exposed dermis. The wound bed appears pink or red and may present as an intact or ruptured blister. These wounds indicate that pressure damage has progressed beyond the superficial skin layer and require more intensive treatment.
Stage 3 ulcers show full-thickness skin loss with visible fat tissue. Slough or eschar may be present, and undermining or tunneling can occur. These deep wounds take months to heal and significantly increase infection risk. Stage 3 ulcers represent serious care failures that should have been prevented.
Stage 4 pressure ulcers involve full-thickness skin and tissue loss with exposed muscle, tendon, or bone. These devastating wounds can become life-threatening when infection reaches bone, causing osteomyelitis. Stage 4 bedsores often require surgical intervention and can lead to sepsis and death. Their development represents egregious nursing home neglect.
Prevention Standards
Regular repositioning is the foundation of pressure ulcer prevention. Immobile residents should be repositioned at least every two hours, with documentation of each position change. Specialty mattresses and cushions distribute pressure but do not eliminate the need for repositioning. Facilities that fail to reposition residents as required breach basic care standards.
Comprehensive skin assessments should occur on admission and regularly thereafter. Assessments identify existing wounds and risk factors including immobility, incontinence, nutritional deficits, and circulation problems. Care plans should address identified risks with specific interventions. Missing or inadequate assessments indicate systemic care failures.
Nutritional support helps maintain skin integrity and promote healing. Residents with protein deficiencies, dehydration, or vitamin deficits are more vulnerable to pressure ulcers and heal more slowly when wounds develop. Dietary assessments and interventions should address nutritional factors affecting skin health.
Proving Bedsore Negligence
Medical records document skin assessments, repositioning schedules, and wound progression. Records should show regular skin checks with detailed descriptions of any wounds and their locations. Repositioning logs indicate whether staff turned residents as required. Records that lack documentation or show identical entries for every shift suggest falsification.
Photographs of wounds provide powerful evidence of severity and progression. Families should photograph wounds when possible, as facility photos may be incomplete or missing. Dating photographs establishes when wounds existed and documents healing or deterioration over time.
Expert nursing testimony establishes the standard of care for pressure ulcer prevention and how the facility breached that standard. Wound care nurses and geriatric nursing experts can explain that bedsores are preventable with proper care and identify specific failures that allowed wounds to develop or progress.
Damages for Bedsore Claims
Treatment costs for serious pressure ulcers can reach tens of thousands of dollars. Stage 3 and 4 ulcers may require surgical debridement, skin grafts, and months of wound care. Hospital stays for infected wounds add substantial expenses. Complications including osteomyelitis require extended antibiotic treatment and sometimes amputation.
Pain and suffering from pressure ulcers can be severe. Open wounds on weight-bearing areas cause constant discomfort. Wound care procedures including debridement are painful. The indignity of developing preventable wounds while in professional care adds emotional distress to physical pain.
Wrongful death claims arise when pressure ulcers cause or contribute to death. Infected wounds can progress to sepsis that overwhelms elderly immune systems. Families can pursue wrongful death claims when facilities' failures to prevent or properly treat bedsores lead to fatal outcomes.
Conclusion
Bedsores in nursing home residents are almost always evidence of neglect. These preventable wounds cause significant pain, expensive treatment needs, and sometimes death. Facilities that fail to provide basic repositioning, skin care, and wound monitoring breach their duties to residents. Legal claims hold negligent facilities accountable and compensate residents and families for the harm caused by these inexcusable care failures.