Bed sores (also known as pressure sores, pressure ulcers, and decubitus ulcers) are preventable ailments for nursing home residents in most cases. Even though they are preventable, they can be serious or even deadly preventable. Pressure sores and bed sores are different terms to describe the same problem – the formation of a wound (usually on the hips, coccyx or sacrum) as a result prolonged pressure. Bed sores can develop while the resident is lying in bed, sitting in a wheelchair or being otherwise immobile. Bed sores can be exacerbated by friction or excessive moisture on the skin. Once a bed sore develops, it can be very painful, can take months to heal (if they heal at all) and can complicate existing health problems. Essentially, a bed sore is an open wound that, at its worst, extends all the way down to the bone, creating an easy pathway for infections that can lead to a resident’s death.

Nursing homes are supposed to have policies and procedures in place that address the prevention and treatment of bed sores. Unfortunately, what many family members are beginning to see, many nursing homes failed to provide even the basic care and bed sore prevention while family members were locked out of the facilities during the Covid shutdown. As family members now return to visit their loved ones, they are often shocked to see that their family members are suffering terrible bed sores.

The main problem is not usually the quality of the policies in the nursing home, but the quantity (and sometimes the quality) of the people responsible for implementing the policy. In most cases, bed sores are indicative of a staffing problem at the nursing home, whether it is 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 often a result of the owners taking so much money out of the facility that it cannot provide quality care. The Terry Law Firm has worked for over twenty years to represent Missouri and Illinois nursing home residents who have suffered from bed sores as a result of negligence in nursing homes that results in painful bed sores. We have regularly pursued and obtained justice for neglected residents and surviving family members of those killed by nursing home abuse or neglect.

What Causes Bed Sores?

Simply stated, bed sores develop on the bony prominences of the body when there is continuous pressure on that area. Areas most at risk for pressure sores include the coccyx, hips, and heels, although other areas with unrelieved pressure are at risk as well. Immobile nursing home residents will likely develop bed sores if those charged with their care do not take consistent measures to reposition the resident and relieve the continuous pressure.

Cleanliness is also a key factor in preventing and healing pressure sores as well. When a resident is forced to lie in her own waste for hours, the acidity of the urine tends to break down the skin. This breakdown can lead to the development of a bed sore or worsen an existing pressure sore. If a nursing home resident with one or more bed sores is forced to lie in their own urine or feces for hours on end (which, sadly, is a common event at nursing homes), there is the added danger of 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.https://www.youtube.com/embed/Y__1TF2JORIAnother key factor in the prevention and healing of pressures 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 those basic staples are not accomplished, residents are at risk for becoming dehydrated and malnourished. Dehydration and malnourishment weaken the body. When a person is 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.

Diagnosing Pressure Sores in Missouri and Illinois Nursing Homes

Pressure sores are classified according to stages and each stage of a bed sore represents a greater degree of tissue and skin damage than the stage before it. Pressure sores can develop quickly and can become a serious problem very quickly without immediate and aggressive treatment.

In February 2007, The National Pressure Ulcer Advisory Panel redefined the four stages of pressure ulcers. Below are pictures of actual cases I have worked on involving the four stages of pressure ulcers:

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. Slough may be present but not to the point of obscuring the wound depth. 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 compromised to varying degrees, they each had family members and a place in the overall story. Their lives were cut short by negligent care caused in large part to a parent corporation that slashed the budget and created multiple corporate entities to drain money from the nursing home and into the owner’s pockets.

What Should Nursing Homes Be Doing To Prevent Bed Sores?

Without a doubt, bed sores are easier to prevent than they are to treat and nursing homes have many practices at their disposal to prevent pressures sores and to stop an existing pressure sore from worsening. For example:

• Residents should be well fed, well hydrated and kept clean and dry.
• Any nursing home facility with aging residents should measure pressure sores at least weekly if not more often. Other observations such as drainage, odor and the appearance of surrounding tissue should be notated in the resident’s medical record.
• Residents who use orthopedic devices, such as braces, should be provided with clothing or a protective pad to keep the appliance from rubbing on the resident’s skin.
• Residents who are in wheelchairs and have adequate upper body strength should be taught “wheelchair pushups”- an exercise that allows the resident to alleviate pressure while they are sitting in the chair.
• Change the position of residents who are bed-ridden or in wheelchairs regularly. Bed-bound patients should be moved at least once every two hours.
  Special mattresses can help alleviate the threat of pressure sores, however these mattresses do not take the place of repositioning the patient every two hours.