Bedsores in Nursing Homes

Patients in nursing homes are often the most at risk of bedsores due to their age, immobility, or other health complications. To anyone not experienced with bedsores, they may sound like a minor issue, but they are extremely dangerous. Complications can be severe and life-changing, or even life-threatening. 

By understanding the nature and risk of bedsores, patients and their families can help ensure that proper care is taken during a nursing home stay to prevent these kinds of injuries.

What is a Bedsore/Pressure Ulcer?

Bedsores, also called pressure sores or pressure ulcers, are injuries to the skin that results from continuous pressure for hours or days. As prolonged pressure is put on a specific spot on the body, the blood supply to the skin can become restricted, leading to a bedsore.

Depending on their health and physical condition, nursing home patients can develop bedsores very quickly, in some cases in as little as 2 to 3 hours. Without proper care, wheelchair or bedbound patients are at particularly high risk for developing bedsores.

Common Locations for Bedsores/Pressure Ulcers

  • Heels of the feet
  • Back of the head
  • Ankles and knees
  • Elbows 
  • Hips, tailbone, and buttocks area
  • Shoulder blades

However, as bedsores are not limited only to those spots, nursing home patients who are at high risk must have daily skin evaluations to make sure bedsores are not appearing in unexpected places.

4 Stages of Bedsores/Pressure Ulcers

Stage 1

The skin in the area is warm to the touch. On a lighter skin tone, the skin may appear red, and on a darker skin tone, the skin may appear to have a blue or purple tint. The patient may feel a burning, itching, or painful sensation at the location. The sore may feel firmer than the surrounding skin. At this point, the wound has not broken through the skin.

Stage 2

The patient is likely to be in significant pain. The discoloration will begin to spread to the skin around the wound. The wound itself may have open sores or blisters. There may also be some drainage of clear or yellowish fluid. At this stage, the wound has broken through the upper two layers of skin.

Stage 3

The wound will begin to sink into the skin and gain a crater-like appearance. The fatty tissue below the skin as well as all layers of skin are now affected. Risk of infection increases at this stage.

Stage 4

The wound is now deep, and the tissue is severely damaged. The injury may be affecting muscles, tendons, joints, ligaments, and bones. The patient will likely be in extreme pain. The tissue may appear black. There is a serious risk of infection at this stage. 

At stage 4, without immediate medical intervention, a patient can die within hours or days of severe blood or bone infection. Bedsores must be caught and treated before reaching this stage.

Risk Factors for Bedsores/Pressure Ulcers

  • Poor nutrition and hydration
  • Diabetes
  • Circulatory issues
  • Incontinence
  • Age

An elderly person’s skin is more fragile and prone to injury, making them particularly vulnerable to developing bedsores. Combined with other risk factors, elderly people are at very high risk.

Regarding incontinence, it alone will not cause bedsores. But if urine or stool is not immediately cleaned and sits against the skin, the risk of bedsores can increase significantly. 

Why Are Nursing Home Patients at an Even Higher Risk of Bedsores/Pressure Ulcers?

While nursing home patients are often at a higher risk for bedsores due to their age or mobility issues, unfortunately, that is not the only major factor contributing to the high rate of bedsores in nursing homes.

Nursing homes are often short-staffed, and patients simply do not receive the care and attention they need. This greatly increases the risk of bedsores in already high-risk patients. Bedsores, even early-stage ones that are easily treated, are a sign that a patient may be suffering from neglect and should always be considered a red flag regarding the level of care they are receiving.

In the prevention and diagnosis of bedsores in at-risk nursing home patients, the most important factor is the regular (usually daily) examination of their skin. A nursing home staff must frequently perform this procedure on patients with mobility issues or other risk factors.

4 Things Family Members Can Do to Help Prevent Bedsores/Pressure Ulcers

For family members of nursing home patients, it can be frustrating to rely on staff for the care and prevention of bedsores. However, there are things a family member can do to help ensure that bedsores are prevented, or if they develop, are caught and treated early.

Ask Questions of the Nursing Home Staff

It can be helpful to ask the staff at a nursing home how often a patient’s position is changed, as well as how often full-body skin checks are performed and documented in their medical file. This information can help a family member understand whether the risk of pressure sores is being appropriately considered and managed by the nursing home staff.

Ask Questions of the Patient

Often patients feel discomfort at the location of a bedsore, even at stage 1. Family members can be proactive by regularly asking whether the patient is feeling any new hot, painful, burning, or itching sensations at the common locations for bedsores.

A family member may also want to verify with the patient the frequency of repositioning and skin checks performed by the nursing home staff.

Purchase a Specialty Wheelchair

Standard wheelchairs can have a higher risk of causing bedsores. Specialty wheelchairs can tilt and position the patient at different angles. These features can greatly relieve pressure and reduce the risk of bedsores in patients who spend extended periods in a wheelchair.

Encourage the Patient to Move

To the extent they are able to, a patient should reposition themselves once an hour. If they cannot move on their own, they should ask for help repositioning. In addition, there are simple exercises that can help relieve pressure and prevent bedsores. For example, some patients can perform “wheelchair pushups,” where they push on the arms of the wheelchair to raise their body off the seat briefly. Family members should encourage their loved one to move and exercise to the extent they can safely do so to help avoid bedsores. 

How Are Bedsores/Pressure Ulcers Treated?

The treatment of bedsores in nursing homes varies based on the severity of the sore and the capabilities of the patients. Common treatments include:

  • Wrapping or dressing the wound to protect it
  • Regularly cleaning the wound
  • Removing the pressure from the wound and affected area
  • Antibiotics or other medications

In the cases of more severe pressure sores, more extreme treatment may be required, such as removal of the dead tissue or skin transplants.

What are the Complications of Bedsores/Pressure Ulcers?

Bedsores can take an extended time to heal. Depending on the severity, it could take the patient years to fully recover. In particularly severe cases, amputation may be required. For vulnerable nursing home patients, severe and even life-threatening complications from bedsores can include:  

  • Blood infections (gangrene or sepsis)
  • Bone infections (osteomyelitis)
  • Deep tissue infections (severe cellulitis) 
  • Flesh-eating bacteria (necrotizing fasciitis)

These serious complications often go unrecognized and undiagnosed by nursing home staff and, if allowed to progress untreated, can be fatal. Even when they are promptly diagnosed, treatment requires specialized and expensive treatments.

Learn More About Bedsores/Pressure Ulcers

Bedsores are a common risk for nursing home patients. The types of patients found in nursing homes are often high risk by nature because bedsores are a serious risk for anyone with mobility issues, as well as elderly people. However, the risk is significantly increased if the care received in a nursing home is subpar, often as a result of understaffing. 

Family members of nursing home patients are advised to educate themselves on the risks, symptoms, and techniques for avoiding bedsores so that they can help their loved one avoid the serious complications that can occur from advanced and poorly treated bedsores.

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