Bedsore Prevention: Methods, Warning Signs, and Causes

Nursing homes and other long-term care facilities may play an important role in our loved one’s quality of life as they grow old and manage serious medical conditions. Residents of these facilities are likely limited in their physical abilities, which can mean prolonged periods in a bed or wheelchair, thereby creating a risk of developing bedsores that can be painful and can cause potential death if left unchecked by professional caregivers and nursing home staff. This guide is designed to provide the reader with an understanding of bedsores, including the causes and preventive measures to be aware of if your loved one or friend is in a nursing home setting.

A Brief Explanation of Bedsores 

Bedsores are the result of prolonged pressure on the skin that causes damage to the underlying skin tissue. We may hear doctors or other medical professionals refer to bedsores as pressure injuries, pressure ulcers or decubitis ulcers. We often see bedsores form on bony areas of skin where pressure is most likely to occur (e.g., the heels, hips, ankles, or tailbone). 

What Causes Bedsores? 

There are many factors that can influence the development of bedsores, including but not limited to, a resident’s lack of water and food intake. However, the most common immediate causes of bedsores are pressure and friction/shearing.  

Constant pressure on the body limits necessary blood flow to a person’s skin tissue. Without blood, we deprive our skin of oxygen and other nutrients that are vital to keeping skin strong and healthy. When pressure is not relieved, the skin begins to break down. Without aggressive intervention, the breakdown can progress from a blister to a deep crater exposing muscle and bone in a matter of weeks (or sometimes even days).

Friction occurs when fragile skin (due to constant pressure) rubs against clothing or bedding. This can be especially damaging when the skin is wet (e.g., immediately after a shower or sponge bath). Shear is when the skin moves in the opposite direction of a surface rubbing against it. We see this happen in the context of elevating a bed near the head, which can cause a person’s body to slide down and pull them in an opposite direction; or when a resident’s sheets are being changed with them still in bed. 

What Are Some of the Warning Signs of Bedsores? 

Bedsores present a wide range of symptoms depending on their severity and location. In minor cases, skin and tissue damage have variations in skin color or texture, but more serious bedsores can have much more painful damage to the underlying muscle and bone. Other symptoms of bedsore can include: 

  • General tenderness
  • Swelling 
  • Pus and other drainage of liquid 
  • The skin may feel cooler or warmer to the touch compared to the rest of the body

Nurses, caretakers, and other staff members should regularly check residents for any bedsore warning signs and ask residents if they are experiencing discomfort. When caretakers identify bedsores early, it helps reduce the odds of an injury developing into a worse condition. Be vigilant with nursing facility staff by requesting information about when the last time the resident’s skin was checked.  Ask whether any bedsores have developed and if so, what interventions and treatment are being provided.  Many nursing homes hide the development of bedsores from the resident’s loved ones and friends and even try to deny the seriousness of bedsores by claiming that everyone in their condition or at their age develops bedsores. It is simply not true.  

The Different Stages of Bedsores

Medical professionals classify bedsores into five different stages that reflect the severity of the sore, or in the case of an “unstageable” sore- reflect the inability to accurately measure and/or stage the sore due to the presence of dead tissue. Stage one is the least severe, while stage 4 is the most severe; unstageable sores are always considered a stage 3 or 4. Bedsores can become progressively worse if nurses or other staff leave them untreated, which can lead to more serious conditions. 

  • Stage one: This beginning stage of a bedsore will be a visible change in skin color to red, purple, or ashen depending on the person’s skin tone. Pain may accompany the change in skin color in addition to the spot being noticeably hot or cold to the touch. 
  • Stage two: The bedsore will appear as an open wound because the outer layer of skin will have rubbed away due to the friction or shear. The sore will be shallow and have a pinkish or reddish color. 
  • Stage three: The sore will grow deeper in this stage due to the additional skin loss, where you may be able to see fat loss. The skin will be dead at this point and have a yellow color.
  • Stage four: In worst-case scenarios, the bedsore will continue to eat away at the person’s tissue, which means loss of muscle or tendon tissue. The person’s bone and tendons may be visible to the naked eye where the skin has deteriorated. 
  • Unstageable: Unstageable bedsores are wounds with substantial skin or tissue loss and accepted as either a Stage 3 or Stage 4 pressure wound. The actual depth of the wound cannot be determined because a gel-like substance known as “slough” and dead tissue called “eschar” obscure the wound’s severity and depth. 

In addition to the pain and injury from the bedsore, this condition can lead to other bodily complications that can be life-threatening in severe cases. Some possible complicating conditions that may arise include cellulitis, bone and joint infections, squamous cell carcinomas, and sepsis. 

Why Nursing Home Residents Have an Increased Risk of Bedsores 

Bedsores are an unfortunate risk for residents of nursing homes and other long-term care facilities because they are often bound to a wheelchair or bed for extended periods. For residents in wheelchairs, bedsores occur on the back of legs, on arms, the tailbone, or shoulder areas that rest against the chair. For bed bound residents, pressure injuries occur on the tailbone, head, lower back, hips, knees, ankles, and heels. 

In addition to having medical conditions that immobilize them, nursing home residents may also experience other challenges or conditions that increase their risk of developing bedsores. They include: 

  • Decreased sensory awareness and mental state: Patients with neurological deficits have difficulty noticing the body’s pain sensors and other signs of discomfort from the bedsores forming.
  • Incontinence: Patients who lack control over bodily functions may require the use of urine pads or adult diapers. This can keep the skin wet and moist.
  • Conditions that limit blood flow: Diabetes and other vascular diseases that can exacerbate the issues of poor circulation from immobilization. 
  • Lack of proper nutrition: Our skin relies on the nutrients from food and water to keep it resilient and healthy. Elderly patients and those with medical conditions may struggle to obtain the daily nutrition they need to battle against bedsores.

Prevention Methods for Limiting the Risk of Bedsores

As mentioned, elderly patients and others in nursing homes or long-term care facilities have an increased risk of developing bedsores because of their limited mobility. Bedsores develop quickly, especially in cases of susceptible individuals. Two to three hours is all it takes for a bedsore injury to occur, although the symptoms may not be visible for a day or two later. The burden and responsibility for preventing bedsores lies with nursing home staff since residents often lack the ability to take proper preventive steps on their own. 

As a general practice, nursing home staff need to ensure residents are drinking enough water, since dehydration causes quicker and more severe weight loss than the lack of proper food intake; dehydration and malnutrition are two of the leading causes of bedsores and pressure injuries. Additionally, nursing staff must prioritize the resident’s diet to ensure they obtain proper nutrients for healthy skin such as vitamins A, C, and E along with healthy fats and proteins. 

Frequently Reposition the Body to Maximize Blood Flow

The other major step towards minimizing the risk of bedsores is finding ways to keep pressure off the body through frequent repositioning. Again, caretakers are responsible for moving their residents every so often because they will be unable to do so themselves. Some tips for repositioning the body from a wheelchair or while lying in bed include: 

  • Changing the focus of the body weight through shifting positions every hour or so
  • Lift the body 
  • Change the bed’s elevation (ideally less than 30 degrees to avoid the risk of shearing from your body sliding down the bed)
  • Use cushions to change the pressure points on your body (e.g., placement along the back, shoulders, head, heels, ankles, etc.)

Consider Specialty Equipment that Alleviates Pressure

You can find specialty wheelchairs, mattresses, and other equipment that also helps to shift the body’s weight and alleviate pressure. Some wheelchairs have a tilting function, and you can find mattresses with air pockets that can deflate or inflate periodically to shift the body’s position thereby relieving pressure.  Heel protectors and boots are also available to prevent the buildup of pressure in your lower extremities. 

Practice a Healthy Skin Care Routine 

Keeping the skin healthy can give it the resiliency it needs to deter bedsores with greater effectiveness. One of the best things nursing home staff can do, besides ensure they are repositioned and turned and kept from being dehydrated and/or malnourished, is to ensure the resident’s skin is clean and dry. Regularly washing the skin with a mild and gentle soap and avoiding the use of overly hot water is one helpful measure. Staff can also pat the skin dry as opposed to rubbing the skin with a towel or cloth.  Keeping a regular cleansing routine for residents helps to limit interaction with sweat, moisture, urine, stool, and other fluids that are likely to build up over time as a resident sits in a bed or chair. 

Caretakers and staff can also protect the skin by using a moisturizing cream that creates a barrier between the skin and urine or stool. As mentioned above, bedsores can develop quickly, which means it’s essential to closely inspect the skin daily for any potential warning signs of bedsores (e.g., color changes). Caretakers can incorporate their daily inspections along with recommended changing of bedding and clothing on a regular basis. 

Preventing Bedsores from Worsening to More Serious Stages 

Once you notice the beginning of bedsores, immediate action can greatly help to limit the odds of the bedsore developing to a more serious stage three or four condition. Once a bedsore reaches stage four, the road to recovery can be long, taking years for the wound site to heal, if it heals at all. Repositioning the body with careful attention to the spot of the bedsore becomes extremely important to prevent additional pressure buildup. Additionally, professional caregivers should be sure to gently clean the site of existing bedsores and adequately bandage the wound to prevent infection. 

When Caregiver Negligence Causes or Contributes to Bedsores

Bedsores are clear signs of neglect in a nursing home setting. Nursing homes and the people who operate them have a duty to protect residents from developing bedsores.  It is far too common for a nursing home to operate with substandard staff who aren’t trained or supervised properly; it is also far too common for nursing homes to understaff the facility to save on operating costs, thereby increasing the profits to the nursing facility owner at the expense of the resident’s they promise to protect. 

Speak with a Bedsore Lawyer About Pressure Injury Legal Claims

Bedsore.Law™ is the nation’s first bedsore specialty litigation firm. Bedsore litigation can be complex and requires experienced attorneys to handle your case. With offices throughout California, Texas, Wyoming and Oklahoma, and with partner firms in all 50 States, we are the largest bedsore litigation firm in the U.S. If you or your loved one suffered from bedsores in a nursing home, call us.

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