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.
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).
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.
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:
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.
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.
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.
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:
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.
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:
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.
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.
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.
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.
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.
Contact Bedsore.Law today for a free consultation about a bedsore injury claim.
