Is the Nursing Home Responsible for Bed Sores and Pressure Ulcers?
You were told your loved one has a pressure ulcer (bed sore), what is that? Did your loved one go into a nursing home for rehabilitation or because they required more care then you could give at home only to then discover that they have a terrible open wound on their backside or heel?
What is a Pressure Ulcer?
Google the words bed sore, pressure ulcer or pressure sore. The images are certainly startling. Some make you gasp and cause you to look away. According to the Center for Disease Control (CDC) pressure ulcers, also known as bed sores, pressure sores, or decubitus ulcers, are wounds caused by unrelieved pressure on the skin over a bony area, for example when a person lays in bed or sits in a chair for hours at a time the bone is pressed against the skin and a wound forms. They usually develop over bony prominences, such as the elbow, heel, hip, shoulder, tailbone, and back of the head. Pressure ulcers are serious medical conditions and one of the important measures of the quality of clinical care in nursing homes. They can be prevalent in nursing homes, about 2% to 28% of nursing home residents have bed sores. Often someone is responsible when this happens to our loved ones in nursing home care.
As a Cleveland bed sore lawyer and pressure ulcer attorney, and as a former nurse, I have seen -many many cases of nursing home residents who have suffered serious ulcers and infections resulting from poor treatment and negligence on the part of nursing home.
Understanding the Severity of the Bed Sore.
Once a pressure ulcer forms it often quickly gets worse, The National Pressure Ulcer Advisory Panel has set forth a staging system to describe the severity of bed sores.
The most common system for staging pressure ulcers classifies them based on the depth of soft tissue damage, ranging from the least severe (Stage 1) to the most severe (Stage 4).
- There is persistent redness of skin in (stage 1);
- A loss of partial thickness of skin appearing as an abrasion, blister, or shallow crater in (stage 2);
- A loss of full thickness of skin, presented as a deep crater in (stage 3); and
- A loss of full thickness of skin exposing muscle or bone in (stage 4).
Bed sores can be deadly when they become infected and that infection spreads throughout the body.
Who is at Risk for Developing Pressure Ulcers (Bed Sores)?
Not every resident in a nursing home gets a pressure ulcer, so what factors put a person at risk for getting these nasty and painful ulcers? The CDC is a reliable source and explains the risk factors- Do any of these apply to your loved one?
- Nursing home residents, with a recent weight loss (20%) were more likely to have pressure ulcers than those who had not had a recent weight loss (10%).
- Nursing home residents who had were not able to walk independently or here high immobility (16%) had an 11% greater occurrence of pressure ulcers than those without high immobility (5%).
- Polypharmacy, or taking more than eight medications, was related to a greater prevalence of pressure ulcers (13% and 9%, respectively).
- Pressure ulcers were more prevalent (12%) among residents who had any recent bowel or bladder incontinence than among continent residents (7%).
- Impaired blood flow
- Resident refusal of care
- Cognitive impairment
- Exposure to urine/feces/moisture
- Nutrition or hydration deficiencies
- History of previous ulcer
If a resident has the risk factors for a bedsore then the nursing home will need to institute additional measures to reduce the risk getting a pressure ulcer such as a specialty mattress, dietary consult, turning and repositioning schedule and regular skin assessments. These interventions should be set forth in a resident’s individualized care plan in their care record.
If a loved one has suffered from a bed sore or pressure ulcer, unless they have a medical condition in which bed sores and pressure ulcer are not preventable, the nursing home or care facility may be legally liable.
Whose fault is the pressure ulcer? Was it avoidable? In 1859 Florence Nightingale wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing”.
Bed Sores / Pressure Sores and Federal Nursing Home Regulations
There are federal regulations that govern nursing homes and specifically set forth the duty of the nursing home in reducing the risk of resident developing a bed sore . They’re a serious problem and it’s imperative that the nursing home staff ensures that our loved ones do not develop them unless it is clinically unavoidable. In fact Federal Nursing Home Regulation §483.25(c) regarding pressure sores states:
The intent of this requirement is that the resident does not develop pressure ulcers unless clinically unavoidable and that the facility provides care and services to:
- Promote the prevention of pressure ulcer development;
- Promote the healing of pressure ulcers that are present (including prevention of infection to the extent possible)….
That is strong language. To comply with this regulation a nursing home must assess the resident for their risk of developing an ulcer, have a prevention plan, which sets forth specific things they must do to reduce the risk of developing a pressure ulcer such as weekly assessments, skin care, turning and repositioning every 2 hours- at least!, use of support surfaces such as a specific mattress or pad that redistributes body weight and a good nutritional plan that includes lots of protein. These are vital components of patient care to prevent bed sores. You would be surprised how often nursing homes are not properly assessing our loved ones! Assessment is the first and most important step in prevention.
Now if the nursing home does all these interventions, assessments, makes a plan, implements the plan, and documents the interventions and a person develops a bedsore the plan doesn’t work, they are to begin again with a new plan. If the nursing home does all of these actions and the person still develops a pressure ulcer then it might be “medically unavoidable” but that is a very unlikely.
The Real Reasons that Most Bed Sores and Pressure Ulcers Occur in Nursing Homes.
Often what I see in my practice as a nursing home lawyer is that the reason people develop pressure ulcers is that there is a breakdown in one of the steps I have described; assessment, individualized care plan, implementation of the plan and reassessment.
In order to prevent pressure ulcers we must be sure the nursing home staff is, at a minimum, keeping skin clean and dry, changing position every two hours and using pillows and products that relieve pressure. Over the years I’ve learned firsthand that this is easier said than done. All too often the nursing homes are understaffed and the staff there isn’t always properly trained. The real reasons that bed sores and pressure ulcers occur in nursing homes are a combination of putting profits over resident care, poor training, and poor oversight.
Putting profits over resident care often leads to seeking less qualified and not enough staff who will work for less money than highly-trained staff. Care assistants – rather than licensed nurses – are often used. Those providing care do not spend the time necessary to care for patients.
Poor training is also a result of putting profits over care. Put simply, many nursing homes and long-term care facilities do not invest the time required to adequately train staff about proper patient care. Even if staff are concerned about providing a high level of care, they may not know how to do so.
Poor oversight can frequently lead to bed sores and ulcers. If staff are not overseen by nurses and other medical professionals, these conditions can quickly develop, and can get significantly worse, before they are even noticed.
Bed sores are most often avoidable if the nursing home is following the federal regulations and has enough well trained and qualified nursing staff-. Labor costs are the biggest costs for a nursing home so if they are looking to maximize profits then often it is staffing that is shorted and the resident pays the price in poor care.
What are your options when your loved one developed a bed sore or worst case passed away because of it?
Call me to discuss your rights and options to hold the facility accountable for poor care. My practice is devoted to not only seeking justice for those who are injured and their families, but also to holding care facilities fully accountable for their negligence. Bringing a lawsuit and demanding fair compensation is often the only way that these facilities will change their management practices. While the harm to your loved one cannot be undone, one of the benefits about demanding accountability is that often other families and their loved ones will be spared the pain, surgery, and sometimes even death caused by bed sores and pressure ulcers. My experience of over 30 years as a nurse and attorney specializing in nursing home cases can make all the difference in your search for justice for your family. I can be reached at 216.696.5700.