Is the Nursing Home Responsible for Bed Sores and Pressure Ulcers?

Did your loved one go into a nursing home or rehabilitation center because they required more care than you could give? Were you told that your loved one has a pressure ulcer, also known as a bed sore, but you’re not sure what it is or what it could mean? Bed sores and pressure sores are open wounds that can lead to infection and death. Each year, 2.5 million patients are affected by bed sores and about 60,000 patients die as a direct result of a pressure ulcer. The good news is that they are usually medically avoidable. This means that, in most circumstances, bed sores should never occur. So, if your loved one is suffering from bed sores, the nursing home or rehabilitation center may be liable.

What is a bed sore or pressure ulcer?

If you do an internet search for bed sore, pressure ulcer, or pressure sore, the images are certainly startling and disturbing. According to the Mayo Clinic, bed sores, also called pressure ulcers and decubitus ulcers, are injuries to skin and underlying tissue resulting from prolonged, unrelieved pressure on the skin over a bony area, such as the heels, ankles, hips, elbows, tailbone, and the back of the head. These wounds can develop over hours or days, for example when a person lays in bed or sits in a chair for hours at a time with limited or no mobility to change positions. The bone is pressed against the skin and a wound forms.

How common are bed sores?

About 2% to 28% of nursing home residents have bed sores. And, unfortunately, the reality is that bed sores occurrences are often significantly underreported.

Bed sores are a serious medical condition and an important marker of the quality of clinical care in nursing homes.

Often someone is responsible when this happens to our loved ones in nursing home care. As an Ohio nursing home bed sore lawyer and pressure ulcer attorney and as a former nurse, I have seen many cases of nursing home residents who have suffered serious pressure ulcers and infections resulting from poor treatment and negligence on the part of nursing home.

What are the symptoms or warning signs of bed sores?

• Unusual changes in skin color or texture
• Swelling
• Pus-like draining
• An area of skin that feels cooler or warmer to the touch than other areas
• Tender areas

Once pressure ulcer warning signs are seen, prompt action must be taken to help them heal.

What are the risk factors for getting bed sores?

Not every nursing home resident gets a pressure ulcer, so what factors put a person at risk for getting these nasty, painful sores? Do any of these risk factors as outlined by the CDC apply to your loved one?

• Recent weight loss
• Decreased mobility or complete immobility
• Polypharmacy, or taking more than eight medications
• Recent bowel or bladder incontinence
• Impaired blood flow
• Resident refusal of care
• Cognitive impairment
• Exposure to urine/feces/moisture
• Nutrition or hydration deficiencies
• History of previous bedsore

If bed sore risk factors are present, the nursing home must institute additional interventions to a resident’s individualized care plan to reduce the risk.

What are the stages of a 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).

What are the complications of pressure ulcers?

Per the Mayo Clinic, pressure ulcers can lead to many complications, such as: 

• Cellulitis is an infection of the skin and connected soft tissues.
• Bone and joint infections. Joint infections (septic arthritis) can damage cartilage and tissue. Bone infections (osteomyelitis) can reduce the function of joints and limbs.
• Long-term, nonhealing wounds (Marjolin’s ulcers) can develop into a type of squamous cell carcinoma.
• Rarely, a skin ulcer leads to sepsis.

In addition, bed sores can be painful and disfiguring, lowering quality of life. Most concerning, they can become infected and may cause death when the infection spreads throughout the body.

Is the nursing home liable for bed sores?

Whose fault was the pressure ulcer? Was it avoidable? In 1859, Florence Nightingale wrote, “If [the patient] has a bedsore, it’s generally not the fault of the disease, but of the nursing.”

If a loved one has suffered from a bed sore or pressure ulcer, the nursing home or care facility may be legally liable.

What are Federal Nursing Home Regulations related to bed sores?

Federal regulations govern nursing homes and specifically set forth the duty of the nursing home to reduce the risk of residents developing a bed sore. 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, signaling the severity of this issue.

What can nursing homes do to prevent bed sores from developing and/or worsening?

To comply with the above regulation, nursing homes must:

• Assess the resident for the risk of developing an ulcer and inspect the skin every day, paying special attention to bony areas
• Turn and reposition every two hours – at the minimum
• Use support surfaces such as a specific mattress or pad in wheelchairs and beds that redistribute body weight
• Implement a prevention plan
• Keep the skin clean and dry
• Provide good nutrition to promote healing

While these are rather simple components of patient care, you would be surprised to learn how often nursing homes do not properly assess our loved ones, the first and most important step in prevention.

If the nursing home follows all of the above steps and the resident still develops a bedsore, then they must begin again with a new plan. If, after that point, the person still develops a pressure ulcer, then it might be medically unavoidable, but this is very unlikely.

What is the real reason most bed sores and pressure ulcers occur in nursing homes?

In my practice as a nursing home lawyer, I often see people develop pressure ulcers due to a breakdown in one of the three key areas; assessment, individualized care plan, or plan implementation and reassessment.

To prevent pressure ulcers, the nursing home staff must, at a minimum, keep skin clean and dry, change position every two hours, and use pillows and products that relieve pressure. Over the years I’ve learned that this is easier said than done. All too often the nursing homes are understaffed and undertrained.

The real reason that bed sores and pressure ulcers occur is when nursing homes put profits over resident care.

 Putting profits over resident care leads to:

• Less qualified staff, who are willing to work for less money than highly trained staff. Care assistants – rather than licensed nurses – are often used and do not spend the time necessary to care for patients.
• Poor training. Put simply, many nursing homes and long-term care facilities do not adequately train staff about proper patient care. Even if staff are concerned about providing a high level of care, they may not know how.
• Poor oversight. If staff are not overseen by nurses and other medical professionals, bed sores can quickly develop and significantly worsen before they are even noticed.

Bed sores are most often avoidable when the nursing home is following federal regulations and has enough well trained, qualified nursing staff. Labor costs are the biggest expense 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.

As a nursing home bed sore lawyer in Ohio, I seek answers, compensation, and justice on behalf of residents and their families.

For more than 30 years, I and my firm have been supporting residents and families with assisted living, rehabilitation center, and nursing home matters throughout Ohio and would be pleased to speak with you about your concerns.

Please Call Our Firm Today for a Free Consultation with Nancy Iler, Ohio Nursing Home Abuse Lawyer, to Learn About Your Options

As both an attorney and a former practicing nurse, I represent individuals and the families of those who have suffered from bed sores and pressure ulcers as the result of nursing home neglect and negligence.

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 to get facilities to change their management practices. While the harm to your loved one cannot be undone, one of the benefits of legal action is to perhaps spare future families and their loved ones from 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 will be happy to speak to you for no charge. I can be reached at 216.696.5700. If you choose to retain me, there is no fee for my services unless and until compensation is recovered, as I accept nursing home neglect cases on a contingency fee basis.