nursing home abuse & neglect news

The Six Warning Signs, What They Mean

Bedsores

Bedsores are sometimes called pressure sores or decubitus ulcers .  In a sore's early stages, the skin will appear red and turn white like a sunburn when touched. If left untreated, decubitus ulcers can crater and leave muscles, tendons, and bones exposed. 

Bedsores are very common in nursing homes, but this does not mean bedsores are acceptable.  Bedsores can be prevented by regular care, such as by changing a person's position regularly and by insuring nursing home residents have adequate nutrition.

Causes of Bedsores in Nursing Homes

Bedsores are caused when nursing homes force residents to lie motionless for long periods of time.  This prolonged pressure wears on the skin and muscle tissue and causes them to not receive adequate nutrients from the blood.  This causes tissue death (“necrosis” in medical terms).  The bony areas of the body (like the lower back, elbows, knees, and hips) are the places most prone to bedsores.  

Because of the degenerative cause of bedsore tissue damage, there is a strong likelihood of the ulcerous wound returning if the person is not properly cared for after recovery.  Tell your healthcare provider immediately if you notice a bedsore change color or produce an odor as both are strong indicators of infection.

The Four Stages of Bedsores

Bedsores are classified into four stages.  Because of the increasing degree of tissue damage at each stage, the classification of bedsores does not decrease during recovery.  In other words, a Stage 3 bedsore never heals to a Stage 1 or Stage 2 bedsore.  Because of the severity of each stage, it would medically be considered a Stage 3 bedsore in recovery.

The following stages, defined by the National Pressure Ulcer Advisory Council (NPUAP), are:

  • Stage 1 Bedsore: Changes in skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching).  The ulcer appears as a defined area of persistent redness in lightly pigmented skin. In darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.

  • Stage 2 Bedsore: Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

  • Stage 3 Bedsore: Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

  • Stage 4 Bedsore: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint, capsule). Undermining and sinus tracts also may be associated with Stage IV pressure ulcers.

View photo examples of bedsore stages. Please note: these images are graphic.

Care for Your Loved One

Bedsores are best prevented by having the pressure ulcer-prone person regularly change positions, proper and immediate cleaning after the resident has used the restroom to remove skin irritants, and the use of pressure-reducing padding such as gel or alternating air mattresses.  Also important is a diet rich in nutrients, including vitamin supplements as prescribed by a registered dietician or as advised by a primary care doctor.

If you notice a bedsore one your loved on in a nursing home at any stage, reduce the amount of skin contact with sweat, urine, and feces to decrease chances of infection.  Do not attempt to massage the area as this may cause more tissue damage, especially in bony areas and avoid washing the affected area with deodorant soaps or applying perfumed lotions.  Have your loved one avoid coffee and alcohol as these reduce the amount of nutrients carried in the blood.  Most importantly, bring the matter up with the nursing home immediately and seek treatment by a qualified physician.

 

Lawyers for Change

If someone you love has a bedsore in nursing home care, contact the Consumer Justice Group immediately. Our nursing home abuse attorneys will put a staff physician on the case to determine why this happened. Click to contact an elder law lawyer in your area.

Resources

  • In this USA Today article, reporter Liz Szabo explains how Christopher Reeves, the paralyzed actor who once portrayed Superman, despite his brave fight to raise awareness about paralysis, was in the end killed by an infected bedsore.  The article also discusses how difficult it is for bedsores to heal and why recovery can be debilitating. 

  • This informative WebMD entry written by Florida Dr. Don R. Revis, Jr. outlines the history of the term and discusses causes, treatment, and the dangers of bedsores.

  • National Pressure Ulcer Advisory Council (NPUAP), an independent nonprofit organization founded in 1987, publishes the standard criteria on the four stages of bedsores in its frequently updated “Pressure Ulcer Stages” (2007).  The council’s mission over the past 20 years has been the prevention of bedsores and to find quality treatments for sufferers.  

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