Posted: February 5, 2017 | Last Updated: February 8, 2017
Pressure ulcers, also known as bedsores or decubitus ulcers, are areas of damage to the skin usually caused by prolonged or extreme pressure, such as from sitting or lying in one position for a long time. Pressure to the skin can interrupt blood flow, which over time causes skin to become starved of nutrients and oxygen. Skin that does not receive enough blood flow will begin to break down. Pressure ulcers form either when the skin is under a lot of pressure for a short period of time, or when it is under a moderate amount of pressure for a long time.
Bedsores are more likely to occur over areas of the body with less body fat or muscle between skin and bone, such as at the spine, tailbone, shoulder blades, hips, heels and elbows.
As we age, our skin becomes more delicate and vulnerable to wounds, tears, and abrasions. Nursing home caregivers are required to take precautions with residents’ skin. When nursing home caregivers are too busy, understaffed, or under-trained, skin wounds are going to become more common.
We investigate bedsore incidents in nursing homes on behalf of families to determine whether the wound was preventable, what efforts were taken to heal the wound or prevent development, and what efforts were taken to prevent infection.
Federal regulations require nursing homes to prevent new wounds from forming unless they were clinically unavoidable because of the resident’s medical condition. Nursing homes are also required to prevent wounds from becoming infected. In my experience litigating nursing home cases involving pressure ulcers, inadequate attention from nursing staff, inadequate training, and poor positioning all contribute to developing wounds.
One frequent cause of bedsores is when a resident is left in one position for an extended period of time, allowing pressure over a specific area of skin to damage the skin. Called a “deep tissue injury,” these types of wounds can develop from the inside out. These types of wounds can develop whether a resident is sitting or lying down.
Many nursing home residents who are unable to reposition themselves well will have a “turn and reposition q 2 hours” order, meaning a staff member should be helping the resident move to a new position at least every two hours. In an understaffed nursing home, that is an order that is much easier to check off in the books than actually get down with multiple residents.
Besides preventing the wounds from developing, nursing staff have to timely change dressings on existing wounds, and do so in a sanitary way to prevent infection. Healthcare-acquired infections are a serious risk in nursing homes. Bedsores that are not treated consistently will worsen, and can lead to infection, sepsis, or death.
Incontinent nursing home residents are especially at risk and should be more closely monitored. Being left in soiled clothing cause open wounds which may develop into bed sores, or lead to infection.
Nursing homes must ensure that residents are well monitored, bed- or wheelchair-bound residents are frequently repositioned, pressure-reducing tools like special mattresses, pillows, and pads are used, incontinent residents are kept clean and dry, and wound dressings (bandages) are regularly changed in a sterile way. All of that can take a lot of staff time and attention. When a nursing home puts its own profits over resident safety, there may not be adequate staff to take that level of care.
Bedsores are preventable if nursing homes take appropriate care. Unless a resident is terribly ill—such as kidney or other organ failure—suffering from vascular / circulatory issues, or otherwise severely compromised, appropriate care should prevent bedsores from developing.
If a loved one develops bedsores that worsen or become infected, it may be a sign of neglect, malnutrition, dehydration, or all three. Ohio and federal nursing home regulations dictate the level of care required, and sometimes a nursing home’s own policies add to that level of care. When we investigate nursing home cases involving bedsores, we answer the question whether they were preventable, and whether the nursing home violated its obligations in allowing them to form.
When nursing homes fail to provide this level of care to prevent, help heal, and avoid infection of pressure wounds, it may be liable for any resulting damages.
We have investigated and tried cases involving nursing home negligence allowing pressure wounds to develop and even become infected. Please contact us to discuss your potential case. You’ll get our candid evaluation at no cost.
Nursing home caregivers should be well-versed in the techniques necessary to prevent bedsores, including:
Nursing homes can be liable for bedsores caused by failing to adequately monitor, assist, or reposition, residents having limited mobility.
Under Ohio law, nursing homes can be held liable for allowing preventable bedsores from developing. We limit our practice to the most extreme cases, because we attack every case as if we’re going to go to trial.
If you’re reading this and the situation is ongoing, there are steps you can take to help us best represent your family. Consider taking pictures of any wounds, noting the time and date. Photos can be some of the most important evidence in a case involving bedsores. Also, keep notes about your conversations and observations. It can be important to know the names of staff providing care—which the nursing home must provide under Ohio law upon request—especially since there can be high turnover at these facilities. The person may not even work there by the time you call us.
Bedsores or pressure wounds fall into four stages, as well as “suspected deep tissue injuries” and “unstageable.”
At the beginning of a pressure sore—Stage I—you will see:
At stage II, a pressure ulcer is more apparent as a wound:
At stage III, the pressure ulcer has become a deep wound:
A stage IV ulcer shows large-scale loss of tissue:
It can become impossible to see how deep a wound is when its surface is covered with yellow, brown, black or dead tissue. At that point, the wound is considered unstageable.
A deep tissue injury is characterized as:
For people who use a wheelchair, pressure sores often occur on skin over the following sites:
For people who are confined to a bed, common sites include the following:
Nursing home staff must be aware of the risk factors for skin breakdowns and wounds, which include:
People who have difficulty with mobility are always more likely to develop pressure ulcers, especially with inadequate care.
The most important part of treating pressure ulcers—besides preventing them—is to recognize them quickly and provide consistent care to keep them from becoming worse. We’ve seen too many cases where a nursing home drops the ball in follow-up care, meaning wounds get worse, or even infected.
Care starts with alleviating the underlying cause, using creams or gels, and pressure-relieving devices to prevent additional sores. More serious wounds require wound dressings / bandages, advanced wound care, special padding or mattresses, or surgery.
Special wound doctors can remove dead / necrotic tissue at the bedside, called “debriding” a wound.
If a wound is allowed to develop to Stage III or IV, serious and life-threatening complications can develop. These include:
If your loved one was in a nursing home and suffered from one of these complications from a wound, call us at 216-777-8856.
Frequent position changes relieve pressure and allow for better blood flow to skin. Repositioning is an important way to prevent pressure ulcers and encourage healing of existing ulcers. At-risk residents should be provided a repositioning schedule such as being turned or moved every couple hours, or even 15 minutes for people at significant risk.
Repositioning should consider:
Pressure Relieving Devices like Cushions
Air mattresses, cushions, and other pressure-relieving devices can help reduce pressure points.
Dietitians understand residents at risk of pressure ulcers, or healing open wounds, need more nutrition—especially protein—to keep their skin healthy or repair wounds. Adequate nutrition is a critical part of preventing and healing pressure sores. Residents at-risk for wounds should be seen by a registered dietician in order to develop an appropriately balanced diet to promote healing.
Dressings and Topical Treatments
Wounds can be protected by barrier creams, gels, and ointments, which can help to protect the wound from infection and promote healing.
There are wound treatments, including dressings, designed specifically to help heal, or stop progression, or pressure wounds. Special wound dressings can reduce pressure and support healing.
Hydrocolloid dressings are a specialized dressing for wounds that provide unique benefits. As described by Advanced Tissue, “Hydrocolloid dressings have an active surface treated with a gel-forming substance consisting of pectin, carboxy-methylcellulose, polymers and other adhesives. They are an opaque, flexible, wafer that adheres to the skin. When in contact with wound exudate, the polymers absorb the fluid and swell, forming a gel which is confined within the structure of the material.” They work best with wounds that are not infected. They provide some benefits, including:
Alginate dressings contain substances like calcium and sodium that help the wound to heal faster, and are made of natural materials.
Whether topical, oral, or IV, antibiotics are critical for stopping infections before they develop to systemic infections or sepsis. Infections place an additional strain, beyond healing the wound, on a person’s body energy.
Cutting away dead or necrotic skin is called “debridement.” Besides using scalpels, wound specialists can also use: (1) cleansing irrigation, washing away dead tissue with high-pressure jets of water; (2) removing dead tissue with sound waves, called “ultrasound”; and (3) laser tissue removal treatment.
Debridement can be extremely painful. Local anesthetics can be employed to help reduce pain.
When a pressure ulcer gets severe—State III or IV—surgery may be needed to close the wound. But the resident needs to be healthy enough to undergo such surgery, and resist infection.
Wound vacuums, called “wound vacs,” or negative-pressure therapy, use vacuum pressure on the wound to help close, extract moisture, and reduce infection risk.
Although it might seem distasteful, “biological debridement” or maggot therapy uses larvae to remove dead tissue while leaving healthy tissue unharmed. Maggots also release bacteria-killing chemicals, which can make infection less likely. This is considered a safe and effective debridement treatment.
When a nursing home neglects obvious conditions, it can rise to the level of abuse, Bedsores might be a sign of neglect, and neglect can affect residents in other ways, too—dehydration, malnutrition, falls form lack of monitoring, even infections caused by inadequate dressing changes or unsanitary conditions. We’ve sued nursing homes for falls and wounds only to find facility-wide issues with staffing and infection controls.
Nursing home neglect contributing to bed sores can include:
Nursing homes are also required by federal and Ohio regulations and laws to notify designated representatives—and doctors—of significant changes in condition. In some cases, a nursing home may not notify the family or physician of the existence of bedsores. Failure to report the existence of bedsores will result in the resident being left with untreated open wounds. Unrecognized pressure sores or inappropriately treated ulcers could result in sepsis, shock, gangrene, or death.
Any attorney who handles injury cases will try to handle bedsore cases, because they seem easy: an open wound. Most attorneys who don’t regularly handle nursing home cases will have no idea how to properly investigate the larger issues: understaffing, systemic failures, even identifying the full impact of a wound. We’ve handled cases where other lawyers do not even recognize that a nursing home injury led to the resident’s death weeks later.
There’s no excuse for trusting a nursing home case to a lawyer who does not focus on nursing home cases. That’s why many of our cases come from other lawyers who recognize our experience and success.
If you would like to discuss your loved one’s situation, injuries, or death at a nursing home, call us at 216-777-8856. While we handle cases throughout Ohio, we’re happy to consult on extreme cases nationwide. If you are outside Ohio, we can help you find qualified counsel in your state.
The first thing to do is complete the contact form at the bottom of this page. That way, you can put in details that we can review before we schedule a phone call.
You can also call us at 216-777-8856 if you prefer.
You will likely not speak to us immediately, but will schedule a phone or in-person meeting. Why? Because we’re busy working on the important cases other families have entrusted to us. Just like we would not constantly take phone calls when we’re entrusted to work on your case.
You should also gather all the records and papers you have from the medical providers, go back and look for dates, names, and events that happened, and otherwise prepare to discuss the case. We’ll have a meeting and, if it seems like a case we’d be a good fit for, we’ll move into an investigation phase.
Once we’ve investigated, we’ll candidly tell you what we think about what happened, whether the medical provider is to blame, and what we think about the strength of the case.
Fair warning: we only take on clients whose cases we believe have very strong merits. We’re not lazy—the cases are still very complex, difficult, and expensive—but the risk to your family of being drawn into a difficult process with little chance of a positive outcome is not something we do.
Which means when we do take on a case, our reputation tells the other side this is a serious case we believe in.
If for whatever reason we do not take on the case, and we think there is some merit to the case, we’ll try and help you find a lawyer who might take it on.