Bedsore lawyers investigate whether pressure ulcers, also known as bedsores or decubitus ulcers, were caused by nursing home abuse or neglect. Nursing homes are required to prevent new wounds from forming unless they were clinically unavoidable, and prevent wounds from becoming infected.
Nursing home bedsores are mostly preventable, and may be a sign of neglect or abuse. We investigate to find answers for families when a nursing home allows a bedsore to worsen or kill their loved one.
What are Pressure Ulcers, Bedsores, and Pressure Wounds?
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 injuries 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.
These are known as bedsores, pressure ulcers (when open), pressure injuries, and decubitous ulcers (an outdated medical term still in use).
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.
What Nursing Home Standards Should Bedsore Lawyers Know?
Rules and regulations matter. Bedsore lawyers should know the federal nursing home regulations inside and out.
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 every 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 done 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.
Read Nursing Home Bedsore Lawyer William Eadie’s Article on How Recent Changes to Nursing Home Regulations Affect Nursing Home Abuse Cases
Do Bedsores Mean the Nursing Home was Negligent?
Bedsores might be a sign of neglect, and neglect can affect residents in other ways, too—dehydration, malnutrition, falls from lack of monitoring, even infections caused by inadequate dressing changes or unsanitary conditions.
When a nursing home neglects obvious conditions, it can rise to the level of abuse.
Nursing home neglect contributing to bed sores can include:
- Bedbound or wheelchair bound (immobile) residents to remain in the same position for too long
- Failing to provide proper nutrition or fluids, which can make residents extremely vulnerable to skin breakdown, infections, sepsis, and death
- Allowing residents to have moist skin for too long, from not changing soiled adult diapers or wet bed sheets.
- Failing to check residents regularly skin problems
- Failing to notify the family and physician upon development of sores so that proper treatment may be rendered
Nursing homes are also required by federal and Ohio regulations and laws to notify designated representatives—and doctors—of significant changes in condition. Nursing home bedsore lawyers should know these regulations inside and out. This is not just another “personal injury” case.
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.
Do you have questions about a possible Nursing Home Abuse and Neglect case? Click below to start an investigation with us. We'll help you get answers.
Finding the Best Nursing Home Bedsore Lawyer for Your Case
Any attorney who handles “personal injury” cases will want your bedsore lawsuit, because they seem easy: an open wound, someone died or became seriously injured.
But most “personal injury” attorneys don’t regularly handle nursing home cases. They have no idea how to properly investigate the larger issues involved, understaffing, systemic failures, even identifying the full impact of a wound on a person’s health. And they may not be used to understanding and communicating the loss of an older person on a family.
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–even from personal injury lawyers!
To find the best bedsore lawyer for your case, start by finding lawyers who focus on nursing home cases. They shouldn’t be doing lots of other things, too. You want lawyers who have not just settled, but taken nursing home cases to trial. Ask them about that!
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.
Filing a Bedsore Lawsuit in Ohio
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.
Nursing home cases are generally considered “medical claims” in Ohio, which means you may have as little as 1 year form the date of negligence in which to sue. This is called the “statute of limitations.”
There are ways to extend that time, and plenty of complicated factors to consider as to when the clock starts running. Get a nursing home lawyer on the investigation as early in the process as you can.
I hate to get calls from families after the time has run. It isn’t their fault–they were worried about things like helping the person recover, funerals, mourning–but the law still takes their right to sue away.
We also investigate the corporate structure of nursing homes to find out who the real decision makers are. Often there are 3 or more companies involved beyond that individual facility controlling the money and staffing levels. Bedsore lawyers should get to them, too, in their investigation.
Warning Signs of Bedsores and Pressure Sores
According to the Mayo Clinic, bedsores can develop fairly quickly. This is why it is so important for nursing homes to be aware and know prevention strategies. The Mayo Clinic outlines the following warning signs of bedsores:
- 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
Bedsores are dangerous because of the risk of infections, which could lead to serious injury or even death. The Mayo Clinic issued the following warning:
Seek immediate medical care if you show signs of infection, such as a fever, drainage from a sore, a sore that smells bad, or increased redness, warmth or swelling around a sore.
Are pressure wounds preventable?
Preventing bedsores is the best options–and nursing homes know it’s their job to prevent avoidable bedsores.
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:
- Daily skin checks
- Repositioning
- “Off-loading” pressure points
- Positioning residents at a 30 degree angle to reduce pressure
- Properly employing pressure-relieving devices like foam padding, air mattresses, and pillows
- Keeping residents, clothing, and bedding clean and dry
- Frequent, multiple daily checks
Nursing homes can be liable for bedsores caused by failing to adequately monitor, assist, or reposition residents having limited mobility.
The National Center for Biotechnology Information (NCBI) states that the prevention of bedsores should be a goal of professional nurses at hospitals, nursing homes, and home care. A NCBI report states the following regarding the cost of treatment versus the cost of prevention of bedsores:
The cost to treat pressure ulcers can be expensive; the HCUP study reported an average cost of $37,800. Cost data vary greatly, depending on what factors are included or excluded from the economic models (e.g., nursing time, support surfaces). It has been estimated that the cost of treating pressure ulcers is 2.5 times the cost of preventing them. Thus, preventing pressure ulcers should be the goal of all nurses.
Unfortunately, some nursing homes are completely focused on dollar signs when it comes to their residents. The research from the NCBI report states that it is significantly more expensive to treat bedsores than it is to prevent them.
5 Tips for Preventing Bedsores in a Nursing Home (Video)
Tools for Preventing Bedsores
The National Center for Biotechnology Information outlines the tools that are used to assess nursing home residents’ risks of developing bedsores. There are two prominent tests that are utilized: the Braden Scale and the Norton Scale. The Norton scale is predominantly utilized in the UK. The Braden Scale was developed and is primarily used in the United States.
The Braden Scale
According to the NCBI the Braden Scale is the most commonly used tool for assessing bedsore risks in the US.
The Braden Scale is designed for use with adults and consists of 6 subscales: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. It is based on the conceptual schema of linking the above clinical situations to the intensity and duration of pressure or tissue tolerance for pressure.The copyrighted tool is available at http://www.bradenscale.com.braden.pdf. The scores on this scale range from 6 (high risk) to 23 (low risk), with 18 being the cut score for onset of pressure ulcer risk. Research has shown that hospital nurses could accurately determine pressure ulcer risk 75.6 percent of the time after an interactive learning session on the Braden scale. Nurses were best at identifying persons at the highest and lowest levels of risk and had the most difficultly with patients with mild levels of risk (scores of 15–18).
If you have concerns about your loved ones potential risk of bedsores, speak with the nursing home administration as soon as possible before it is too late. Ask them what tools they use to assess your loved ones risks of bedsores and how they are prepared to prevent them.
Pressure Wound Complications from Bad Care
Unraveling the cause of someone’s death in a nursing home can be complicated. Serious wounds can lead to complications that cause death, but it may not be obvious.
If a wound is allowed to develop to Stage III or IV, serious and life-threatening complications can develop. Bedsore lawyers should know these complications, so they can identify cases where a bedsore caused more problems.
These include:
- Sepsis: the presence in tissues of harmful bacteria and their toxins, typically through infection of a wound. This can lead to organ damage or failure, which can lead to septic shock, respiratory failure, and death. This is a medical emergency.
- Cellulitis: a potentially serious bacterial skin infection that may appear as a swollen, red area of skin that feels hot and tender. Without treatment, the infection may spread to the blood (sepsis), bones (osteomyelitis), joints (septic arthritis), or to the brain and spinal cord membranes (meningitis).
- Gangrene: localized death and decomposition of body tissue, resulting from either obstructed circulation or bacterial infection, a medical emergency that requires immediate removal of the infected area by debridement or amputation.
- Osteomyelitis: inflammation of bone or bone marrow, usually due to infection, which can spread from surrounding tissue or blood, and requires treatment with antibiotics and possibly surgical removal.
- Septic arthritis: is a painful infection in a joint that can occur when a penetrating injury delivers germs directly into the joint. Requires treatment with antibiotics or surgery to remove infected areas.
- Necrotizing fasciitis: a flesh-eating bacteria that causes rapid tissue death (necrosis) requiring immediate medical intervention including antibiotics and removal of dead tissue.
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.
Are the Nurses and Aides to Blame for Bedsores?
Nursing staff is often understaffed and over worked by greedy nursing home corporations.
In a very obvious way, yes, nurses and aides–the people responsible for evaluating skin, providing the positioning and offloading to prevent or help heal bedsores, and the rest–are “responsible” for bedsores.
But it is important to realize that in the nursing home bedsore cases we’ve handled, the nurses and nursing aides are really victims, too. What I mean by that is that the nursing home company under-staff the facility, meaning the nurses have to try and do too much in too little time.
The result is people not getting care. And one of the easiest things to skip are detailed skin checks, re-positioning residents, and changing undergarments.
The natural result is skin breakdown and infections.
Is it really the nursing staff’s “fault” that they can’t do the impossible? Of course not.
Now, you may be angry at them, or specific staff. We get that. They seem rude, short tempered, lazy, disinterested, you name it. But in a very real sense, they’re trying to cope with a terrible situation: their company is putting its own profit over resident care.
That’s why we don’t sue the nurses directly, or beat them up at trial. We get under the surface to the real, root cause of the bedsore. That’s what bedsore lawyers should do.
Otherwise, this seems like just one mistake, or failure, by a few nurses. When the real problem is a system set up by the nursing home company that was going to lead to injury or death no matter what.
Do you have questions about a possible Nursing Home Abuse and Neglect case? Click below to start an investigation with us. We'll help you get answers.
Common Pressure Sore Locations
Where pressure ulcers are likely to develop depends on where the person spends time under pressure. (Image courtesy of the JAMA Network, by Cassio Lynm, MA, available here)
Pressure sore lawyers should be aware of the common locations for bedsores, so they can compare that with the person’s condition. And to understand when unusual bedsores show up so they can investigate why.
For people who use a wheelchair, pressure sores often occur on skin over the following sites:
- Tailbone or buttocks
- Shoulder blades and spine
- Backs of arms and legs where they rest against the chair
For people who are confined to a bed, common sites include the following:
- Back or sides of the head
- Rim of the ears
- Shoulders or shoulder blades
- Hip, lower back or tailbone
- Heels, ankles and skin behind the knees
Risk Factors for Bedsores
Nursing home staff–and bedsore lawyers–must be aware of the risk factors for skin breakdowns and wounds, which include:
- Age: the older we are, the more delicate and vulnerable our skin becomes. Older people have less efficient circulation, less elastic skin, and fewer protective fat stores under the skin, which provides padding.
- Poor nutrition. Older people are at a higher risk of poor nutrition and dehydration, which can compound other risk factors such as aging skin tissue and problems with mobility. Residents who cannot feed themselves in particular are more vulnerable to nutrition issues, that can lead to skin breakdowns.
- Dehydration, which can set in quickly, can lead to rapid health decline, including skin breakdowns.
- Underweight residents;
- Limited mobility, especially bedbound or wheelchair bound.
- Incontinent residents, which leads to damp skin, and possibly less sanitary conditions.
- Friction caused by turns, lifting, or pushing a resident too rapidly;
- Shear resulting from a resident sliding down in a bed or chair or from being positioned incorrectly; and
- Serious medical conditions affecting the skin, circulation, or immune system, including diabetes, kidney disease, chronic obstructive pulmonary disease (COPD), which can lead to too little oxygen in the blood, heart failure, and peripheral artery disease.
People who have difficulty with mobility are always more likely to develop pressure ulcers, especially with inadequate care.
Bedsore Staging
Bedsores or pressure wounds fall into four stages, as well as “suspected deep tissue injuries” and “unstageable.” When nursing homes do a bad job staging a bedsore over time, that can be a violation of government nursing home regulations.
Healthy Skin
Understanding how to stage pressure ulcers requires understanding what healthy skin is, and how it can differ when looking for signs of sores based on skin pigmentation and whether it is really skin or mucous membranes.
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- Staging a nursing home pressure ulcer starts with knowing what healthy skin is. This is a cross section image of lightly-pigmented healthy skin. Pigmentation can make staging pressure ulcers (commonly called bedsores) more difficult. (Courtesy of the National Pressure Ulcer Advisory Panel.)
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- This is a cross section image of darkly-pigmented healthy skin. Pigmentation can make staging pressure ulcers (aka “bedsores”) more difficult. (Image courtesy of the National Pressure Ulcer Advisory Panel)
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- The moist lining of body cavities like the mouth and nose–called the mucous membrane–can be next to normal skin areas that have pressure ulcers, but you cannot use the same assessments to determine pressure ulcers. For example, these areas do not blanch like normal skin. (Image courtesy of the National Pressure Ulcer Advisory Panel)
Stage I
At the beginning of a pressure sore—Stage I—you will see:
- Unbroken skin
- The skin appears does not blanch—lighten when pressed briefly—and looks red on people with lighter skin color, or discolored on people with darker skin tones.
- The skin may be tender, firm, soft, warm or cool compared with the normal, surrounding skin.
Here are images of stage 1 sores:
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- This is a cross section image of darkly-pigmented skin with a Stage 1 pressure ulcer (also called a bedsore, decubitous ulcer, or pressure wound). Pigmentation can make staging pressure ulcers more difficult because you cannot see discoloration or blanching as easily. (Image courtesy of the National Pressure Ulcer Advisory Panel)
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- Cross section of lightly-pigmented skin with a stage 1 pressure ulcer or bedsore, represented as a red area extending below the skin’s surface. Red areas are easier to observe on lighter skin. (Image courtesy of the National Pressure Ulcer Advisory Panel)
Here is some information on blanching and edema:
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- When a patient’s skin loses redness with pressure it is called “blanchable”; “unblanchable” skin does not. A stage 1 bedsore is defined as non-blanchable. (Image courtesy of the National Pressure Ulcer Advisory Panel)
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- This is a cross section image of skin with a Stage 1 pressure ulcer (also called a bedsore, decubitous ulcer, or pressure wound), with excess fluid collecting in the skin, called “edema.” Edema increases the risk of developing a skin ulcer, and can complicate healing, by compressing small blood vessels. (Image courtesy of the National Pressure Ulcer Advisory Panel)
Stage II
At stage II, a pressure ulcer is more apparent as a wound:
- The outer layer of skin is damaged or lost, and the under layer is damaged.
- The wound may be shallow and pinkish or red.
- The wound may look like a fluid-filled blister or a ruptured blister.
- It is possible for skin at this stage to be damaged beyond repair or die.
A stage 2 bedsore, which presents as partial thickness loss of dermis and a shallow open wound with a red or pink wound bed, or as an intact or open/ruptured serum-filled blister. (Image courtesy of the National Pressure Ulcer Advisory Panel)
Stage III
At stage III, the pressure ulcer has become a deep wound:
- The wound gets below the skin to the level of fat below
- The wound appears “crater” like
- There may be dead (necrotic) tissue on the bottom of the wound
- The damage may extend or tunnel beyond the primary wound below layers of healthy skin.
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- Stage 3 pressure wound showing wound open to fatty layer (full-thickness tissue loss), but not to bone or muscle (which would be stage 4). Devascularized yellow tissue (“slough”) may be present but does not hide the bottom of the wound. (Image courtesy of the National Pressure Ulcer Advisory Panel)
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- A Stage 3 pressure wound (bedsore or pressure ulcer) with rolled or curled-under closed wound edges, called “epibole.” Epibole is usually lighter colored than surrounding skin, with a raised and rounded appearance. (Image courtesy of the National Pressure Ulcer Advisory Panel)
Stage IV
A stage IV ulcer shows large-scale loss of tissue:
- Muscle, bone or tendons may be visible.
- There is likely dead tissue—yellow or black—at the wound bottom.
- The damage often tunnels or extends below layers of healthy skin around the wound.
Stage 4 pressure wound showing wound open to bone, tendon, or muscle. Devascularized or dead tissue (slough or eschar) may be present, but the bottom of the wound can be seen. (Image courtesy of the National Pressure Ulcer Advisory Panel)
Unstageable
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.
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- Staging a nursing home pressure ulcer becomes impossible when the open wound is filled with devitalized yellow tissue (“slough”) or black, dead skin (“eschar”). This is called “unstageable.” It’s important to note that eschar is not a scab. (Courtesy of the National Pressure Ulcer Advisory Panel.)
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- An unstageable open pressure wound with dark dead skin (eschar) hiding the depth of the wound. (Image courtesy of the National Pressure Ulcer Advisory Panel)
Deep tissue injury
A deep tissue injury is characterized as:
- Unbroken, discolored skin (purple or maroon)
- A blood-filled blister is present.
- The area is painful, firm or mushy.
- Compared with the healthy surrounding skin, the injured area will be warmer or cooler temperature
- In people with darker skin, a shiny patch or a change in skin tone may develop.
Deep tissue injury is a term proposed by the National Pressure Ulcer Advisory Panel to describe pressure ulcers that do not fit within the standard staging, perhaps presenting as unbroken skin but being much more serious than a Stage I bedsore. (Image courtesy of the National Pressure Ulcer Advisory Panel)
Do you have questions about a possible Nursing Home Abuse and Neglect case? Click below to start an investigation with us. We'll help you get answers.
Treating Pressure Ulcers
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.
Protecting Elderly Skin
(Re)Positioning
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:
- ability of the person to independently reposition
- educating any staff or caregivers about proper repositioning
- sitting position and posture
- lying position
- supporting feet, arms, neck, trunk, and head
- using any necessary equipment and supports
Pressure Relieving Devices like Cushions
Air mattresses, cushions, and other pressure-relieving devices can help reduce pressure points.
Nutrition
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:
- Minimal Disruption to Healing—needing application every 3-7 days, there is less disruption of healing, room for infection through changing dressings, and less intensive staff needs (meaning less risk of staff missing dressing changes).
- Impermeable to Bacteria
- Adheres Only to Intact Skin
- Easy to Apply
Alginate dressings contain substances like calcium and sodium that help the wound to heal faster, and are made of natural materials.
Antibiotics
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.
Surgical Debridement
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.
Surgery
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.
Vacuum Treatments
Wound vacuums, called “wound vacs,” or negative-pressure therapy, use vacuum pressure on the wound to help close, extract moisture, and reduce infection risk.
Maggot Therapy
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 Is It Safe To Reapply Pressure?
When someone is suffering from bedsores or pressure ulcers it is extremely important that pressure remains off of the wound. But when is it safe for the pressure to be reapplied to the wound? Your loved one’s doctor or other medical professionals should make sure that it is safe to apply pressure once again. But you can follow the these guidelines.
According to an article by the University of Washington, complete healing is the key. The article outlines the following:
Only when a pressure sore is completely healed can pressure be reapplied over the area. Complete healing means that the outer layer of skin (the epidermis) is unbroken and normal coloring has returned to the area. Sometimes a scar may remain. A scar is healed tissue but will remain a somewhat different color from the surrounding skin. Scar tissue is never as tough as uninjured skin.
The first time pressure is applied to a newly healed area, it must be for a very short time (15 minutes at most). Then remove pressure from the area and inspect it for redness (erythema).
If there is redness, observe it and time carefully how long it takes to fade to the color of the surrounding tissue (or the color it was before the pressure was applied in the case of a scar). If fading occurs in 15 minutes or less, no damage has occurred. Wait at least one hour and repeat pressure application.
After three successful 15-minute trials, increase to 30 minutes and repeat the above process using the guideline of a 15-minute or less fading time as a successful trial. After three successful 30-minute trials, you may increase the time by 30 minutes each day.
If at any point a trial is not successful, hold at that level until three successful trials are accomplished. In this way, you will rebuild your skin pressure tolerance.
If you are concerned about the timing of a nursing home reapplying pressure to your loved one’s bedsores, it is important to speak to a medical professional. Applying pressure too soon could be extremely dangerous.
Bedsore and Pressure Ulcer Articles
Eadie Hill Trial Lawyers has filed a lawsuit against Villa Georgetown Rehabilitation and Healthcare Center in 77-Year-Old’s Death
Image by: Villa Georgetown Rehabilitation and Healthcare Center via Google Maps
The lawsuit claims that Phyllis Hale was injured and died on February 8, 2020, as a result of Crown Ohio Holdco Inc.'s persistent understaffing and profiteering. Due to the lack of care provided by Villa Georgetown Rehabilitation and Healthcare Center, which resulted in Stage 4 skin wounds (pressure ulcers or "bedsores") and infection.
According to the lawsuit that Crown Ohio Holdco Inc.'s systemic understaffing, inadequate training, and poor management of its Villa Georgetown Rehabilitation and Healthcare Center facility resulted in poor care for resident Phyllis Hale, who suffered from: Skin wounds (pressure ulcers or bedsores), infections of those wounds, systemic inflammation and organ damage from sepsis, and failing to respond to call lights for Phyllis Hale and other residents in a timely manner.
The lawsuit can be found here.
The federal agency that oversees the operations of nursing homes receiving federal or state funding, the Centers for Medicare and Medicaid Services, or "Medicare," requires every nursing home receiving Medicare or Medicaid funding, including those at issue in this case, to report significant amounts of data to the federal agency that oversees the operations of nursing homes receiving federal or state funding, the Centers for Medicare and Medicaid Services, or "Medicare."
The lawsuit alleges that:
Defendants in this case have control over decisions that affect the day-to-day care of Villa Georgetown residents, such as the resources available for providing nursing staff and care to ...
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Family Sues Country Club Rehabilitation Campus for Mother’s Death
According to a lawsuit filed by Eadie Hill Trial Lawyers, Helen Remke was injured and died as a result of the Country Club Rehabilitation Campus's failure to give necessary care and treatment leading to her death from an unstageable skin wound (pleasure ulcer or bedsore), sepsis, and systemic neglect. Helen was hospitalized on February 22, 2021 and died on February 25, 2022.
According to the lawsuit, Defendants purposefully understaff the facilities in order to make more money, with the predictable result of increased preventable resident injuries and deaths due to things like falls, dehydration, malnutrition, bedsores (pressure ulcers), and infections such as urinary tract infections.
You can read the lawsuit here:
Holland Group II, Ltd's persistent understaffing, inadequate training, and bad management of its Country Club Rehabilitation Campus at Bellaire facility resulted in substandard care for its resident Helen Remke.
The lawsuit alleges that:
The nursing staff is overworked and unable to provide needed care to all residents, such as turning and positioning (leading to bedsores and infections), changing incontinent residents (leading to bedsores and infections), toileting residents (leading to increased falls and other issues), and assisting residents with eating and drinking (leading to increased falls and other issues) (leading to dehydration, malnutrition, choking, and other complications). Infections of those wounds from inadequate cleanliness and wound care;
Systemic inflammation and organ damage from sepsis, a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs, caused by those infections
Defendants have been consistently determined to have failed to ...
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Eadie Hill Trial Lawyers Files Suit Against Cooper’s Trace in 41-Year-Old’s Death
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Eadie Hill Trial Lawyers Files Wrongful Death Suit Against Progressive Quality Care and Embassy Healthcare Facilities
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Preventing Bedsores with Technology
It’s placed in areas where pressure would be placed. The sensors then pick up any signs of pressure and will alert a caregiver to alleviate the pressure being placed.This is would be a wonderful tool in the prevention of bedsores, but, again if there is a lack of staff present, this tool would be useless. You can access the full Fox 55/27 article with video here. Another potential tool that could be used to prevent bedsores is described by Irelands RTE website. According to the article, the device was:
using technology developed for the NASA Mars lander, a company in the US has produced a wireless device which isThe article reports that the wireless device is attempting to address ...
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Eadie Hill Trial Lawyers File Medical Malpractice and Wrongful Death Suit in Painful Pressure Sore Case
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Ending Nursing Home Abuse: Nursing Home Offers Incentive for Improved Care
The agreement between Bishop, formerly known as James Square, and 1199SEIU includes a wage incentive program that gives workers lump sum increases for meeting quality benchmarks. "We took over a struggling facility both financially and operationally and found a true partner in the turnaround with 1199," Edward Farbenblum, who bought the 440-bed nursing home in December, said in a prepared statement. The new contact calls for the creation of a committee, made up of certified nurse aides, to improve resident care. Under the agreement, Bishop has also agreed to provide tuition reimbursement for employees who continue their nursing education.Often times a common cause of bedsores and falls are understaffing and lack of education. According to the article, Bishop is attempting to curb these common causes. According to research published by PHI National, the following are nursing home employee statistics:
- The poor quality of nursing assistant jobs makes it difficult for nursing homes to attract and retain enough workers to meet demand.
- Nursing assistants earn a median hourly wage of $11.87, and a median annual income of $19,000.
- Half of nursing assistants have completed no formal education beyond high school. Because nursing assistant jobs require little education, experience, or training, it is an accessible ...
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Bedsores in Nursing Homes: The Facts
The occurrence of bedsores in a nursing home is typically preventable. A study by the Advances In Wound Care describes pressure ulcers, or bedsores, as being a frustrating problem for healthcare professionals. The article describes how bedsores develop and what can be done in an attempt to prevent them:Pressure ulcers develop as a result of a combination of physiologic events and external conditions. The classic thinking of tissue ischemia induced by prolonged external pressure on tissue being the sole causative factor of pressure ulcer formation has been examined more systematically. Along with localized ischemia and reperfusion injury to tissues, impaired lymphatic drainage has been shown to contribute to injury as well. Compression prevents lymph fluid drainage, which causes increased interstitial fluid and waste build up and contributes to pressure ulcer development. Deformation of tissues has been shown to be a greater indicator of pressure ulcer formation than pressure exerted on tissues alone. The time required to develop a pressure ulcer is dependent on many factors, including the patient's physiology and the degree of pressure and shear force placed on the tissue. Pressure ulcers occur over predictable pressure points where bony protuberances are more likely to compress tissues when the patient is in prolonged contact with hard surfaces. For patients unable to move themselves, such as intubated patients in the ICU, positional change every 2 hours has been widely accepted as effective prevention.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. 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 ...
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Numerous Nursing Home Residents Suffer From Bed Sores
The government says the province's long-term care homes were ordered last week to report bedsores, and "that reporting identified 152 stage three and four (most severe) pressure injuries." It says wound care experts will be sent in to address these injuries, and all other bedsores.It also reports that the Nova Scotia Nurses' Union has gotten involved as well. The article states that
The union is calling for "staffing standards that will better guarantee the health and well being of long-term care residents," and penalties for homes that fail to comply with those standards. Union president Janet Hazelton says staff are attempting to care properly for residents, but there's a lack of licensed personnel who can care for patients who need higher amounts of care.Sadly, this is a problem that is being faced by many nursing homes. Often times though, understaffing occurs when large corporations that own nursing homes are attempting to cut costs. You can read more about the dangers of understaffing here. The article reports that the investigation into bed sores in Nova Scotia's nursing homes was sparked by the death of a nursing home resident. According to the article, the Halifax police are also involved.
Halifax police announced last week they are investigating the death of Chrissy Dunnington for possible criminal negligence ...
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Resident’s Bedsores Related to Understaffing
According to an article in the Inquirer by Harold Brubaker, the St. Francis Center for Rehabilitation & Healthcare in Darby, PA is accused of cutting staff in order to turn a profit resulting in one resident suffering from severe bedsores and infections that resulted in her death. The article reports that Lois Coleman came to St. Francis Center after a hip replacement surgery in 2014 and died in 2017 from severe infections from bedsores. According to the article, Coleman's family noticed a significant change in staffing at the nursing home. Her daughter, Shirley Burch, spoke with reporters at the Inquirer and they report that:“She went in there for rehab, and she never came out,” said Coleman’s daughter Shirley Burch, who, on her visits from Los Angeles, noticed dramatic declines in staffing levels at St. Francis.The article in the Inquirer states that:
In a lawsuit filed last month, Burch said that a doctor ordered staff to change Coleman’s position every two hours on all shifts, but that did not happen, and the resulting bed sores pushed all the way through to the bone over the next two weeks.According to the article, Charles-Edouard Gros bought the St. Francis Center for Rehabilitation and Healthcare along with four other nursing homes from the Archdiocese. The article reports that:
St. Francis Center for Rehabilitation & Healthcare went from roughly break-even in the two full years before Gros bought it to being the second-most profitable nursing home in the Philadelphia region last year. Then, its quality of care tanked. Last September, inspectors found rampant neglect at the Darby facility and revoked its license, a step taken only in extreme cases. Gros’ homes comprised four of the region’s five most profitable nursing homes, achieved by cutting staff and taking on sicker patients, an Inquirer analysis found. At the ...
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Nursing Home Residents Suffer Bedsores Due to Neglect
The lawsuit claims the nursing home left residents lying in their own urine and feces for hours because it did not have enough staff to care for them. Clinton Square Operations LLC bought the nursing home at 918 James St. formerly known as James Square in December. As part of the settlement, it also agreed to pay $495,000. If the settlement is approved, more than $300,000 of that money will go to class members and the rest will pay for legal and administrative fees.According to the article, the Bishop Rehab and Nursing Center has been under investigation for over a year. The article states that:
The state Attorney General's Medicaid fraud unit has been investigating the nursing home for more than a year over patient care issues. The AG's office raided the 440-bed facility last June and seized records as part of the investigation.Unlike many stories similar to this one, the article reports that the owners of the facility are attempting to turn this one around. The article states that the nursing home was recently bought from River Meadows LLC, James Square Nursing Home Inc. and 918 James Receiver LLC. According to the article, the attorney who filed the law suit stated that the new owners are attempting to turn the facility around.
Jeremiah Frei-Pearson, a lawyer who filed the class action lawsuit on behalf of a resident and former resident, said Clinton Square Operations has been increasing staffing at the nursing home since taking over in January. "They inherited a disaster," he said. "The owner wants to make it ...
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Mt. Vernon Family Sues The Laurels at Mt. Vernon for Korean War Veteran’s Death
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Our No Fear Guarantee
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