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 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.

The study also states that:

The fastest growing segment of our population is those over 65 years of age, and there are increased rates of obesity, diabetes, and cardiovascular disease. This combination of factors has resulted in more people needing assistance with activities of daily living due to decreased mobility. A major morbidity of decreased mobility is development of a pressure ulcer. The treatment for pressure ulcers is lengthy and causes a significant financial burden on the healthcare system. In the United States, an estimated $11 billion dollars is spent on pressure ulcers yearly, with $500 to $70,000 being spent on a single wound.

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. For more information on bedsore cases, please visit this page.

If you feel that your loved ones injury or death was caused by bedsores, and the nursing home is responsible, please comment below or contact me here on our confidential form. I can walk you through the process of holding nursing homes accountable for neglecting to prevent your loved one from getting bedsores.

You can read the full study referenced above here.