Is someone you love in a nursing home?
Have you recently found out that they have a bed sore?
There are various names for skin breakdown used in nursing homes. Skin breakdown can be referred to as a bed sore, or a decubitus ulcer, or a pressure sore, or a pressure wound. Skin breakdown is caused by unrelieved pressure. If someone is unable to move themselves around and change position, they need help. Often nursing home residents who have recently suffered a fall and a fracture, or for some other reason are less mobile than they used to be, need help being moved around. They are required to be turned and repositioned usually every 2 hours and sometimes more often than that. If they are not turned and repositioned and they are left to sit in the same position for an extended period of time, then they will begin to develop skin breakdown. This means they are required to be turned and repositioned every two hours, twenty four (24) hours a day. When they are in a chair. When they are in bed. Etc.
Bed sores are evaluated in stages: Stage 1; Stage 2; Stage 3; Stage 4; and unstageable.
A Stage 1 bed sore is not yet opened. It is simply a reddened area. If someone is allowed to sit for an extended period of time they may begin to develop a reddened area. This area is caused by unrelieved pressure on a single area of the body. Usually bed sores start to form on areas of the body that make contact with the surfaces the person is either sitting on or laying on. We see bed sores on a person's buttocks, coccyx, sacral area. Sometimes we see bed sores on a person's heels. We have seen bed sores on a person's shoulder blades, on their hips, and on other areas of their body that make contact with a seating surface or a surface where they're laying down.
A Stage II bed sore is open. A Stage III bedsore is open and deeper. A Stage IV bed sore is even deeper, and usually extends into the resident’s muscle and can even extend to their bones. Ones their bones are exposed to the air the resident can suffer an infection known as osteomyelitis. An unstageable bed sore is covered in dead tissue so the depth cannot be measured.
There are many, many ways that skin breakdown can be prevented. One of the most common ways is to systemically, periodically turn or reposition the person every 2 hours. However, this requires sufficient staff at the nursing home. One of the things to make sure of when you put your loved one in a nursing home is whether or not they have sufficient staff to care for your loved one. At The Dickson Firm we strongly recommend that you visit your loved one at all different times of the day. Go first thing in the morning. Go at lunch time. Go during midmorning. Go during the afternoon. Go in the evening time. Go at dinner time. Go later in the evening. Make sure whenever you go you see a sufficient number of nurses and aides working in the nursing home to provide for the needs of your loved one.
If you are in your loved one's room, push the call button, see how long it takes for the staff to respond. Talk to your loved one. If your loved one is coherent and able to tell you what goes on when you're not there, ask them if they're getting adequate attention. Ask them if the staff responds to the call light when they need them to. Ask them if the staff comes in and checks on them on a regular basis.
If you have questions about the care your loved one is receiving, ask to speak with the administrator. Ask to speak with the director of nursing. Ask to speak with the nurse supervisor. But make sure that you advocate for your loved one and ask questions about the care that they are or are not receiving. Ask the facility if your loved one has any skin breakdown. If they do, ask to see it. If you find out that your loved one has skin breakdown, make sure you check on it on a regular basis. Make sure it's healing. The worse a bed sore gets, the harder it is for the bed sore to heal. A Stage 1 bed sore is easy to heal or resolve. The worse it gets, the harder it is to heal.
There are lots of things that can be done to prevent bed sores and there are lots of things that can be done to heal bed sores. Once your loved one has a bed sore it is imperative that the nursing home keep pressure off the bed sore. They must turn and reposition your loved one so they are never positioned with direct pressure on the bed sore. So in other words, if your loved one has a bed sore on their coccyx or on their sacral area, they should not be sitting up on that area and they should not be lying flat on their back. They should be turned right to left so that the pressure is not on the area of the bed sore. The wound must be kept clean and dry. They should be changing the dressing often. Further, you should ask the people at the nursing home if they have an expert in skin breakdown or an expert in wounds. If so, who is that person? Do they have a certified nurse practitioner who is a wound expert? Have they called your loved one's doctor? Is he or she aware of your loved one's condition and the fact that they have this wound? Is he or she involved in revising the plan of care and coming up with new interventions to address the bed sore? Has the nursing home involved specialty wound care consultants. There are companies that deal exclusively with wounds and can be brought in to give your loved one additional care.
If the nursing home is not doing everything it can to heal the bed sore, you must consider moving your loved one to a different nursing home. This can be difficult, if they have an active wound. However, bed sores can be fatal. Nursing home residents die every day from neglected bed sores. Bed sores can become infected. And the process of having to heal a large bed sore can be an incredible strain on a person. If that person does not have sufficient reserves to endure that strain, the process of healing the bed sore can be fatal for your loved one. Furthermore, bed sores can be incredibly painful. This may require your loved one to receive pain medication. This may also cause them negative side effects. Receiving significant pain medication over an extended period of time can have serious long-term effects on your loved one.
The best advice for keeping your loved one safe is to be vigilant, visit often, and any time you see anything you're unhappy with, make sure you speak up. Ask to talk to the administrator. Ask to talk to the director of nursing. And if your concerns are not addressed promptly, think about moving your loved one to a different nursing home.
If you have any questions or concerns about anyone you care about who is or has been a resident of a nursing home, feel free to call us at any time and speak with one of our attorneys at 1 (800) OHIO-LAW.