Can Skin Breakdown be Prevented?

Can skin breakdown be prevented? At The Dickson Firm, we see hundreds of cases where residents have been allowed to develop skin breakdown or decubitus ulcers, or bed sores. Skin breakdown is a very, very serious concern. A person's skin is a protective layer that keeps out dirt and contaminants and prevents infection. When a resident has skin breakdown, and they have an open wound or an open sore, they're very susceptible to infection. Very often, we see skin breakdown in the coccyx area or the buttocks area. This makes the resident very vulnerable to an infection. It's very easy to get feces in a wound near a person's coccyx or sacral area.

So, can skin breakdown be prevented? The answer is often yes, but sometimes no.

There are two ways that skin breakdown occurs. Skin breakdown occurs because of unrelieved pressure. The resident is left sitting or laying in a certain position where the weight of their body presses down, and there's pressure between the surface they're on and the bone inside their body. This often occurs in the buttock area. It can also occur with the hips. At The Dickson Firm, we've seen residents who have suffered bed sores on their ears, on their elbows, on their shoulders. This pressure, if it is unrelieved, prevents blood from getting to the tissue. Eventually, the tissue dies. This is how the skin breakdown begins. Bed sores are evaluated in stages. There are five stages. Stages 1 through 4 and then unstageable. Bed sores progress.

So bed sores begin with a reddened area or a Stage 1 bed sore. Stage 1 bed sores are easily healed. The nurses and/or the aides must simply make sure that they keep pressure off of the wound, and Stage 1 bed sores often heal. They also must make sure that the resident is getting adequate nutrition and adequate hydration, particularly adequate protein.

A Stage 1 bed sore that's not treated properly will advance to a Stage 2 at which point it is open. It will advance to a Stage 3 at which point it is deeper. It will advance to a Stage 4 which is a very deep wound that often involves muscle and bone. It can even advance to an unstageable bed sore where there's so much dead tissue covering the bed sore that the depth cannot be measured. The worse a bed sore gets, the harder it is to heal. As a result, nurses and aides must take skin breakdown very seriously.

Someone visualizes the entire body of every resident in a nursing home every single day. The residents are gotten up in the morning and they are toileted and they are cleaned up after toileting. They are dressed. They are bathed. They are either given a shower or at least a bed bath. During all this care, multiple employees see the resident's entire body, and they have a duty to inspect their skin for any type of skin breakdown. The minute they see a Stage 1 bed sore, they are obligated to notify the staff, and consider interventions to heal that bed sore. If that bed sore gets worse, they are obligated to implement additional interventions. They are obligated to contact the resident's family and their doctor. They're obligated to have a care conference and figure out additional interventions.

Untreated bed sores are very often fatal. As a result, nursing homes must treat the prevention of skin breakdown and the healing of skin breakdown as a matter of life and death. Pursuant to the federal law, the nursing home must ensure that a resident who comes into a nursing home with no skin breakdown does not develop skin breakdown unless that skin breakdown is clinically unavoidable. Likewise, if a resident comes in with skin breakdown, the nursing home must ensure that that skin breakdown is healed unless it is clinically unavoidable to heal that skin breakdown.

This brings us to the second part of the question. Is skin breakdown always avoidable? Sometimes no.

As indicated above, skin breakdown is often caused by unrelieved pressure. It can also be caused by issues with a resident's circulatory system. If a resident has advanced diabetes or peripheral vascular disease, or other comorbidities involving their circulation, their lung and heart function, then their tissue may not receive proper oxygenation and proper blood flow because of the malfunction of their internal circulatory system. Oftentimes, nursing homes claim that avoidable skin breakdown was, in fact, unavoidable. Often they claim that the person's comorbidities made the skin breakdown unavoidable. They even hire experts to falsely testify that skin breakdown was unavoidable. At The Dickson Firm, we handle hundreds of cases involving nursing home residents who have suffered avoidable skin breakdown and suffer grave consequences as a result, including the death of the resident.

If someone you love is a resident of a nursing home, and they have the early stages of skin breakdown, make sure that the nursing home is providing them with proper care. Make sure that resident's doctor has been contacted. Make sure that skin breakdown begins to heal. Obviously, people are often reluctant to examine the sacral area of their loved one, particularly if it's a parent with a child or a sibling or even a spouse. However, if your loved one complains of pain in their butt or seems uncomfortable, you must find out if they have suffered skin breakdown. The earlier you catch the skin breakdown, the more likely it will be that the nursing home is able to heal it. If that skin breakdown does not get better, you must consider moving your loved one to a better nursing home.

If someone you love has been neglected or abused in a nursing home, please call us at 1-800-OHIO LAW, as we would be happy to talk with you at any time and help you in any way that we can.