Bedsores or Pressure Sores or Decubitus Ulcers
If an individual is not turned and repositioned on a regular basis, unrelieved pressure can cause a pressure sore or a bedsore or a decubitus ulcer to develop. Individuals who cannot turn and reposition themselves must be turned and repositioned. Many residents in a nursing home cannot turn and reposition themselves. This may be because they have recently suffered an injury, like a fractured hip, that required surgical repair. And now they are dependent on others to turn and reposition them. The staff at the nursing home is required to turn and reposition these residents usually at least once every 2 hours. Sometimes they must be turned and repositioned more often. If they are not turned and repositioned, and the pressure is not relieved from a certain area of their body, that pressure will lead to a bedsore. Bedsores or pressure sores or decubitus ulcers, evolve in stages. There are four stages of a bedsore, Stage 1 through Stage 4.
- Stage 1 is simply a reddened area.
- Stage 2 involves actual breakdown of the skin.
- Stage 3 involves more skin breakdown and a deeper wound.
- And Stage 4 is the most serious decubitus ulcer. Many Stage 4 ulcers never heal. Many Stage 4 bed sores go all of the way to the bone.
Common places for these ulcers to occur are where a person's body makes contact with a chair or a bed. We often see bedsores on people's buttocks and heels, sometimes on their backs, and we have even seen bedsores on a person's shoulder blades, elbows, and ears.
If a bedsore is in a person's sacral area, proper hygiene is essential. The nursing home staff is required to keep a person clean and dry. Feces can be toxic on a person's skin. If a nursing home resident is not able to toilet themselves, then the staff must take them to the bathroom on a regular basis. They must put them on a toileting schedule. If a nursing home resident is incontinent, then that resident must be checked frequently and kept clean and dry. If the skin is not kept clean or dry, this can contribute to skin breakdown.
The nursing home must also address the resident's nutritional needs. Poor nutrition puts a nursing home resident at increased risk of skin breakdown. Dehydration puts a nursing home resident at increased risk of skin breakdown. Poor nutrition and dehydration also make it harder to heal an existing ulcer.
Is a Bedsore Evidence of Abuse or Neglect?
According to the federal law, a nursing home resident who enters a nursing home without a bedsore must not develop a bedsore unless, based on the comprehensive assessment of that resident performed by the nursing home, that person's clinical condition makes that bedsore unavoidable. In other words, there are certain individuals whose medical conditions are such that bedsores are unavoidable. Despite the best care, that person is still going to develop a bedsore. However, in a great many cases involving bedsores, the bedsores were completely avoidable.
Oftentimes, bedsores are the result of a systemic breakdown at the nursing home. Nursing home residents are supposed to be attended on a regular basis by state-tested nursing assistants, nurses, physical therapy staff, dietitians, social workers, and a variety of other individuals whose job it is to address the nursing home resident's physical and psychosocial needs. Nursing home residents are supposed to be bathed on a regular basis and kept clean and dry at all times.
Because bedsores develop in a predictable pattern, a person does not simply develop a Stage-4 bedsore all of a sudden. Initially that bedsore is a reddened area. Nursing homes have an obligation to immediately notify a resident's physician any time a bedsore develops or gets worse. Most residents should not develop a bedsore to begin with. If they do, and they receive proper care, that bedsore can often be healed. But a resident who is not turned and repositioned on a regular basis will be at increased risk for a bedsore. A resident whose nutritional needs and hydration needs are not being addressed is at increased risk for a bedsore. Once that resident develops a bedsore, if the nursing home does not contact their physician and/or seek additional treatment for them, that bedsore can become dramatically worse.
Our skin is a system that is designed to protect our bodies from infection. Once that skin breaks down, a person is exposed. If a person suffers a bedsore or other skin breakdown in their sacral area, then they can be exposed to feces and urine. Feces can cause infections.
The worse a bedsore gets, the less likely it is to ever heal. Many Stage 4 pressure ulcers never heal. Sometimes a person who has a severe bedsore has to undergo a procedure known as a debridement where the dead skin is cut away. This can be extremely painful and initially makes the bedsore worse as it makes it larger. However, debridement is often essential to the healing of the bedsore. Some people have to undergo a surgery known as a flap procedure whereby additional skin is used to cover the bedsore. Some bedsores are bandaged and the dressing must be changed on a regular basis. Other wounds are left open and healing is promoted by exposing them to the air. Oftentimes nursing homes use a protective cream or barrier to keep the skin healthy, particularly the skin near the sacral area.
It is very important that anybody who has a bedsore, receives constant care and treatment to keep that area of their body clean, and to constantly relieve the pressure of that area of their body.
Signs and symptoms that your loved one has an infected bedsore or pressure sore:
- Oftentimes when bedsores become infected they give off a foul smell.
- Oftentimes when someone has an infected bedsore, there is a certain amount of drainage from the sore.
Many bedsores can heal and/or get better. If your loved one has skin breakdown at any stage, their doctor should be notified. They should consult with a wound nurse. All options should be considered to prevent that bedsore from getting worse. The worse the bedsore gets, the less likely it is to ever heal. Further, the more severe the skin breakdown, the more your loved one is exposed to infection. Infections like sepsis can cause a person significant problems including causing their death.
If you have questions or concerns about a loved one who is in a nursing home who develops a bedsore, you can speak with one of the experienced Ohio nursing home attorneys at The Dickson Firm, toll free, at 1 (800) OHIO-LAW (1-800-644-6529), 24 hours a day, 7 days a week.