What Are Bedsores?

What Are Bedsores?

Bedsores, also known as “pressure ulcers” or “decubitus ulcers,” are painful sores on the skin and the tissue beneath the skin that develop when affected parts of the body endure prolonged pressure, especially at the bony parts of the body, such as:

• Heels
• Back
• Tailbone
• Hips
• Ankles

This usually occurs in elderly people in nursing homes or assisted living facilities who are bed-ridden and are not able to reposition themselves.

Although bedsores can develop quickly for someone who cannot reposition themselves, this is a sign that a health care provider is not providing the care and attention they should be providing and, in fact, may be a sign of nursing home negligence. No one should develop bedsores.

If you or a loved one are in a nursing home, long-term care facility, or assisted living facility and suspect that you have developed or are developing bedsores, call the attorneys at Foster Wallace immediately. We will evaluate your case and determine the best way for you to proceed. Most importantly, we will see that the situation is corrected and that the negligent care-provider is held accountable for any injury their negligence or abuse may have caused.

What You Should Know about Bedsores?

If you are concerned that a loved one may be susceptible to bedsores or is not receiving proper care, it is important to learn as much as you can about bedsores so that you know:

• What causes bedsores
• Where to inspect your loved one’s body for signs of bedsores
• What symptoms to look for
• What risk factors may be present
• The consequences of developing bedsores
• How to treat and prevent bedsores
• What to do if you discover bed sores on your loved one

What Causes Bedsores?

Bedsores develop when someone is immobile for an extended period of time, usually sitting in a wheelchair or lying in bed. When there is prolonged pressure on the skin where boney parts of the body press heavily on the bed or chair, it cuts off blood flow to the skin, depriving it of oxygen and nutrition—much like squeezing a plastic straw in the middle will cut off the flow of liquid running through it.

When the skin that is pressed between the bones and the bed is deprived of blood flow for an extended period of time, it causes damage to the skin as well as the tissue under the skin. That damage develops into painful bedsores.

Bedsores can be worsened by continued friction and shearing, which occur when two surfaces move in the opposite direction, such as when the head of the bed is raised and the patient slides down slightly. Friction occurs when the skin surface and bed surface move in opposite directions, causing a visible injury on the surface of the skin. “Shearing” occurs when the underlying tissue and the bone move in opposite directions and the tissue tears away from the bone. “Shear” is not a visible injury because it occurs under the surface of the skin.

What Parts of the Body Should You Inspect for Bedsores?

Bedsores typically develop on the boney parts of the body that sustain contact with the bed or wheelchair. Thus, someone restricted to a bed may develop bedsores on the:

• Back and sides of the head, depending on how they sleep
• Back of the shoulders
• Elbows
• Hips and tailbone
• Back of the knees
• Ankles
• Heels

However, when someone is restricted to a wheelchair, they will more likely develop bedsores on the:

• Back of the shoulders
• Middle of the back and spine
• Tailbone or buttocks
• Back of the thighs
• Back of the arms
• Elbows

Therefore, when you visit your loved one, it is important to inspect these areas to assess whether bedsores are formed or may be starting to form.

What Signs Should You Look For?

If you inspect your loved one’s body where bedsores are likely to form and you see any of the following symptoms, there is a high likelihood that bedsores will create:

• Swelling
• Noticeably different colors in the skin
• Areas of skin with course or unusual texture
• Infected areas
• Pressure areas that are tender or sore to the touch
• Patches of skin or pressure areas that feel either warmer or much cooler than the area surrounding them

The extent of bedsores can vary. If not prevented, bedsores can develop into even more serious or life-threatening conditions such as:

• Skin and soft tissue infection (cellulitis)
• Infection of the bone (osteomyelitis) or joint (septic arthritis)
• Cancer
• Sepsis

It is important to check for signs of bedsores often and to be sure any skin sores are treated immediately.

What Are Some Risk Factors that Contribute to Bedsores?

Your loved one may have an increased risk of developing bedsores if they cannot change positions and, as a result, can easily affect the blood flow to their skin. Therefore, any conditions that may limit their ability to move or sense irritation at relevant pressure points on their body may increase their risk of developing bedsores. Such conditions may include:

Paralysis from neck or spinal cord injury.

Being physically unable to move creates a very high risk of bedsores and leaves your loved one completely dependent upon caretakers to reposition them.

Neurological disorder.

A neurological disorder that may decrease your loved one’s ability to feel pain or sense discomfort at affected areas will increase their risk of developing bedsores.

Poor diet.

If your loved one is not receiving proper nutrition or hydration, this could affect the condition of their skin and underlying tissue, making them more susceptible to bedsores.

Vascular disease.

Having poor vascular circulation or diabetes can affect the condition of the skin and underlying tissue.

Poor hygiene.

If a loved one is incontinent and is not cleaned and changed, extended contact with urine or feces can exacerbate the development of bedsores.

Can a Health Care Provider Be Responsible for a Patient’s Bedsores?

Yes. A patient should not develop bedsores. There are many federal laws that apply to hospitals and nursing homes that require certification and address issues of policy, procedure, and standards of care. There is a specific federal regulation—42 C.F.R. § 483.25 (2016)—that deals specifically with bed sores and the quality of care for patients in long-term care facilities. The regulation provides:

(b) Skin integrity— (1) Pressure ulcers. Based on the comprehensive assessment of a resident, the facility must ensure that— (i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable; and (ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.

If you see signs of bedsores developing on your loved one, this is an indicator of neglect. Caretakers in a hospital or nursing home should be doing the following to make sure bedsores are treated or do not develop in the first place:

• Repositioning your loved one at least once every hour
• Using beds and wheelchairs that incline or tilt (no more than 30 degrees), to relieve stress on pressure points and prevent shearing of the skin
• Providing mattresses, cushions, and pillows to relieve pressure
• Keeping your loved one clean and their skin dry
• Changing bed sheets and clothes regularly
• Providing an appropriate diet for hydration and nutrition
• Inspecting your loved one’s back and body for signs of shearing skin or developing bedsores
• Keeping you informed of your loved one’s condition and activities

If your health care team is not doing these things on a regular basis and bed sores develop, they may be liable for abuse, neglect, or wrongful death.

• If your loved one enters a facility with no bedsores and then develops them, this may be neglect.
• If your loved one enters a facility with bed sores and they do not improve because they were not treated properly, this may be neglect.
• If your loved one has bed sores that develop into a more serious condition, this is neglect.
• If your loved one develops a more serious condition and dies from that condition, the facility could be liable for wrongful death.