Causes of Bedsores in Nursing Homes

Bedsores, also called pressure sores, pressure ulcers, or decubitus ulcers, are caused by pressure on the skin that is not relieved in a timely manner. Bedsores usually develop on bony areas of skin if pressure cuts off blood supply for more than 2-3 hours. Bedsores are almost always preventable, meaning they may be a sign of nursing home neglect.

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What Causes Bedsores in Nursing Homes?

According to the Mayo Clinic, the physical causes of bedsores are pressure, friction, and shear (when skin pulls in opposite directions). If someone remains in the same position for an extended period of time, such as in a hospital bed or wheelchair, they may be at risk of bedsores.

Pressure sores can affect anyone. However, they are quite dangerous for nursing home residents because of the underlying health conditions that they may have. Dementia, diabetes, and paralysis tend to cause immobility, making it more likely that residents are unable to change position freely.

Bedsores are also more likely to develop in people who are dehydrated or malnourished, which may occur in nursing home residents, especially those with feeding issues.

“About 2% to 28% of nursing home residents have pressure ulcers.”

– National Institutes for Health (NIH)

Additional causes of pressure ulcers include skin that is exposed to moisture from urine or feces. This is often a red flag of nursing home neglect, as providing proper skin care is a major component of caregivers’ responsibilities.

Ultimately, elderly people are more likely to develop pressure sores, and it is the responsibility of the nursing home to ensure they do not.

Bedsores Causes and Nursing Home Neglect

Just because bedsores in nursing homes are common does not mean they should be.

According to an article published in the National Law Review, the U.S. federal government has declared that bedsores should not be happening in nursing homes, with the sole exception being those cases in which a resident’s condition makes bedsores unavoidable.

Since causes of bedsores are almost always avoidable, bedsores and nursing home neglect are closely tied together.

It is the duty of nursing home staff to ensure residents get proper care. Not only can bedsores be extremely painful to already frail residents, they can also lead to sepsis and even death. Therefore, preventing bedsores from developing, and especially from worsening once they begin, is vital.

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How Do Bedsores Form?

Bedsores form due to unrelieved pressure on the skin that limits blood flow. They usually form in one of three ways: pressure, friction, or shear.

Pressure

Proper blood circulation is critical in carrying oxygen and other nutrients to the body’s tissues. Constant pressure can reduce blood flow and cause damage to tissues, which in turn causes bedsores to form. With prolonged pressure, bedsores worsen, and skin tissues may eventually die.

Friction

Friction can occur when a nursing home resident’s skin rubs against their clothing or bedding. This friction can be one of the main causes of bedsores, especially if the skin is also moist.

Shear

Shear is a term used to describe two surfaces that move in opposite directions. Shear can often cause bedsores if a bed is elevated at the head. If a nursing home resident’s body begins to slide down an elevated bed, but the skin at the bony parts stays in place, shear can cause harm.

Risk Factors of Pressure Ulcers

The biggest risk factor of bedsores is lack of mobility, including having difficulty moving or changing positions in bed or while seated.

Additional risk factors of bedsores include:

  • Incontinence
  • Lack of sensory perception due to spinal cord injury or neurological disorders
  • Medical conditions that affect blood flow, such as diabetes and vascular disease
  • Poor hydration
  • Poor nutrition

According to the Centers for Disease Control and Prevention (CDC), the prevalence of bedsores varies by age, sex, and length of time in a nursing home.

The CDC reports the following statistics:

  • 13% of males had bedsores, while 10% of females did
  • 14% of residents 64 and younger developed pressure ulcers, while 10% of older residents did
  • 16% of nursing home residents with a stay of 1 year or less had bedsores, while 7% of residents with longer stays did

Additionally, nursing home residents with recent weight loss were more likely to have pressure ulcers. The likelihood of developing bedsores was also increased in nursing home residents who take more than eight different medications.

Common Signs of Bedsores

Bedsores tend to form on parts of the body that do not have a lot of fat and/or muscle. They are common near bones and joints, including the tailbone, shoulder blades, back of the head, and other areas of the body that are bony.

Some warning signs of bedsores include:

  • Patches of skin that feel cooler or warmer to the touch than surrounding areas
  • Pus-like drainage of the skin
  • Swelling
  • Tender areas
  • Unexplained changes in skin color or texture

The degree of tissue damage ranges from unbroken skin to deep injuries that extend to the muscle and bone.

Bedsore Stages

Bedsores are most commonly staged based on the depth of soft tissue damage. They are divided into 4 stages, from least severe to most severe.

The four stages of bedsores are:

  • Stage 1: Typically characterized by a persistent redness of the skin. Darker skin may appear to have a blue or purple tint. Skin may also feel warm or cool to the touch. A stage 1 bedsore may burn, hurt, or itch.
  • Stage 2: Usually appearing as a blister, abrasion, or shallow crater, the affected area appears more damaged. A stage 2 bedsore often causes significant pain.
  • Stage 3: The affected area looks like a deep crater with a loss of thickness of the skin. This is due to the damage that is occurring below the surface of the skin in underlying tissue.
  • Stage 4: The affected area is severely damaged. A large wound is present that likely exposes muscle, tendons, or bone. There is a very high risk of infection.
According to the CDC, 35% of nursing home residents with stage 2 or higher pressure ulcers received special wound care.

A bedsore may begin at stage 1 and rapidly advance to a stage 4 bedsore if it is not properly treated.

Stage 4 Bedsores

A stage 4 bedsore is a large open wound that extends into the muscle and bone. The skin is severely damaged, usually appearing purple or maroon and sometimes containing a blood-filled blister. There is also substantial dead tissue and drainage.

Progression at this stage may be rapid, which will cause additional layers of tissue to become exposed, even with treatment. Additionally, there is a possibility that sepsis will set in. Surgery is often required for a stage 4 bedsore.

Stage 4 bedsores should be examined immediately by a health care provider. Bedsores that advance to stage 4 can take up to two years to heal.

For these reasons, it is critical to detect and treat bedsores long before they advance to stage 4. Thankfully, those affected by a stage 4 bedsore may be able to take legal action to seek compensation to cover the costs of care.

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Preventing Bed Sores in Nursing Homes

Since the causes of bedsores are almost always avoidable, preventing them is a matter of proper care.

“It is estimated that 95% of all pressure ulcers are preventable. Prevention rather than mere treatment of established ulcers remains a top priority in the effort to reduce the incidence of this common, complex, and difficult problem.”

– National Institutes for Health (NIH)

In many cases, the first sign of a bedsore is areas of redness on the skin — this indicates that the skin may be breaking down. Thus, it is critical for nursing home staff members to pay close attention to residents’ skin, especially in bony areas.

Some other ways to prevent bedsores include:

  • Changing positions of residents in wheelchairs every 15 minutes
  • Encouraging residents to sit upright and straight in wheelchairs
  • Providing soft padding to reduce pressure
  • Taking proper care of healthy skin by keeping it clean and dry
  • Turning or repositioning nursing home residents every 2 hours

An often overlooked way to prevent bedsores from worsening is proper nutrition. Insufficient amounts of calories, vitamins and minerals, fluids, and protein hinder the healing process for pressure injuries.

Without these things, pressure ulcers will not get better, no matter how well the wound itself is cared for.

Nursing Home Abuse Bedsore Lawsuit

At a bare minimum, once bedsores develop, nursing homes must take immediate measures to ensure they don’t get worse. This is because as bedsores progress, recovery time and the risk for serious complications increases.

When nursing homes are entrusted with caring for your loved one, their safety and comfort must be top priority. This includes having preventative measures in place to avoid bedsores.

If you suspect nursing home abuse and neglect are the causes of bedsores, it is important to take action without delay. Filing a nursing home abuse bedsore lawsuit can be a very effective way to get the money and justice your loved one deserves for their suffering.

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Author:Nursing Home Abuse Justice Team
Nursing Home Abuse Justice Team

Nursing Home Abuse Justice was founded to shine a light on nursing home and elder abuse. Every day, thousands of people in nursing homes and assisted living facilities are abused. Our team helps educate seniors and their loved ones on the common causes, signs and preventions of nursing home abuse. We report on real-world studies and current events from respected news outlets to expose this national problem.

Last modified: June 21, 2021

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  2. Johns Hopkins Medicine. (n.d.). Bedsores. Retrieved May 29, 2021 from https://www.hopkinsmedicine.org/health/conditions-and-diseases/bedsores

  3. Mayo Clinic. (2020). Bedsores (Pressure Ulcers). Retrieved May 29, 2021 from https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893

  4. Model Systems Knowledge Translation Center. (n.d.). Recognizing and Treating Pressure Sores. Retrieved May 29, 2021 from https://msktc.org/sci/factsheets/skincare/Recognizing-and-Treating-Pressure-Sores

  5. National Center on Elder Abuse. (n.d.). Statistics and Data. Retrieved May 29, 2021 from https://ncea.acl.gov/What-We-Do/Research/Statistics-and-Data.aspx

  6. The National Law Review. (2019). Are Bedsores a Sign of Nursing Home Neglect? Retrieved May 29, 2021 from https://www.natlawreview.com/article/are-bedsores-sign-nursing-home-neglect

  7. Park-Lee, E. & Caffrey, C. (2009). Pressure Ulcers Among Nursing Home Residents: United States. NCHS data brief, no 14. Hyattsville, MD: National Center for Health Statistics. Retrieved May 29, 2021 from https://www.cdc.gov/nchs/products/databriefs/db14.htm#citation