Stage 4 Bedsores

A stage 4 bedsore is a large wound in which the skin is significantly damaged. Muscle, bone, and tendons may be visible through a hole in the skin, putting the patient at risk of serious infection or even death. Since they are usually preventable, a stage 4 bedsore can be a sign of nursing home abuse. Thankfully, those affected may be able to take legal action.

What Is a Stage 4 Bedsore?

Bedsores, also called pressure sores or pressure injuries, are described in 4 stages. Staging is based on the depth of soft tissue damage. Pressure ulcer stages range from least severe (stage 1) to most severe (stage 4).

  • A stage 1 bedsore is not an open wound but it may be painful.
  • At stage 2, the skin breaks open or forms an ulcer that might look like a scrape or shallow crater.
  • During stage 3, the bedsore gets worse and may show fatty tissue but not muscle or bone.
  • A stage 4 bedsore is very deep and muscle or bone may become exposed, causing significant risk for serious infection.

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

Who Is at Risk for a Stage 4 Bedsore?

Anyone with an existing bedsore may be at risk of developing a stage 4 bedsore. In assisted living facilities, this may happen when residents are left to lie in bed, in a chair, or in a wheelchair without being properly tended to.

Those most at risk include people who have:

  • Anemia
  • Decreased mental awareness
  • Diseases that affect blood flow, such as diabetes
  • Fever
  • Fragile skin
  • Hypoxemia (low oxygen levels in the blood)
  • Immobility or limited mobility
  • Infection
  • Ischemia (restriction of blood flow to a part of the body)
  • Neurological disease
  • Neuropathy (nerve damage that causes pain, weakness, and/or numbness)
  • Obesity
  • Poor nutrition or dehydration
  • Spinal cord injury
  • Urinary or fecal incontinence
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Causes of a Stage 4 Bedsore

Stage 4 bedsores may occur when less severe bedsores are not treated in a timely or proper manner. Any stage of bedsore can form if an older adult cannot reposition themselves when lying in bed or sitting down. 

When blood supply to healthy skin is cut off for more than two to three hours, the skin tissue starts to die — and the bedsore starts as a red, painful area. Left untreated, the skin then turns purple and can break open. A bedsore’s stage increases as the wound deepens.

With proper care, it is usually possible to prevent a stage 4 bedsore. Thus, if a nursing home resident develops one, it is often a sign of nursing home abuse or neglect.

Symptoms of Stage 4 Bedsores

A stage 4 bedsore is usually a very deep, big, and painful open sore. Symptoms are most noticeable around the affected area since the skin has been damaged.

Patients with stage 4 bedsores may have:

  • Discolored or blackened skin
  • Exposed deeper tissues, tendons, ligaments, muscles, and bone
  • Signs of infection (blisters, red edges, pus, odor, heat, and/or drainage) near the skin

Seek medical help immediately if you notice any symptoms of a stage 4 bedsore.

Stage 4 Bedsore Prevention

The best way to prevent a stage 4 bedsore is by being proactive. If your loved one is at risk for bedsores, you can help them take the following precautions.

To prevent stage 4 bedsores, you can:

  • Avoid buttons on clothes and wrinkles in bedding
  • Avoid doughnut cushions, as they can add pressure to surrounding areas
  • Change bedding and clothing on a regular basis
  • Check skin (especially the shoulder blades and tailbone) daily
  • Consider specialty wheelchairs that can be tilted to relieve pressure
  • Elevate bed to no more than 30 degrees at the head
  • Have the resident perform wheelchair pushups if possible
  • Keep skin clean and dry
  • Purchase special mattresses or cushions to position the body properly
  • Shift weight about once an hour
  • Use moisturizing skin care to protect the skin

Stage 4 Bedsore Treatment

Doctors treat stage 4 bedsores by:

  • Creating moisture levels for the best healing
  • Properly dressing and removing infected or dead tissue from the wound
  • Protecting the wound from infection
  • Relieving the pressure caused by the bedsore

Proper nutrition and hydration should be a priority to help with healing. Surgery may be necessary to close the wound if it does not heal on its own.

If your loved one has developed a severe bedsore while staying in a care facility, there may be financial compensation available. This can help you pay for the costs of care. Contact the Nursing Home Abuse Justice team to learn more about accessing compensation.

You deserve justice. Get a free legal case review now.

Get a Free Case Review

Complications From a Stage 4 Bedsore

Bacterial Infection

A dangerous complication of a stage 4 bedsore is a serious bacterial infection. Some bacteria can become resistant to the same antibiotics used to fight them. With high bacteria counts in a stage 4 bedsore, tissue may be unable to heal.

Stage 4 bedsores can also cause cellulitis. This is a bacterial infection of the skin that causes it to become swollen, red, and painful. Left untreated, cellulitis can spread to the bloodstream or lymph nodes and become life-threatening.

Severe bedsores, especially those in stage 4, can cause systemic or metastatic infections.

These serious infections include:

  • Bacteremia
  • Endocarditis
  • Meningitis

These deep-seated infections are difficult to treat and can turn deadly. If the bedsore progresses far enough, infection of the bone (osteomyelitis) or sinus tracts (where the wound tunnels down into the body) can also occur.

Tissue Calcification

Tissue calcification is another possible complication of a stage 4 bedsore. This painful condition occurs when built-up calcium hardens. The hardened calcium causes a reaction that slows the healing of the bedsore.

Financial Complications

Staying in a hospital to treat a stage 4 bedsore can cost your family thousands of dollars.

“The costs incurred from stage 4 pressure ulcers are much greater than previously estimated. Halting the progression of early-stage pressure ulcers has the potential to eradicate enormous pain and suffering, save thousands of lives, and reduce health care expenditures by millions of dollars.”

– American Journal of Surgery

If you or a loved one developed a severe bedsore while staying in a nursing home, you may be able to take legal action. Compensation from a legal settlement can be used to help pay for treatment and more.

Prognosis for Bedsores Stage 4

The prognosis for a stage 4 bedsore is good with proper treatment. However, it can take anywhere from three months to two years for a stage 4 bedsore to properly heal.

If wound care for the stage 4 bedsore cannot be improved, the long-term prognosis is poor. This is true even if short-term wound healing occurs. Without treatment, stage 4 bedsores can even cause deadly complications like sepsis.

Compensation for Stage 4 Bedsores

It is critical to monitor the care your loved one receives in a nursing home. Understanding the signs and knowing the statistics of elder abuse are the best defenses.

If your loved one has developed a stage 4 bedsore in a nursing home, they may be the victim of ongoing abuse or neglect. You may be entitled to compensation through a nursing home lawsuit that can help pay for better care and life-saving medical treatments.

Contact us today to get a free legal case review. Our team can help determine if you can file a claim to access financial compensation.

You deserve justice. Get a free legal case review now.

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: April 1, 2021

View 14 References
  1. Anthony, K. (2018). Pressure Ulcer Sore Stages. Healthline. Retrieved November 30, 2020 from

  2. Brem, H., Maggi, J., Nierman, D., Rolnitzky, L., Bell, D., Rennert, R., Golinko, M., Yan, A., Lyder, C., & Vladeck, B. (2010). High cost of stage IV pressure ulcers. American journal of surgery, 200(4), 473–477. Retrieved November 30, 2020 from

  3. Grada, A. & Phillips, T. (2019). Pressure Ulcers. Merck Manual. Retrieved November 30, 2020 from

  4. Horino, T., Sato, F., Hosaka, Y., Hoshina, T., Tamura, K., Nakaharai, K., Kato, T., Nakazawa, Y., Yoshida, M., & Hori, S. (2015). Predictive factors for metastatic infection in patients with bacteremia caused by methicillin-sensitive Staphylococcus aureus. The American journal of the medical sciences, 349(1), 24–28. Retrieved December 2, 2020 from

  5. Johns Hopkins Medicine. (n.d.) Bedsores. Retrieved November 30, 2020 from

  6. Mayo Clinic. (2020). Bedsores (Pressure Ulcers). Retrieved November 30, 2020 from

  7. Mayo Clinic. (n.d.) Cellulitis. Retrieved December 2, 2020 from,face%2C%20arms%20and%20other%20areas

  8. My Health Alberta. (2019) Stages of Pressure Sores. Retrieved November 30, 2020 from

  9. National Center on Elder Abuse. (n.d.) Statistics and Data. Retrieved November 30, 2020 from

  10. 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 November 30, 2020 from

  11. Samuels, C. (2020). Elderly Bedsore Stages and Prevention. A Place for Mom. Retrieved November 30, 2020 from

  12. Model Systems Knowledge Translation Center. (n.d.). Recognizing and Treating Pressure Sores. Retrieved December 09, 2020, from

  13. Wound Source. (n.d.) Pressure Ulcers, Stages 3 and 4. Retrieved November 30, 2020 from,mobility%20and%20range%20of%20motion.

  14. Caron, T., & Anna Wolke, A. (n.d.). Frequently Asked Questions. Retrieved December 03, 2020, from