Stage 4 Bedsore

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. A stage 4 bedsore can be a sign of nursing home abuse since it is usually preventable with proper care. Thankfully, those affected may be able to take legal action. Get started with a free case review.

What Is a Stage 4 Bedsore?

A stage 4 bedsore is the most severe type of bedsore. Bedsores, also called pressure sores, decubitus ulcers, or pressure injuries, are described in four stages. Staging is based on how deep the sore is.

Stage 4 bedsores are the deepest. Muscle or bone may become exposed in this stage, putting the patient at risk of serious infection.

Pressure ulcers that are advancing to a stage 4 bedsore.
Illustration showing the different stages of bedsores.

If your loved one developed a stage 4 bedsore while living in a long-term care facility, they may be a victim of nursing home abuse or neglect. Nursing home staff members know how to properly prevent bedsores or treat them before they become serious.

Fortunately, you can take legal action against the nursing home to get justice and compensation if your loved one has a stage 4 pressure ulcer.

Get started with a free case review from our team right now.

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Causes of a Stage 4 Bedsore

Stage 4 bedsores may occur when less severe bedsores are not treated for an extended period of time.

A bedsore can form if an older adult cannot reposition themselves. Residents of assisted living facilities can develop bedsores if they have mobility problems and are left in bed, in a chair, or in a wheelchair for long spans of time.

Sitting for long periods of time can cut blood supply off to healthy skin. This is ultimately what causes the bedsore to form.

A 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, it is often a sign of elder abuse or neglect if a nursing home resident develops one.

Who Is at Risk for a Stage 4 Bedsore?

Anyone with an early-stage bedsore may be at risk of developing a stage 4 bedsore.

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

Signs and Symptoms of Stage 4 Bedsores

A stage 4 pressure ulcer is usually a very deep, big, and painful open sore. By this stage, the bedsore has broken through the top layers of skin, burrowed past fatty tissue, and reached muscles and bone.

Stage 4 bedsores that have become infected.
Illustration of a stage 4 bedsore.

Patients with stage 4 bedsores may have:

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

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

Stage 4 Bedsore Diagnosis

Doctors can diagnose a bedsore by looking at it and seeing how deep it is. Doctors may diagnose you with a stage 4 bedsore if they can see muscles or bone and nearby skin is dead or very discolored.

Doctors can provide a prognosis (health outlook) and recommend treatments for a stage 4 bedsore after providing a diagnosis.

Prognosis for Bedsores Stage 4

The prognosis for a stage 4 bedsore depends on your overall health and how the bedsore responds to treatments.

Loved ones holding hands in a nursing home.

It can take anywhere from three months to two years for a stage 4 bedsore to properly heal. In some cases, if the damage is too great, a stage 4 bedsore might never heal completely.

Stage 4 bedsores need to be properly cared for or a patient’s life expectancy can be limited. Without proper treatment, stage 4 bedsores can cause deadly complications like sepsis. This is true even if short-term healing occurs.

Stage 4 Bedsore Prevention

The best way to prevent a stage 4 bedsore is by being proactive.

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 bony areas like 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
  • Make sure you’re repositioning at least once an hour
  • Purchase special mattresses or cushions to position the body properly
  • Use moisturizing skin care to protect the skin

Remember: Nursing home staff members are trained to prevent stage 4 bedsores. They may be to blame if your loved one developed a stage 4 bedsore while living in a long-term care facility.

You can hold nursing home staff accountable for bedsores. Chat with us now to learn more.

Stage 4 Bedsore Treatment

Stage 4 pressure ulcer treatments include:

  • Maintaining good moisture levels for healing
  • Properly dressing and removing infected or dead tissue from the sore
  • Protecting the bedsore from infection
  • Relieving the pressure caused by the bedsore
  • Using antibiotics to treat infected bedsores

Proper nutrition and hydration should be a priority when treating pressure sores. Surgery may also be needed to close the bedsore if it does not heal on its own.

Thankfully, there may be compensation available to cover the costs of medical treatment if your loved one has developed a severe bedsore while staying in a care facility.

Contact the Nursing Home Abuse Justice team to learn more about accessing compensation.

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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. Stage 4 bedsores might not heal properly due to high bacteria counts.

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

Additionally, severe stage 4 bedsores can cause systemic or metastatic infections.

These serious infections include:

  • Bacteremia
  • Endocarditis
  • Meningitis

These 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 open 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. Bedsores take longer to heal if tissue calcification occurs.

Financial Complications

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

According to the American Journal of Surgery 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.

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

Compensation for Stage 4 Bedsores

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

Some older adults who developed stage 4 bedsores received big payouts by filing nursing home lawsuits against negligent caregivers.

Examples of payouts for bedsores include:

  • $1.2 million to a resident who suffered from severe bedsores and kidney damage after staying at a nursing home
  • $407,000 to a woman who suffered from bedsores and other forms of severe nursing home neglect
  • $346,000 to the wife of a man who was left dying after developing severe bedsores

Contact us today to get a free legal case review. The help you need is just around the corner.

Stage 4 Bedsores: Common Questions

What do stage 4 pressure ulcers look like?

Stage 4 bedsores look like deep holes or craters in your skin. The skin around the opening of the bedsore may be reddish and inflamed. Blackened, dead skin may also be present near the affected area.

You may see muscles or tendons inside the bedsore. These can be red or white in color. Part of the bone may be exposed at the very bottom of the bedsore.

Can stage 4 bedsores be cured?

Doctors might be able to cure your stage 4 bedsore. Treatment methods include properly dressing the wound, keeping it clean, and performing surgery to remove dead tissue (debridement) and cover up the sore.

Doctors may need to amputate part of a limb that the bedsore has affected in severe cases.

How long does it take for a stage 4 bedsore to heal?

Stage 4 bedsores can take anywhere from three months to two years to fully heal. Healing depends on how the bedsore responds to treatment, as well as the patient’s overall health.

Some stage 4 bedsores may never completely heal. However, following the medical advice of your health care providers gives you the best chance of making a full recovery.

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

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: November 16, 2023

  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. 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

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

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

  6. Johns Hopkins Medicine. (2021, August 08). Bedsores. Retrieved May 4, 2022, from

  7. Mayo Clinic. (2022, April 19). Bedsores (pressure ulcers). Retrieved May 4, 2022, from

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

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

  10. Model Systems Knowledge Translation Center. (n.d.). Surgical and reconstructive treatment of pressure injuries. Retrieved May 4, 2022, from

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

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

  13. 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

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

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