Whether you are looking for a nursing home to care for a loved one, or currently have a family member living in a nursing home facility, you want them to be well cared for and safe. According to the U.S. Census Bureau, there are almost 54 million residents 65 years and older, and that population is increasing rapidly. About 1.3 million people live in nursing homes, many with mobility issues.
Bedsores are a common problem among the elderly. Many people living in nursing homes have mobility problems and are at high risk of bedsores. Research indicates that bedsores affect 3 million people in the United States.
The cause of a bedsore is, ultimately, negligence on the part of caretakers. Thus, victims and their families usually have strong legal cases against nursing homes, hospitals, and long-term care facilities that could have prevented pressure sores with proper care.
What Are Bedsores?
Bedsores Are damage the skin and underlying tissue. They are also known as pressure ulcers and decubitus ulcers. Bedsores result from lengthy pressure on the skin. They can develop over hours or days and can become a dangerous infection without proper medical care. They often develop when people spend a great deal of time confined to a wheelchair or bed and can’t change positions.
They are classified in stages:
- Stage 1 is the mildest stage. The pressure sores only affect the upper layer of skin.
- Stage 2 means that the sore has progressed deeper below the surface of the skin. The skin is broken, swollen, warm, and painful.
- Stage 3 sores have gone through the second layer of skin into the fat tissue. It looks infected and may have a bad odor.
- Stage 4 sores are the most serious. They are large, deep, and may affect your muscles and ligaments.
Common Sites of Pressure Ulcers
For people with limited mobility, bedsores commonly develop from pressure in areas that aren’t well-padded with muscle or fat and that lie over a bone, such as the hips, tailbone, ankles, and heels. For those who are in a wheelchair, bedsores often occur on the tailbone, spine, shoulder blades, and the backs of their arms and legs, where they touch the chair. For those who are bedridden, bedsores often occur on the head, shoulders, tailbone, hips, back of the knees, ankles, and heels.
Symptoms of Bedsores
Symptoms of bedsores include:
- Texture changes.
- Skin temperature changes
- Broken skin. The wound may contain pus.
- Signs of infection
Complications of Bedsores
Complications of bedsores, some of which may be life-threatening, include:
- Cellulitis. Cellulitis is a frequently painful bacterial skin infection. It may first appear as a red, swollen area that feels hot and tender to the touch.
- Bone and joint infections. An infection from a pressure sore can move into joints and bones. These infections may damage cartilage and tissue and affect the function of joints and limbs.
- Cancer. Long-term, non-healing wounds can lead to squamous cell carcinoma.
- Sepsis. Bedsores and pressure sores that are not diagnosed and treated promptly can lead to a sepsis infection. This is a serious infection in which bacteria overwhelm the bloodstream.
What Causes Bedsores?
Bedsores are caused by pressure against the skin that limits blood flow to the skin. They are generally preventable.
The three main contributing factors for bedsores are:
- Pressure. Constant pressure on the skin reduces the blood flow to tissues so that the tissues are not receiving oxygen and essential nutrients.
- Friction. When fragile skin rubs against bedding or clothing, the skin is more vulnerable to injury.
- Shear. When two surfaces move in opposite directions, such as the skin moves in one direction while the bone moves in another, the opposing movement puts stress on the blood vessels and keeps tissue from receiving proper nutrients.
Other risk factors include:
- Immobility. People often become less mobile due to age, poor health, or injuries.
- Incontinence. Overexposure to urine and feces causes the skin to become fragile and break down.
- Lack of sensory perception. Some health conditions, such as spinal cord injuries or brain injuries, may lead to a loss of sensation. Someone who cannot feel pain may not realize that they need to change position or that a pressure sore is beginning to develop.
- Poor nutrition and hydration. Proper nutrition and hydration are essential for maintaining healthy skin.
- Medical conditions affecting blood flow. Certain conditions, such as diabetes and vascular disease, affect blood flow and can increase the risk of bedsores.
Treatment depends on the bedsore’s severity. However, treatments may involve the application of topical preparations and dressings, frequent position changes, padding or supports for affected parts of the body, removal of damaged skin, antibiotics, and other therapeutic regimens. In severe cases, doctors may perform surgery.
Can You Hold a Nursing Home Accountable for Bedsores?
According to the National Council on Aging, approximately one in 10 people over the age of 60 report incidents of abuse, neglect, or exploitation every year. Bedsores may be fairly common among the elderly or disabled. However, bedsores are not an inevitable fact of life in a nursing home or hospital. Those who care for any persons susceptible to bedsores must be vigilant. They have a responsibility to prevent, identify and treat these injuries. Failure to do so may result in a lawsuit.
As we age and develop health conditions, skin often becomes thinner and more fragile. Therefore, nursing home residents and or hospital patients, especially those who spend a great deal of time in bed or a wheelchair, need special care. Certified nursing assistants (CNAs) or other staff must turn, reposition, and carefully monitor each resident so that they do not develop skin conditions. If a patient is not properly cared for, he or she may develop bedsores that can cause serious injuries or infections. In rare cases, death may occur.
Medicare and Medicaid have regulations requiring a certain standard of care for long-term care facilities. Failure to meet the level of care under 42 CFR 483, Subpart B is a violation of the regulations intended to protect residents. Section 483.25(c)(1) provides that a facility and its nurses ensure that a resident who does not have pressure sores when they enter the facility does not develop them unless they were unavoidable. It also provides that a resident who develops pressure sores must receive the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.
Who Can You Hold Liable for Bedsores?
Hospitals admit hundreds of thousands of people each year due to bedsores. Nursing home residents or hospital patients may develop bedsores if the staff does not regularly turn them in their beds or wheelchairs. Turning a patient typically does not require special nursing skills, but it does require some training, and doing it may involve two or more aides.
Bedsores are often a sign of nursing home negligence, such as failing to move or turn the resident regularly, failing to notice or diagnose bedsores, failing to take steps to prevent worsening bedsores, and not obtaining proper medical treatment. If the nursing home was negligent and that negligence caused a resident to develop bedsores, the nursing home may be liable.
Some of the factors that contribute to recovering compensation in these cases will depend on establishing the four elements of negligence which are:
- There was a duty of care between the resident and the nursing home
- The nursing home and staff members breached their duty of care to the resident
- The breach of duty directly caused the bedsores to occur
- Therefore, the resident suffered damages.
Liable parties may include:
- Owners: Nursing homeowners include individuals, businesses, and local governments.
- Management companies: Nursing homes often pay money to management companies to handle day-to-day operations.
- Corporate offices: Corporate offices often dictate the budget, policies, and procedures that lead to injury.
- Staff: This includes physicians, nurses, CNAs, and other staff.
- Administrators and executive directors.
Nursing Home Malpractice at the State Level
Most state statutes set forth the rights of nursing home residents. These include the right to be free from nursing home abuse and neglect. Under most state laws, you can make a claim for violating a nursing home resident’s rights and for personal injuries and/or death stemming from such a violation of rights. You can also file a medical malpractice claim if the nursing home did not adhere to the acceptable standards of care for patients.
While procedure varies depending on the state of residence, in general claimants must take these (or similar) steps:
- Notify the facility by certified mail of an alleged violation;
- Identify the specific rights that were violated;
- Identify the alleged negligence that caused the injuries and/or wrongful death;
- Describe the injuries sustained; and
- The plaintiff or their attorney must file a certification of good faith before filing a claim so that an insurance company can investigate the incident.
At a minimum, the nursing home staff needs to change the resident’s position at frequent and regular intervals. In addition, appropriate care to prevent bedsores can include:
- Monitoring of skin condition
- Repositioning of the resident
- Keeping skin dry
- Keeping pressure off bony areas of the body
- Providing appropriate mattresses
- Infection control measures
Staffing issues are an ongoing and growing problem in nursing homes, as well as across the United States. If a nursing home does not have enough qualified, experienced, and properly trained staff, the residents may be at risk. Despite regulations designed to protect residents, if the facility does not have enough staff or they do not know what they are doing, they may violate regulations.
Residents frequently need help and attention. When there is not enough staff, workers may cut corners, such as cleanliness and monitoring the health and well-being of the resident.
Neglected tasks may include:
- Regularly checking on patients and recording symptoms.
- Turning residents to prevent bedsores, which are a telltale sign of nursing home neglect. Overworked staff may ignore or put off taking care of this important task.
- Checking up on patients and noting changes in health
- Keeping residents clean to prevent infection
- Preventing dangerous falls by helping residents move around and perform everyday tasks
Staff members may become frustrated because they cannot provide the necessary care—they lack the qualifications, or their employer doesn’t give them sufficient time. In their frustration, they may become abusive or get burned out and quit. Then the nursing home is even more short-handed. Employers may hire unqualified or poorly trained new hires, so the problem continues.
Other types of neglect may be related to bedsores. These include lack of supervision, incorrect medication or dosage, deficient wound care, or not reporting bedsores promptly to minimize the harm. If the patient was ultimately admitted to a hospital for bedsores or otherwise, there might be a claim for hospital negligence if the patient did not receive the appropriate standard of care and suffered harm.
A nursing home abuse and neglect attorney can help you understand the procedure for pursuing a claim against a negligent nursing home in your state.
Bedsores and Medical Malpractice
A medical malpractice claim may arise from the development of pressure sores. Nursing home negligence is one of the leading causes of wrongful death and medical malpractice cases in the United States.
Based on federal and state regulations, as well as medical malpractice law, doctors must provide an acceptable standard of care, one that a reasonably prudent medical provider would provide under similar circumstances. A malpractice claim may arise when a doctor does not identify and treat bedsores, or fails to admit a residence when needed.
Collecting Compensation From Bedsores
Similar to other medical malpractice cases, damages in a bedsore case consist of economic and non-economic damages such as:
- Medical bills for all past and future care
- Pain and suffering
- Out-of-pocket expenses
- Specialized medical equipment
- Disability and emotional damage
If the nursing home, hospital, or medical providers do not diagnose or treat a resident’s bedsores and the person dies, their family may wish to file a wrongful death lawsuit to obtain compensation for the loss of support and companionship of the deceased.
Residents or their family members may be eligible to file a lawsuit due to bedsores. All claims and lawsuits have strict filing deadlines, called the statute of limitations. To learn more, an attorney can help you understand pursuing a claim against a negligent nursing home or hospital.