Bedsores and Pressure Ulcers

If a Loved One Suffers from Bedsores While Living in a California Nursing Home, You May Need to Speak with a Bedsores Lawyer 

Pressure ulcers, more commonly known as bedsores, affect more than 2.5 million people in the United States every year. Pressure ulcers are injuries to the skin and underlying tissue that result from prolonged pressure. Seniors may be at risk for developing bedsores because the skin becomes more fragile with age making it more susceptible to damage. Risk is heightened if the senior is limited in mobility. It is important to know how to prevent, recognize, and treat pressure ulcers as they can lead to extreme discomfort and complications. If a senior is a resident or patient at a facility that does not take adequate preventative measures, the senior may be at risk for bedsores or pressure ulcers. A facility that neglects its senior patients and residents to the point where they contract bedsores may be committing physical elder abuse. If you believe a loved one is suffering from abuse in a nursing home or healthcare facility, you need to contact an experienced California bedsores lawyer. 

Bedsores and Pressure Ulcers – Prevention

The key to preventing pressure ulcers is frequent position changes. Position changes must avoid stress on the skin, and position the body in a way that minimizes stress to vulnerable areas where the skin is thin over the bone (e.g. tailbone, shoulder blades, and knees).

For persons confined to a wheelchair or bed, adding cushions and/or devices that elevate parts of the body may help reduce stress on the skin. Additionally, it is important to keep the skin clean and free from excess moisture. Urinary or bowel incontinence should be managed to prevent moisture and bacterial exposure to the skin. Nutrition and daily activities may help prevent pressure sores and should be discussed with a healthcare professional.

Bed Sores/Stage-3 or Higher Pressure Ulcers

Pressure ulcers or bedsores can develop in patients with limited mobility who are confined to a bed or a wheelchair. When a patient who cannot move freely sits or lays in the same spot for long periods of time, the constant pressure from laying in the same position can damage the skin and the tissue underneath the skin.

There are different stages of pressure sores depending upon the extent of damage to the skin and tissue. With stage 1, sores develop but no open wounds are visible. By stage 2, the skin breaks open, or an ulcer forms. Both stage 1 and stage 2 can be painful for seniors.

In stage 3, the pressure sore has progressed and is no longer just a superficial sore with an open ulcer or wound. The tissue underneath the skin is damaged and a small crater is formed. Fat may be visible within the sore. If the problem continues to progress to stage 4, the opening will further deepen and muscle and bone will be affected. Deep tissue, joints, and tendons can also sustain damage.

While a senior may experience less pain in stages 3 and 4 because the tissue is dead, the risk of permanent damage and life-threatening infection is significantly greater once the pressure sores have reached this stage.

Holding Caregivers Accountable for Stage 3 or Greater Pressure Sores

With proper caregiving, pressure sores should ideally never develop and should never progress to stage 3 or greater. Seniors should be rotated or helped to move frequently by nursing home staff or other caregivers to avoid staying in the same place for too long.  Special pressure-reducing furniture and equipment are often used as well to try to fight the development of pressure sores.

Once these sores begin to form, nursing home staff or caregivers should seek prompt medical attention for a senior to stop the progression of the bedsores. A failure to either prevent bedsores or secure medical aid can be clear sign of negligence that could result in civil liability. California nursing home lawyers at the Evans Law Firm, Inc. should be consulted for help in pursuing a civil action for damages resulting from a caregiver and nursing home’s lapse of reasonable care that caused the advanced pressure sores to develop.

Bedsores and Pressure Ulcers – Recognition

Pressure ulcers are categorized into four stages.

Stage 1 and Stage 2 pressure ulcers may be difficult to detect.

• Stage 1 ulcers are often signified by redness but the skin remains intact. If skin appears red, there may be a pressure ulcer if the skin does not briefly lighten when touched or if the site of the sore feels more differently (e.g. more painful or firm) than other parts of the skin.
• Stage 2 ulcers are characterized by the appearance of damage to the skin. Sores may appear as a reddish basin-like wound. Pressure ulcers at this stage may be mistaken for a ruptured fluid-filled blister.

Stage 3 and Stage 4 pressure ulcers are easier to detect because of the severity of damage to the skin.

• Stage 3 sores are deep crater-like wounds that may expose fat cells.
• Stage 4 ulcers exhibit a total loss of tissue possibly exposing muscle, bone, and tendons.

Bedsores and Pressure Ulcers – Treatment

Stage 1 and Stage 2 pressure ulcers normally heal within weeks with appropriate care. If you or a loved one has symptoms of pressure sores, notify a healthcare professional immediately. Avoid applying pressure to the ulcer and keep the area clean and free from moisture that sits on the skin. Medications for pain management may also be necessary.

Pressure ulcers in Stage 3 and Stage 4 require more intensive care under the supervision of a healthcare professional. Again, treatment begins by relieving the pressure that caused it. Treatment for these sores may include the removal of dead or infected tissues. Removal can be done surgically, with a medical device (e.g. a pressurized irrigation device), or by using natural or chemical enzymes to break down the tissue. Antibiotics and/or pain medications may be prescribed to keep the sore free of infections and keep the senior comfortable.

What Causes Bedsores?

Bedsores are caused by pressure against the skin that limits, and in some cases, cuts off, blood flow to the skin for an extended period of time. Loss of blood flow can cause the affected skin to die, subsequently turning red and then purple. If left untreated for an extended time, the affected area can rupture and become infected.

There are three primary contributing causes to bedsores:

1. Pressure: Pressure on any part of the body can lessen blood flow to the skin tissue. Without an adequate supply of blood, the skin and nearby tissues lose oxygen and other nutrients, which eventually can cause them to die.
2. Friction: Friction occurs when the skin rubs up against clothing or bedding
3. Shear: Shear occurs where two surfaces move in opposite directions. This can occur, for example, when a person in an elevated bed slides down. As the tailbone moves down, the skin remains in place.

Excessive moisture and other irritants — such as urine and feces — can accelerate and exacerbate the severity of bedsores.

Risk Factors for Bedsores

Bedsores are most common among individuals who sit or lie in bed for extended periods of time. While bedsores can occur in any setting, they are most common in hospitals and nursing homes. Under normal circumstances, individuals who are sitting or lying down move periodically to relieve pressure on certain parts of their bodies, often unconsciously. Individuals who cannot move on their own must be repositioned by others. If they are not repositioned frequently enough, the pressure can result in bedsores.

The most common risk factors for bedsores include:

• Limited mobility or immobility
• Loss of sensation (such as diabetes)
• Cognitive impairment
• Incontinence (can irritate vulnerable skin)
• Poor nutrition or dehydration
• Poor hygiene
• Medical conditions affecting blood flow

If these conditions sound like those commonly experienced by the elderly, it is because they are; the elderly — especially the elderly living in nursing homes — are at the highest risk of developing bedsores due to their physical infirmities and living conditions.

How Bedsores Can Become Fatal

Bedsores are more than a mere inconvenience or cause of passing pain. Severe bedsores can be fatal. At Stage 4, bedsores can cut through all layers of the sufferer’s skin and make their way to the bones, tendons, joints, and muscles beneath. These severe bedsores can lead to many complications that can prove fatal if left untreated or not treated quickly enough, such as cellulitis, a bacterial skin infection, and sepsis (an immune response to an infection that can damage the body’s tissue) and, in some cases, cancer. In some cases, bedsores can also lead to gangrene, a condition in which the body’s soft tissue dies from oxygen starvation. If you suspect that someone you care about is suffering from Stage 4 bedsores, you should consider speaking to a California bedsores lawyer as soon as possible to prevent further serious injury.

How Your Nursing Home California Bedsores Attorney Will Establish Liability

Nursing homes can be held liable for injuries to their residents caused by bedsores. The most common theory of liability for bedsore injuries is negligence. Negligent behavior is behavior that fails to meet the standard of care a reasonable person would have engaged in and that causes injury. The four elements required to prove negligence in a bedsore injury case are as follows:

1. Duty: Nursing home staff owe a legal duty to their residents to prevent harm, including injuries from bedsores. Knowing that a particular patient was immobile, a reasonable nursing home employee would take actions consistent with duty, such as frequently repositioning them, cleaning and drying them regularly if incontinent, and responding promptly to their calls for assistance.
2. Breach: A breach of duty occurs when the defendant’s behavior falls below the relevant standard or is otherwise not consistent with the actions a reasonable person would have taken in the same or similar circumstances. Failing to diligently reposition an immobile resident or keep an incontinent patient clean and dry fall below the relevant standard of care for a nursing home employee.
3. Causation: The plaintiff must then show that the defendant’s breach caused their injury. For example, in a bedsore injury case, the plaintiff could show causation by arguing that the bedsores would not have developed had the nursing home employees frequently repositioned or cleaned the resident.
4. Damages: Damages are the harm the defendant suffered due to the defendant’s breach, such as medical bills, pain, and suffering, loss of enjoyment of life, etc.

Multiple parties can be held liable in nursing home bedsore injury cases. Those held responsible include the nursing homeowners, nursing home administration, nursing home supervisors, staff and workers, and even medical device and equipment manufacturers (in cases where the bedsore injury was caused or exacerbated by a defective medical product).

Common Locations for Bedsore Development

Anywhere the skin comes into contact with another surface for an extended period without moving is prime for bedsore development. They are especially common where there is not much muscle or fat between a bone and an exterior surface. The most common locations for bedsore development include:

• The tailbone and buttocks
• The shoulder blades and spine
• The backs of arms and legs
• The back and sides of the head
• The hips, lower back, and tailbone
• The heels, ankles, and skin behind the knees

The most common settings for bedsore development are spaces in which individuals with limited mobility spend a vast amount of their time, including wheelchairs and beds.

Our California Bedsores Attorney Outlines How to Recognize a Bedsore

Early-stage bedsores can often be difficult to identify, as they may appear to be an ordinary bruise or laceration to the untrained eye. However, it is imperative to catch bedsores in their early stages before they progress to more severe injuries. Some common warning signs of bedsores are:

• Unusual changes in skin color or texture
• Swelling
• Foul odor
• Draining of pus
• Areas of skin that feel cooler or warmer than other areas
• Tender areas

If you notice any of these signs, a California bedsores attorney can help you determine whether nursing home abuse is occurring and what steps you should take. 

Schedule a Free and Confidential Consultation with California Nursing Home Abuse Lawyers

The Evans Law Firm focuses on nursing home and elder abuse litigation in California. If you believe that you or a loved one has suffered from bedsores due to neglect or lack of care from a caregiver or nursing home, contact the lawyers at the Evans Law Firm toll-free at 1-888-50EVANS for a free and confidential consultation or email info@evanslaw.com.