Why a Bedsore Acquired in a Nursing Home Is a Sign of Inadequate Care

Bedsores (pressure wounds, pressure sores, pressure ulcers, decubitus ulcers) can be a severe medical complication that could claim the life of the nursing home resident. Sadly, acquiring a bed sore in a nursing facility is not an uncommon occurrence in America.

Elderly patients, the disabled, and rehabilitating patients can quickly develop an advancing bedsore through neglect or mistreatment by the nursing home staff.

What Causes a Facility-Acquired Bedsore?

Overwhelmingly, many patients develop pressure ulcers due to immobility, especially elderly residents in nursing facilities and hospital patients that cannot move without assistance. A Stage I bedsore will generally reveal itself as a reddened area of skin on a bony prominence on the body. Usually, the pressure sore develops due to prolonged pressure on the affected area that restricts blood flow and nutrients to tissue and skin.

Without effective treatment, a Stage I bedsore can quickly degrade to a Stage II pressure wound where the skin becomes damaged, exposing some underlying tissue. The most common places bedsores develop include:

• The resident’s buttocks, hips, tailbone, shoulders, elbows, heels, toes, and back due to constant pressure caused by long-term lying down or sitting for a prolonged time.
• Bedsores manifest on the foot and ankles. These wounds are caused by not removing footwear or from pressure caused by some wheelchair or bed components.

Any area of the body affected by a sedentary lifestyle without turning and repositioning can irritate body tissue and cause a pressure wound. Because of that, the nursing staff is required to develop an effective Plan of Care, to ensure that the resident receives adequate care, including turning and positioning, when necessary.

Severe Bedsore-Associated Risks

A newly formed pressure wound can rapidly degrade to a life-threatening decubitus ulcer if the staff does not provide the appropriate resident care. Any failure to provide the necessary treatment for developing bedsore could lead to a debilitating infection involving osteomyelitis (bone infection) or sepsis (blood infection). Other risk factors include:

• Patient immobility, especially those with specific injuries and disabilities that have involuntary immobility
• Residents exposed to urinary or fecal incontinence that degrades skin integrity and can contaminate or worsen an existing bedsore
• Residents experiencing deficits in cognitive capacity or diminished mental status
• Residents with co-morbid conditions including obesity, malnutrition, dehydration, clotting disorder, diabetes mellitus, or another autoimmune deficiency tend to be at an extremely high risk for developing pressure wounds

Identifying a Facility-Acquired Bedsore

Observing facility-acquired bedsore at a nursing home is a cause for alarm. This wound could be an indicator of in-house abuse, neglect or mistreatment. If found, the resident or the responsible party should notify the nursing staff immediately so that appropriate action can be taken.

Even developing bedsores can quickly degrade to Stage III or Stage IV pressure wounds where bone, muscle and underlying tissue are exposed. Clinicians and researchers at Medicare believe that every bedsore is preventable if the nursing staff follow the established protocols to minimize damage in its early stage.

A Never Event

In recent years, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing nursing homes to recover the costs of treatment for residents with facility-acquired bedsores. The CDC stated that developing a pressure wound in a nursing facility should be a “never event.”

The so-called “never events” include mismatching blood types during a transfusion, performing a surgical procedure on the wrong body part, developing certain infections through exposure, and the development of Stage III and Stage IV pressure ulcers.

Preventing Bedsores

Prevention by taking immediate action and following established protocols is a crucial component to avoiding the development of a pressure ulcer. Studies show that it is significantly easier to prevent bedsores than to treat them.

Practitioners, including caregivers, can provide the elderly, disabled, and immobile patients the care they need to prevent the development of ulcers in a nursing setting. The caregiver should serve as an advocate, especially to patients who are at high risk for the development of a pressure wound.

Providing the resident the best care and following established protocols can help reduce pressure, eliminate moisture, avoid sheer friction, and use devices that can eliminate pressure points on areas of the body most likely to develop a wound. Any failure to provide adequate care could be seen as a sign of negligence.