Bed sores are some of the most unfortunate injuries that can arise from nursing home negligence. These are pressure injuries on the skin that frequently occur on parts of the body that are normally covered by bedsheets, clothing, or which are otherwise obscured from view.
If caught and treated early, bed sores can be addressed and healed. However, often, due to understaffing in nursing homes, bed sores are left untreated or not addressed properly. When this happens, and they are left to fester, the resulting infections and complications from surgical treatment can significantly compromise a person’s health or result in their premature death.
In this blog post, I explain how bedsores occur, outline the different stages of bedsore development, and offer tips on what you should do if you discover a loved one in a long-term care home has developed these terribly painful wounds.
How do bedsores occur?
Decubitus ulcers, more commonly known as bedsores, are pressure injuries on the skin that manifest under certain conditions. They can eventually cause damage to multiple layers of tissue, even exposing muscle and/or bone.
Bedsores derive their name from one of the most common reasons for their onset. When a person spends prolonged periods in a bed without enough movement or repositioning, skin damage can occur at pressure points usually in contact with the surface of the bed: shoulder blades, elbows, spine, lower back, tailbone, hips, and heels. People who spend lengthy periods in stationary chairs or wheelchairs may develop these sores on the buttocks or soles of their feet.
When these parts of the body make contact with a firm surface, blood flow to the skin can become temporarily restricted or cut off completely. Unless blood flow resumes to the affected skin tissue (usually within a few hours), it can become damaged.
Beyond restrictive pressure to skin, other factors can aggravate damaged skin and contribute to these ulcerous wounds, including:
- Advanced age (older adults, especially people aged 85 and over, are more likely to develop bedsores as their skin thins/becomes fragile).
- Decreased movement (pressure is released during even small movements that vary which body parts are in contact with a firm surface).
- Friction (fragile skin can be damaged by shearing and friction against material such as bed sheets).
- Neurological conditions (nerve damage that causes decreased or altered sensation may prevent a person from realizing a pressure point has become uncomfortable or painful and requires movement to release pressure).
- People with poor circulation from atherosclerosis, swelling, or complications from diabetes are more prone to bedsores because blood flow to their skin is significantly diminished even before pressure is exerted on skin.
- People with poor nutrition.
- Prolonged periods of time when there is excess moisture from sweat, urine, or feces on damaged skin.
What are the stages of bedsores?
Bedsores are categorized by progressively damaging stages. Ordinarily a doctor will only need to examine affected skin to diagnose a bedsore; however, certain medical tests (lab tests, imaging) may be ordered to rule out infection or to gauge damage from late-stage bedsores.
Stage I
Skin becomes discoloured. In fair-skinned people, it may appear as a red patch of skin that does not turn white when pressure is applied. In people with darker skin, the damaged skin may appear red, purple, or blue and may be more difficult to detect. At this stage, the affected area may hurt, burn, or feel itchy. It can be warm or cold to touch and feel more firm than surrounding skin.
Stage II
Skin features greater abnormalities, including blistering, looking similar to a scrape, or becoming an open sore on the most superficial layers of skin. Surrounding skin may be discoloured, swollen or ooze. Pain becomes worse.
Stage III
Damage progresses to lower layers of skin tissue and the ulcer becomes crater-like. The risk of infection greatly increases.
Stage IV
The crater advances to encompass surrounding muscles and tendons, sometimes exposing joints and bones. There is a substantial risk of infection.
If a bedsore becomes infected, the wound may produce pus, emit a foul odour, and feel warm to the touch. In some cases, the infection may cause fever, chills, and/or develop into life-threatening sepsis.
If bedsores are diagnosed at an early stage (I or II), depending on the relative health of the person, prognosis is usually good. Properly treated Stage II sores normally heal in one to six weeks. Late-stage bedsores can take more than six months to heal and, in some cases, never heal. In certain cases, skin grafts, and other surgical interventions are required to treat these ulcers. If left untreated, infections that develop in the bedsore can spread to the bloodstream, leading to sepsis. Sepsis is an extremely dangerous condition for anyone and is often fatal to an elderly person.
Bedsores are often preventable injuries caused by neglect
Although people with certain conditions or illnesses may be more prone to bedsores, proper care and prompt treatment should significantly reduce their risk of developing a bedsore and the risk that a Stage I bedsore deteriorates. Unfortunately, substandard care and outright neglect are frequently the cause of bedsores in long-term care homes.
Bedsores can be prevented by:
- Keeping skin dry and clean
- Changing positions every two hours to relieve pressure
- Lifting a bed-ridden person rather than dragging them across sheets
- Keeping bedding clean from dirt, food crumbs, and excessive moisture
- Putting padding on certain body parts
- Using certain types of mattresses/beds
- Avoiding overuse of harsh chemicals on skin
- Encouraging good nutrition and exercise
- Inspecting skin daily for early signs of tissue damage
A 2003 study of pressure ulcers across all health care settings by the Canadian Association of Wound Care (Wounds Canada) recorded a 26 percent prevalence rate and found that these injuries were preventable in 7 out of 10 cases. And, despite greater awareness of this preventable injury, the rate of pressure ulcers in Canada has not significantly decreased in recent years compared to other developed countries.
The Canadian Institute for Health Information tracks Ontario long-term care home residents for new or worsened bedsores between assessments by health care professionals. Although the province set a benchmark of one percent prevalence rate among residents, it has consistently recorded results about 2.5-3 times higher than that goal. Some facilities have posted results that are much worse.
Tragically, since bedsores are often found on parts of the body that would not generally be visible to people visiting their loved one in a long-term care home or communicating with them through video-calling, signs of injury may not be evident until it has significantly affected their overall health or even resulted in their death.
What should you do if you discover a bedsore on a loved one in long-term care?
Learning that your loved one has sustained an injury that might be the result of neglect can be devastating. You may feel angry or hurt that the staff you trusted could be complicit in causing this harm, or you might feel guilty for not having noticed it yourself sooner.
It is important to remain as calm as possible, take the following steps, and document your efforts. Hopefully decisive corrective action will be taken, your loved one will heal, and this type of injury will not occur again. However, if the injury leads to negative outcomes or becomes a repeat occurrence, you will have evidence to take action on behalf of your loved one.
- Take photos of the bedsore (obtaining permission of the resident if they have capacity to make decisions about their care or privacy).
- Inform the nursing staff that you have discovered what you believe to be a bedsore. Ask whether they are aware of the wound, and if so, what steps they are taking to treat it and prevent other bedsores from occurring.
- Arrange for a meeting with nursing home management to express your concerns. This meeting can and should be recorded. It is important to note that you may record a conversation in Ontario without notifying the other party or obtaining their consent provided you are privy to the conversation, and it is occurring in a place where there is no reasonable expectation of privacy. If this recording may ever be used as evidence in court, you should record the date and location where it took place and the names of anyone who was present. You should also take steps to preserve the original digital metadata.
- If the situation doesn’t improve following your meeting with management, file a complaint with the Ministry of Long-Term Care. They will send an investigator into the home to review your loved one’s file and interview witnesses. They will then post a report, documenting their findings online.
- Contact an experienced nursing home negligence lawyer. At Howie, Sacks, and Henry LLP, our nursing home negligence lawyers provide a no cost, no obligation initial consultation. We will listen to your story with empathy, explain your legal rights, and outline your options, including whether a civil claim for damages is feasible or how and why a case of neglect could become actionable at some point in the future.
In the event your loved one passes away while they have active bedsores, it is important to ensure the wound is listed as a cause of death and/or noted in an autopsy or by a coroner. Some nursing homes may try to report an alternative cause of death to cover up the full extent of the harm their negligence has caused.
Hope and help for people who have been harmed
People who contact our law firm are very often at one of the lowest points of their lives. As you contend with the knowledge that your loved one has been seriously or fatally injured, you may not be able to even begin to allow yourself to think that better days are ahead.
But at HSH LLP, we strive to demonstrate to our clients that “Hope Starts Here.” Whether the action you take improves the life of your loved one or achieves a sense of justice being done in their memory, we know it can be a powerful step forward on your healing journey.
To learn more about what we can do for your loved one, contact us for a free consultation.
