Why Do Bedsores Occur?
Many families agonize over the decision to put a loved one into a nursing home or other type of long-term care facility. When they finally commit, they expect their family member to receive exceptional care and be treated with dignity and respect. Florida has the largest population of elders in the nation, and is home to a large number of nursing care facilities that many call home.
Fortunately, many facilities and caregivers provide above-standard care, but others do not meet our expectations, let alone provide proper care. Many accidents and injuries in nursing care facilities occur because of neglect. Bedsores are a direct consequence of neglect and, if left untreated, can cause severe illness and death.
This guide provides in-depth information about the nature of bedsores, negligent caregiver behaviors that cause them, and steps you can take if your loved one has developed bedsores during their stay at a nursing care facility. We also discuss the physical and financial consequences of bedsores for nursing home residents and those who love them.
What Are Bedsores?
Bedsores refer to damaged skin from sitting or lying in one position for too long. Bedsores have other informal names, too, which include pressure sores, pressure ulcers, or pressure injuries. The formal medical name for a bedsore is a decubitus ulcer. Whether you call them sores or ulcers, bedsores can cause unrepairable skin damage, illness, and excruciating pain for those who develop them.
Bedsores occur because blood flow slows or stops in areas of the body when a person lies or sits in one position too long, creating an open wound. Bedsores typically develop where the skin is closest to the bone. This includes a person’s hips, ankles, heels, back, tailbone, elbows, and shoulder blades. Bedsores can vary in their severity, and medical professionals categorize them based on severity and treatment options. Below is a broad overview of the four stages of a bedsore.
Stage I Bedsores
The genesis of a bedsore is not easy to identify if you do not know the exact signs. A Stage I bedsore subtly changes the skin, but the change is not the same on everyone. Sometimes the area shows some redness and sometimes the skin feels warmer to the touch around the bedsore. You will not notice any breaks in the skin when someone develops a Stage I bedsore.
Stage II Bedsores
Bedsores that have developed into Stage II affect the top layer of the skin formally referred to as the epidermis, and sometimes the layers of the dermis which lie just below the epidermis. A Stage II bedsore can present as a shallow open wound, but it can also look like a big blister that is full of pus. When Stage II bedsores are left untreated, they can break open. This can increase complications associated with the bedsore, especially in terms of cleanliness and lack of proper skincare surrounding the sore.
Stage III Bedsores
A Stage III bedsore is exponentially more serious than Stage I and II bedsores. At Stage III, the bedsore has eaten through most layers of skin and has begun to infect the final layer of skin, primarily made of fat and connective tissues. This layer of skin also houses large nerve endings which means those who suffer Stage III bedsores experience a lot of pain. They can also suffer nerve damage and many more medical issues once the bedsore reaches the final layer of skin. In the most extreme cases of a Stage III bedsore, doctors can see bone and muscle.
Stage IV Bedsores
The most dangerous and painful bedsores occur at Stage IV, where the sore extends into muscle and bone. If you look at a Stage IV bedsore, you can typically see dead skin and a lot of drainage and pus. Those who suffer from the most extreme Stage IV bedsores usually need surgery to remove and reconstruct the area around the bedsore.
Caregiver Neglect Causes Painful Bedsores
Federal and state laws require nursing homes to provide a specific standard of care to those who reside in the facility. Neglect is a criminal act that can result in felony charges when it occurs. Neglect can occur for different reasons. Sometimes nursing care facilities do not have enough nursing assistants, leaving employees overworked. This makes it impossible for caregivers to provide an adequate level of care to all residents no matter how hard they try. Other times, overworked and underpaid nursing assistants are tired and overwhelmed, so they intentionally neglect residents.
Poorly staffed nursing homes put caregivers in situations where it’s easy for them to neglect residents, putting vulnerable residents at risk for bedsores. Residents who are forced to stay in bed without regular repositioning may develop bedsores at some point. The presence of bedsores serves as a strong indicator that caregiver neglect is occurring. So far, we have discussed bedsores in the context of Florida nursing homes, but they can occur in private care settings, too. Those who provide in-home nursing care have the same responsibility to reposition their clients as those who work in nursing homes.
You cannot directly prevent your loved one from developing bedsores if you are not their primary caregiver. Yet, if you understand the actions that nursing assistants and other caregivers must take to prevent bedsores, you can advocate for your loved one and make sure they are getting the care they deserve.
Johns Hopkins, one of the United States’ most respected medical schools and facilities, recommends the following to prevent bedsores:
- Turn and reposition a bedridden person every two hours.
- Reposition those in wheelchairs every 15 minutes and ensure they sit up straight.
- Pad areas in a bed and wheelchair where pressure sores can occur.
- Ensure skin is always clean and dry so sores are less likely to develop.
- Ensure proper food and water intake to help bedsores heal when they do occur.
Long-term Medical Complications Associated With Bedsores
Nursing home residents who have little or poor mobility, those who are bedridden, and those who are in comas or a permanent vegetative state have the highest chances of developing bedsores. Stage I and II bedsores can be treated easily and often heal completely; however, the story changes when bedsores develop beyond stage II.
Residents who develop higher stage bedsores sometimes must deal with them for weeks or months before they heal. This is especially true for those who suffer from underlying health conditions such as diabetes. Some bedsores are so severe, medical professionals cannot categorize them. These “unstageable” ulcers can be fatal.
Examples of long-term medical complications associated with bedsores include:
- Infections. Once a pressure sore reaches Stage II, it is an open wound that can easily become infected. Infections in bedsores can enter the heart, bones, and bloodstream causing fevers, disorientation, an elevated heart rate, and general weakness. If left untreated, these infections can cause death.
- Amputation. Bedsores reduce or stop blood flow to affected areas. During treatment, doctors try to restore blood flow. Yet, some sores are too severe, forcing doctors to make the difficult choice to amputate a limb so they can save the person’s life. Amputation is not only a complication of severe bedsores, but it also can come with its own set of complications on top of the physical and emotional pain of losing a limb.
- Recurring Bedsores. The only way that bedsores can properly heal is with extensive bed rest. This can create a never-ending cycle of recurring bedsores when nursing assistants do not provide adequate care. Failure to turn and reposition residents can create new bedsores or cause existing bedsores to further develop.
- Autonomic dysreflexia. This is the medical term for the human body’s abnormal reaction to stimuli in the nervous system. Those who suffer spinal cord injuries and develop pressure sores have the most risk of experiencing autonomic dysreflexia. Some common symptoms include elevated blood pressure, muscle spasms, excessive perspiration, and paleness, redness, or bluish skin in the affected area.
The Financial Impact of Bedsores and Treatment
If you or a family member you love has developed bedsores as a result of caregiver neglect, you potentially face colossal expenses. The specific financial impact depends on the severity and number of bedsores and which course of action you take to deal with the neglect.
Examples of expenses associated with treating bedsores include:
- Medical expenses. You may know that developing bedsores means additional medical bills from doctor’s visits, medication, and sometimes hospitalization. Yet, you also may be faced with other medical expenses. Some who develop bedsores must undergo surgery, as well as costly imaging tests to examine the extent of the sores. Those who develop severe bedsores typically must also take prescription pain medication and antibiotics. When residents get stuck in a cycle of recurring bedsores or their sores aren’t healing quickly, these expenses can go on for months.
- Counseling. Many times the presence of bedsores on a resident of a long-term nursing care facility is an indication of a larger problem in the facility. A resident with bedsores may have suffered emotional distress because of the abuse and neglect they have suffered. Those residents who do not suffer from Alzheimer’s or dementia or aren’t in a coma or a permanent vegetative state may need to engage in therapy to work through their trauma. Depending on the extent of the neglect and abuse, some residents might need to utilize mental health services for the rest of their lives.
- Moving to another facility. If your loved one has developed bedsores because of intentional neglect or nursing home negligence, you may want to find them a new home. Change is traumatic for nursing home residents and it’s also inconvenient, and the financial consequences of transferring facilities can be overwhelming. Moving your loved one can mean paying much higher rates for a new nursing home or private nurse, or it can mean placing them in a facility much further away.
Four Steps to Take if Suspect Your Loved One Was Neglected
Florida law clearly defines abuse and neglect of the elderly and other vulnerable adults. Under Florida law, neglect is the failure to “provide an elderly person or disabled adult with the care, supervision, and services necessary to maintain the elderly person’s or disabled adult’s physical and mental health.”
Bedsores are a consequence of this failure. If you suspect neglect because of the presence of bedsores or other symptoms, you must stop the behavior as soon as possible.
You can take the following steps to start an investigation process and protect your loved one from further harm.
- Notify the administration. As soon as you notice bedsores on a loved one or if you have suffered bedsores from a neglectful caregiver, you must notify the facility’s administration. This can motivate caregivers and charge nurses to ensure your loved one’s bedsores receive the proper treatment and care.
- Notify DCF. Call the Florida Department of Children and Families (DCF) Abuse Hotline to report the neglect of your loved one. You can also file a report online. This will begin a formal investigation process through the state. DCF often shares information with other agencies and with a local prosecutor when they find evidence to support the complaint. The prosecutor will determine whether to criminally charge caregivers responsible for neglect.
- Notify AHCA. You can file a complaint about the facility by calling Florida’s Agency for Health Care Administration (AHCA) at (888)419-3456 or by submitting a complaint online. Once you file a complaint, it gets forwarded to an administrative unit that assigns the case. If the official who reviews the case believes residents are in immediate danger, they will inspect within two business days. Without immediate danger, the inspection can take longer. In either case, the AHCA will notify you of the outcome of the inspection.
- Contact a nursing home attorney. The law permits you to take action against caregivers who cause you or your loved ones harm through their abuse or neglect. Suing the facility and associated caregivers will not undo the pain of developing bedsores, but it can help cover the financial costs of treating them. Furthermore, a nursing home lawyer can help you complete the previous four steps, helping to ensure that other persons at the nursing home don’t suffer the same way your loved one did.