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ABSTRACT
Millions of Americans develop bedsores every year. The majority of these cases are preventable.
According to the Agency for Healthcare Research and Quality (“AHRQ”), more than 2.5 million people in the United States develop bedsores each year. Bedsores need pressure to form, which is why nursing home residents who are immobile are at a greater risk of developing this serious and life-threatening condition. In fact, by some estimates, nearly 40 percent of all nursing home residents develop bedsores at some point during their stay.
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What Are Bedsores?
Bedsores, also termed decubitus ulcers or pressure ulcers, are a type of ulcer that develops on the body in situations where constant or long-term pressure is exerted on the skin. When someone sits or lies in the same position for a long period of time, the pressure from their body can cut off blood flow to the part of the body touching the bed or chair. This reduction in blood flow can cause a person’s skin to turn a reddish-purple color. This is an indication that the skin is dying. If left untreated, the area can turn into an open wound, which is highly susceptible to infection.
People who have suffered a loss of consciousness, a lessening of senses, or decreased mobility are most susceptible to pressure ulcers. Such patients may not be aware of pain or discomfort, and at the same time, they may not be able to move to relieve the pain.
Pressure is not the only external contributing factor to ulcer formation. Friction and moisture can also lead to bedsores. Other health factors, like fever, dehydration, and malnutrition can cause bedsores to form more quickly.
Causes of Bedsores
Both internal and external factors contribute to the formation of pressure ulcers and bedsores. The predominant external factor is prolonged pressure on the skin. The pressure may come from contact with a hard surface like a wheelchair or bed. Involuntary muscle spasms that continuously press parts of the body against a surface can also lead to bedsores.
Moisture can also be an issue, as the consistent presence of moisture can help break down the outer layer of the skin, leading to infection.
Bedsores begin as the skin succumbs to pressure and decreased blood flow. Without an adequate blood supply, the skin does not receive enough oxygen or nutrients and will be damaged and eventually die.
A lack of blood also means that infection-fighting white blood cells cannot reach the skin tissue. Therefore, bedsores are prone to dangerous bacterial infections.
People with certain conditions, beyond incapacitation, are also more prone to developing bedsores. These conditions include:
- Cardiovascular disease
- Dehydration
- Malnutrition
- Diabetes
- Hypotension
- Kidney failure
- Having undergone surgery
Where do Bedsores Form?
Bedsores most often affect the areas of the body that come into contact with a bed or chair when someone is lying down or sitting, such as:
- Back and sides of the knees
- Back of the head
- Buttocks
- Heels of the feet
- Hips
- Shoulder blades
- Tailbone
Of course, bedsores can develop in other areas as well. For example, if a nursing home resident recently had surgery and couldn’t lie on their back, they may develop bedsores along their upper arm and thigh, as these are the areas that would be in contact with the bed.
Factors that Contribute to Bedsore Formation
The Four Stages of Bedsores
Medical experts classify bedsores into four categories, with bedsores progressing from Stage 1 to Stage 4 as they are left untreated.
Below is a description of the various stages of bedsores.
Stage 1 Bedsores: The affected area of the skin appears red for those with lighter skin and a purplish hue for those with darker skin. Some residents may indicate that their skin feels unusually warm or may experience burning, itching, or pain. When the affected area is pressed against a finger, it will not lighten in color as it normally would.
Stage 2 Bedsores: Sores in this stage are characterized by visible damage to the skin, such as blisters or sores. This is the stage during which the top layer of the skin begins to die and fall off. The skin around the affected area will also typically look discolored. Second-stage bedsores are significantly more painful than first-stage sores.
Stage 3 Bedsores: The affected area takes on a crater-like appearance as the ulcer extends through the top layer of the skin to the fatty layer of skin underneath. Third-stage bedsores resemble the look of open wounds, although the wound is not yet deep enough to see muscles or bone.
Stage 4 Bedsores: These are the most severe, as the damage reaches the underlying muscles and bones. This greatly increases a resident’s risk of infection, which can be life-threatening.
Preventing Bedsores
Nursing home staff are aware of the dangers of bedsores and must be properly trained on how to care for residents who are immobile or otherwise at risk for developing bedsores. For example, nursing home staff should do the following to prevent the development of bedsores:
- Keep residents’ skin clean and dry of all bodily fluids, including sweat.
- Frequently reposition residents to avoid constant pressure on one or more parts of the body.
- Use pillows and foam wedges to reduce pressure on bony parts of the body.
- Ensure residents maintain a healthy diet.
Once a bedsore forms, a resident’s health is in jeopardy. Depending on a resident’s overall health, bedsores can take months or even years to heal. Thus, it is imperative that nursing homes take every precaution to prevent bedsores from developing.
Bedsore Prevention
Risks Associated with Bedsores
While bedsores can be excruciatingly painful and negatively impact a nursing home resident’s quality of life, the health risk of bedsores is that the wound becomes infected. In the most serious cases, an infection that starts at the site of a bedsore can spread to other parts of the body. Below is a list of some of the most common infections that can result from untreated bedsores.
Infections from Untreated Bedsores
Bacteremia – Bacteremia is a blood infection that usually occurs in those with weakened immune systems. Typically, the human body is capable of eliminating harmful bacteria; however, if a resident’s immune system is compromised due to other health conditions or medications, it can result in an increase in blood-borne bacteria, which may lead to bacteremia.
Cellulitis – Cellulitis is a skin infection that is often caused by the introduction of the bacteria group A Streptococcus (group A strep). Skin affected by cellulitis looks red and is tender to the touch. Typically, cellulitis develops near the site of the bedsore.
Endocarditis –Endocarditis is an infection affecting the inner lining of the heart, usually the heart valves. Endocarditis develops when bacteria in the blood travels through the body and reaches the heart. If left untreated, endocarditis can lead to heart failure, kidney damage, or a pulmonary embolism.
Meningitis – Meningitis is an infection of the fluid and membranes surrounding the brain and spinal cord. There are several types of meningitis, all of which are extremely serious and can quickly lead to death.
Osteomyelitis – Osteomyelitis is the swelling or inflammation of a bone, usually caused by an infection that starts elsewhere in the body and travels to the bone. Depending on the source of the infection and its severity, osteomyelitis may develop quickly or very gradually. If left untreated, osteomyelitis can cause fractured bones or gangrene.
Fatalities from Bedsores
In some cases, a bedsore infection can become so severe that a resident enters sepsis. Sepsis is the body’s extreme response to a serious infection. Sepsis results from the body’s internal defense mechanisms turning on the body’s healthy tissue instead of targeting the source of the infection. When the body enters septic shock, the brain, heart, and lungs do not receive as much blood as they need, which can cause these vital organs to fail, quickly leading to death.
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Nursing Home Negligence
What You Can do When Faced with Nursing Home Negligence
What Are a Family’s Options After Discovering a Loved One’s Death Was Caused By Nursing Home Neglect?
In the tragic event that a nursing home resident dies due to complications from bedsores, the resident’s loved ones can bring a wrongful death claim. A wrongful death case is similar to other personal injury lawsuits, except that instead of being brought by the victim, the case is filed by the personal representative or executor of the victim’s estate.
Typically, the court will appoint an executor or administrator under the resident’s estate plan. However, if a resident does not have a will or the named representative cannot serve, the court will appoint a representative. Usually, the court appoints a family member, although that is not always the case.
While a nursing home resident’s personal representative must file a wrongful death claim, any damages recovered are for the benefit of the resident’s surviving family members. This includes a surviving spouse, children, grandchildren, or other named or unnamed heirs.
Five of the ten nursing homes within 15 miles of Charleston's city center have ratings of only one or two stars.
To successfully bring a Charleston wrongful death claim based on preventable bedsores, one must prove each of the following elements:
Duty – Did the nursing home owe the resident a duty of care?
Breach – Did the nursing home breach the duty of care owed to the resident?
Causation – Was the resident’s death caused by the nursing home’s negligence?
Families that can meet each of these elements are entitled to recover compensation for their economic and non-economic damages, which include:
- Loss of care, protection, companionship
- Mental anguish experienced by surviving loved ones
- Funeral and burial expenses
In some bedsore cases, the court may award punitive damages. Punitive damages, although rare, are awarded when the facility’s actions were “willful, wanton, or reckless.” Unlike economic and non-economic damages, which are awarded to compensate grieving family members for their loss, punitive damages are intended to punish a nursing home for its reprehensible conduct.
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Speak with an Experienced Charleston Nursing Home Neglect Attorney to Learn More About Your Options
The majority of bedsores are preventable, especially in the context of a nursing home. Nursing homes are paid to provide skilled nursing care, which includes rotating residents regularly to prevent bedsores. However, whether it’s due to a staffing shortage, an untrained workforce, or overworked nurses, nursing home staff can neglect their duties, causing residents to unnecessarily suffer.
At the Steinberg Law Firm, our Charleston personal injury and wrongful death attorneys have more than 95 years of experience aggressively pursuing justice on behalf of those harmed due to nursing home negligence.
Charleston nursing home neglect lawyers represent residents and their families in bedsore lawsuits. If your loved one was seriously injured or died as a result of bedsores, we can help you recover compensation for your loss. We offer free, no-obligation consultations to anyone interested in learning about their options.
To learn more and to schedule a free consultation today, call 843-720-2800.