Statistics Related to Bedsores as Nursing Home Abuse Symptoms
According to a CDC study, more than one in ten nursing home residents had bedsores, also known as pressure sores or pressure ulcers. Residents over the age of 64 were more likely to have bedsores, and those with recent weight loss were significantly more likely to have bedsores. Residents with high immobility, those taking more than eight medications, and those with recent bowel or bladder incontinence were also more likely to develop bedsores. Unfortunately, bedsores can sometimes be a sign of nursing home abuse or neglect.
What Are the Primary Causes of Bedsores?
Bedsores occur after a constant pressure against the skin limits blood flow. Elderly patients in nursing homes are at a high risk of bedsores because they may have limited mobility, often require extra protein in their diets, and, due to age and other conditions, typically have extremely fragile skin that is easily injured. This requires staff to ensure they do not stay in the same position for extended periods of time, whether in bed or in a wheelchair. Areas that are not well-padded with fat or muscle, or areas that lie directly over a bone (sacrum, heels, shoulders, etc.) are more likely to develop bedsores. Friction between the skin and other surfaces can damage the skin, so transfers of the resident can have specific requirements. Poor nutrition, as well as medical conditions affecting blood flow, can also contribute to the development of bedsores.
What are the “Stages” of Bedsores?
There are four stages of bedsores which vary in severity. Eventually, bedsores can become unstageable. Stage 1 bed sores are somewhat minor, whereas stage 4 bedsores are incredibly dangerous. There are specific diagnostic techniques that nursing home staff are to use in assessing pressure sores. The National Pressure Injury Advisory Board has published specific guidelines relating to pressure wounds, and in 2016 redefined pressure injuries, providing clearer guidance to medical practitioners and lay persons in the prevention and assessment of pressure wounds. Technically speaking, there are approximately 19 “stages” of a pressure wound that may exist, but most practitioners list four general stages that have been defined as follows by the National Pressure Injury Advisory Board:
- Stage 1 Pressure Injury: Non-blanchable erythema of intact skin Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.
- Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel. This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).
- Stage 3 Pressure Injury: Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location.reas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.
- Stage 4 Pressure Injury: Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.
- Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss. Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e. dry, adherent, intact without erythema or fluctuance) on the heel or ischemic limb should not be softened or removed.
Can There Be Medical Complications from Bedsores?
Because the elderly often have thin skin, less mobility, and may also have other concurrent health issues, bedsore complications can be severe, even fatal. Nursing home employees must not only be trained to take the appropriate steps to prevent bedsores, but also identify these injuries in a timely manner and treat them appropriately to prevent further complications. They should notify medical providers with advanced training in wound care, such as wound care nurses and wound care physicians, for guidance in treating the wounds as well.
Infection can be extremely serious, with patients developing bone infections (osteomyelitis), sepsis, and other life-threatening conditions. The quality of life for these patients can become extremely poor due to the pain caused by advanced pressure wounds, leading to depression and prolonged hospital stays.
Treatment of Bedsores
There are various forms of treatment depending on the staging of the wound. They range from fairly conservative treatment upto and including surgery. Below, we will outline some forms of treatment as recommended by the Mayo Clinic.
The first step in treating a bedsore is reducing the pressure and friction that caused it. Strategies include:
- Repositioning. If you have a pressure sore, turn and change your position often. How often you reposition depends on your condition and the quality of the surface you are on. Generally if you use a wheelchair, try shifting your weight every 15 minutes or so and change positions every hour. If you’re in a bed, change positions every two hours.
- Using support surfaces. Use a mattress, bed and special cushions that help you sit or lie in a way that protects vulnerable skin.
Cleaning and dressing wounds
Care for pressure ulcers depends on how deep the wound is. Generally, cleaning and dressing a wound includes the following:
- Cleaning. If the affected skin is not broken, wash it with a gentle cleanser and pat dry. Clean open sores with water or a saltwater (saline) solution each time the dressing is changed.
- Putting on a bandage. A bandage speeds healing by keeping the wound moist. This creates a barrier against infection and keeps the surrounding skin dry. Bandage choices include films, gauzes, gels, foams, and treated coverings. You may need a combination of dressings.
Removing damaged tissue
To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing this tissue (debridement) is accomplished with a number of methods, such as gently flushing the wound with water or cutting out damaged tissue.
Other interventions include:
- Drugs to control pain. Nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — might reduce pain. These can be very helpful before or after repositioning and wound care. Topical pain medications also can be helpful during wound care.
- Drugs to fight infection. Infected pressure sores that aren’t responding to other interventions can be treated with topical or oral antibiotics.
- A healthy diet. Good nutrition promotes wound healing.
- Negative pressure therapy. This method, which is also called vacuum-assisted closure (VAC), uses a device to clean a wound with suction.
A large pressure sore that fails to heal might require surgery. One method of surgical repair is to use a pad of your muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).
Are There Other Injuries Related to Nursing Home Bedsores?
There can be. Any resident developing bed sores should be immediately evaluated by a competent physician and wound nurse. A plan of care should be developed to treat existing wounds and to prevent additional wounds from developing.
What Should I Do if a Loved One Exhibits Nursing Home Abuse or Neglect Symptoms?
If you have reason to suspect nursing home abuse, you must take immediate action. If you believe your loved one is in imminent danger, call 911. But if you are unsure whether nursing home abuse or neglect is present in the first place, remain calm as you question the nursing home staff and management about signs of suspected abuse. Contact the Illinois Department of Public Health and file a complaint. IDPH staff can interview the nursing home staff, review the medical records, and conduct a comprehensive investigation into whether abuse and neglect occurred.
Talk to your loved one privately. Oftentimes dementia and other medical conditions make it difficult for residents to explain nursing home injuries, including pressure wounds. If staff in any way try to limit your private conversation, it is an immediate red flag.
Take photographs of any injuries or wounds. In this way, if a medical record is altered by nursing home staff to minimize the wound in records, you have an accurate reflection of what the wound actually appeared as. Request a copy of the resident’s medical records, so that if it is altered later by nursing home staff, you have a copy of what the records contained, originally.
Simply put, your loved ones are entitled to protection. If you suspect abuse or neglect, the lawyers at the Noll Law Office are happy to meet with you to provide a free initial consultation. The local, central Illinois attorneys have an office in Springfield, Illinois, directly across the street from the courthouse. The Noll Law Office attorneys are experienced and will not hand off your file to a newly graduated associate lawyer or paralegal to process. The law firm is from the community, for the community. Consult an experienced nursing home abuse attorney from the Noll Law Office if you think your loved one is a victim. The firm does not charge a fee unless it is able to successfully obtain a settlement or a jury verdict against the nursing home.
How Do I Choose the Best Nursing Home Abuse Lawyer for Me?
You need an attorney who not only understands the Illinois Nursing Home Care Act, but also has extensive experience litigating these cases. Nursing home abuse victims and their loved ones may need to share sensitive information with their attorney—and should feel comfortable doing so. Select an attorney who can provide you with compassionate counsel, while simultaneously providing aggressive representation. You need a lawyer who seeks justice for the victims or abuse and neglect.
Attorneys Sarah Noll and Daniel Noll are fifth-generation Springfield attorneys who believe strongly in treating their neighbors like neighbors. You will work with experienced personal injury attorneys directly throughout the litigation process. They are experienced in looking through medical records and nursing home policies to use the nursing homes own practice and procedures to verify if the facility even followed its own internal practices in providing care to your loved one.
Do My Loved One’s Nursing Home Abuse or Neglect Symptoms Mean I Have a Case?
Sometimes, yes. Sometimes, no. Perhaps the single most comforting thing about obtaining a nursing home attorney is that you can often obtain answers to your questions, that would otherwise go unanswered. Sometimes, nursing home injuries are just that – an unfortunate accident with injuries. Other times, abuse or neglect is involved. Obtaining an experienced nursing home attorney will help you to make sense of the medical records, agency investigative reports, and governing law, so that at minimum, you can make informed decisions on moving forward with a potential case and deciding whether to file a claim for abuse and neglect. Nursing home cases can involve elder abuse, financial exploitation, negligent hiring practices, violations of the Nursing Home Care Act, medical malpractice, breach of contract, or wrongful death and survival actions, depending on the facts and circumstances of your loved one’s case. This is obviously an incredibly difficult time for you and your loved one—you deserve an experienced attorney that can help you make sense of all of the legal technicalities and help represent your loved one following abuse or neglect. Let the Noll Law Office help you.
How Noll Law Office Can Help
The Noll Law Office believes that frequent, honest communication with their clients, advanced medical records review, and aggressive litigation experience are the key indicators of a successful outcome in nursing home litigation. As highly successful litigators, the Noll Law Office provides quality representation to their clients. At the Noll Law Office, their attorneys take pride in their deep roots and shared history with community members and neighbors — their family will fight for yours. Contact the Noll Law Office today to meet directly with an attorney.