Bedsore FAQ

What are bedsores or pressure ulcers and how do they develop?

Bedsores are also called pressure ulcers or decubitus ulcers. Bedsores develop when a patient is left lying or sitting in the same position for too long, restricting the flow of blood to the area of the body that is bearing the patient's weight. Once blood stops flowing to any area of the body, the skin and surrounding tissues begin to die. The primary cause of a stage 3 or stage 4 ulcer is neglect.

Bedsores are classified in four stages:

Stage 1: The skin appears discolored. On light skin, a bedsore will usually appear pink or red. On dark skin, it may appear ashen or slightly darker than usual. The skin may also feel slightly itchy or tender.

Stage 2: The skin is red, swollen, and has blistered or progressed to an open wound.

Stage 3: A stage 3 bedsore involves destruction of a full layer of skin and extends into the underlying subcutaneous tissue layer. Necrotic (dead) tissue may be present which is usually black in color, but may appear to be hard red or white tissue. Neglect is the primary cause of a stage 3 ulcer.

Stage 4: A stage 4 ulcer extends down into deeper soft tissues (muscle and ligaments) and may proceed all the way down to the bone. Sometimes, the ulcer is covered by a thick black scab (eschar). Neglect is the primary cause of a stage 4 ulcer.

Not all patients complain of severe pain when a bedsore is developing. A vague complaint such as "My back is sore" may be an early warning sign. Sometimes, medication prescribed for other injuries dulls the pain of a bedsore and prevents early detection. Or, if a patient has suffered nerve damage, the patient may not experience any pain at all. For all of these reasons, it is important that caregivers regularly perform thorough "skin checks" on their patients, whether they complain of pain or not. Do not assume that because your loved one is in a nursing home, he or she is being examined on any regular basis.

Where on the body are bedsores most likely to develop?

Bedsores develop due to constant pressure and lack of circulation. For this reason, the most common areas for a bedsore to develop are "bony" areas that bear a patient's weight when the patient is lying in bed or sitting in a wheelchair. These areas include:

  • Lower back or tailbone
  • Hips
  • Buttocks
  • Heels
  • Back of the head and ears
  • Elbows

Because many of these areas are often covered by a nightgown or adult incontinence brief, they are not usually visible to visitors. For this reason, many family members are shocked when they learn — often too late — that their loved one has developed a stage 3 or stage 4 bedsore at a hospital or nursing facility.

What can I do to prevent this from happening?

The best prevention against a bedsore is body movement, so that the patient's blood can freely circulate throughout the body. Do not assume that the staff is repositioning your loved one. If possible, encourage him to stay out of his bed or wheelchair, or move around as much as possible. If the patient's health prevents this, he must be turned and/or repositioned at least every two hours. Frequent turning or repositioning prevents prolonged pressure on any one area of skin, and thus deters bedsores.

Family members should consistently look for skin discoloration on the patient's body. This is usually the earliest sign that a bedsore is developing. Do this even if the nursing staff reassures you that they are already taking care of this. Well-trained, reputable nurses will welcome the help of family members in conducting "skin checks." Less-than-dedicated nurses may feel threatened by the family's involvement, but will also understand that the family is supervising their work, and may be more diligent with your loved one.

If you have any suspicion that a bedsore is developing, immediately notify both the head nurse and the Director of Nursing. Do not be intimidated by nursing staff. In this situation, it is often the "squeaky wheel" that receives the care. Make sure that the attending physician has also been notified. Bedsores can develop very quickly, sometimes in mere hours.

If a bedsore is not identified and aggressively treated, it will likely progress and may become infected, especially if the patient is incontinent. Be proactive. Continue to check for new bedsores, and signs of progression or infection. If you believe that the staff at a hospital or nursing home is not providing the care or services needed by your loved one, consider the following:

  • Meet with the Director of Nursing, Administrator and/or owner of the facility;
  • File a written grievance report with the facility;
  • Demand to speak with or meet with the attending physician;
  • Hire an independent nursing agency or doctor to evaluate the patient; and/or
  • File a complaint with the Department of Health Services.

Finally, keep a journal. Write down the names and titles of the people you speak to, as well as dates, times and the content of your conversations. Let them see you doing this, so that they know you are an organized and credible witness to their neglectful conduct. This may cause them to increase their caregiving efforts toward your loved one. If not, your records will provide a detailed and powerful history of your loved one's neglect, if litigation becomes necessary.

When is a bedsore the result of neglect?

Bedsores can happen anywhere, not only in nursing homes. One of our clients even developed a stage 4 bedsore while in the Intensive Care Unit of a reputable hospital. It is natural for us to assume that nursing staff will regularly and diligently check our loved ones for signs of a developing bedsore. Sadly, this is not usually the case, especially in nursing homes where the nurses are underpaid, overworked and not properly trained. One or more of the following may indicate that a bedsore developed or progressed due to neglect:

  • The patient was not turned or repositioned regularly (at least every 2 hours), especially patients who spend a lot of time in bed or in a wheelchair.
  • The staff failed to use pillows or other devices to position the body and relieve pressure over bony prominences.
  • The patient was not bathed regularly, and his or her skin was not kept clean, dry and free of feces and urine.
  • The staff failed to notify the doctor when a bedsore first developed or continued to progress.
  • The patient was not provided a special pressure-reducing mattress when he or she developed a stage 1 or stage 2 ulcer.
  • The patient did not receive adequate liquids, a protein-rich diet, or sufficient vitamins and minerals so that his or her body could fight infection and repair skin breakdown.
  • The staff failed to monitor and promptly report signs of infection to a doctor .

What can I do if I think my loved one developed a pressure ulcer because of neglect?

If you believe your loved one was a victim of neglect, contact The Gebler Firm, PC, for a free consultation. We are available to speak with you by phone at 818-876-9600 or you may submit an online consultation request.

We would be honored to speak with you about your rights and explain the options that are available. We do not charge any attorney fees unless we obtain a recovery.

We know this is a difficult time, but don't delay. The law limits the amount of time to pursue legal action. In some cases, this can be as short as six months.

With offices in Calabasas and Long Beach, our elder abuse lawyers advise and represent clients throughout Southern California.

Disclaimer: The information on this site is for informational and educational purposes only. None of the medical information is intended to be a substitute for professional medical judgment. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.