During Thanksgiving and Christmas many people travel to see family members. They often see their loved ones in various nursing homes. Sometimes they see their loved ones in a nursing home, and it has been some time since they have seen them in person. Even family members who keep in constant contact with their loved ones by telephone, are often surprised to find the condition of their loved ones when they finally see them in person. This often takes place around the holidays. In December and January we receive a lot of calls from family members with grave concerns about their loved one in the nursing home.

One of the most common problems that we see with nursing home residents is skin breakdown. What often happens is that a person who is living at home on their own, independently, and is mobile, has no issues with skin breakdown. They get up every morning. They are able to get up on their own. They are able to take a shower on their own. They are able to move around throughout the day. So they do not have issues with skin breakdown. Then they suffer a fall. Often they suffer a fracture. They go to the hospital where they sometimes have surgery. Then they are admitted to a nursing home for rehabilitation. In the nursing home, they are less mobile than they were before, and as a result, they need help. They rely on the staff at the nursing home to help them.

If someone is at risk for skin breakdown, and they are not able to turn and reposition themselves, the nursing home must turn and reposition them every two (2) hours when they are in bed and often more often when they are sitting in a chair. If that is not sufficient, then the nursing home has to increase the frequency of turning and repositioning the person.

When you are sitting in a chair, notice that eventually you will move around, reposition yourself. If you are laying in bed, you will eventually roll over. If you are on a long plane flight or a long car ride and you cannot get up and move around, at the end of the flight or car ride you may feel stiff. Your buttocks may feel numb.

Skin breakdown is caused by unrelieved pressure. If a person has unrelieved pressure on an area of their body for an extended period of time, it impedes the blood flow and the tissue dies.

Bedsores are staged in stages from 1 to 4.
A Stage 1 bedsore is a reddened area that has not yet opened.
A Stage 2 bedsore is open.
A Stage 3 bedsore is open and deeper.
A Stage 4 bedsore often goes all the way down to the bone.

Some bedsores are unstageable because they have eschar over the top of the bed sore so the depth cannot be determined. But all of these bedsores come from unrelieved pressure. The more unrelieved pressures on any area of the body, the worse the bedsore becomes.

These bedsores also make the resident vulnerable to infection. One of the main functions of your skin is to protect your body. Once you have an open area on your body, you are very susceptible to infection. This is particularly true of skin breakdown around the coccyx or buttock area. Bed sores often occur in an area of pressure on the body. We see a lot of bedsore cases where the person's bedsore is on their coccyx or buttock area because there is always pressure on that area when the resident is sitting and/or when the resident is lying down. We see bedsores on a person's hips. We sometimes see bedsores on a person's heels. We see skin breakdown in a lot of areas of the body.

The key to preventing bedsores is to relieve the pressure. If someone you love is at risk for skin breakdown, they must be on a turning and repositioning schedule. You should ask the nursing home to show you the care plan, and show you that section of the care plan that tells the staff to turn and reposition your loved one every two (2) hours. You should ask the nursing home to show you the documentation that your loved one is being turned and repositioned every two (2) hours. If the documentation is incomplete, you should be concerned. If the nursing home cannot show you a specific area of the care plan where the staff is instructed to turn and reposition your loved one every two (2) hours, you should be concerned.

Oftentimes nursing homes tell family members that skin breakdown is unavoidable.

Sometimes this is true. One of the questions to ask yourself is, has your loved one suffered skin breakdown in the past? Do they have advanced diabetes? Do they have peripheral vascular disease or other circulatory problems? If the skin breakdown is being caused by poor circulation and it is happening from the inside out, then that skin breakdown may be unavoidable. However, if your loved one does not have a history of skin breakdown, and/or does not have diabetes or peripheral vascular disease or other circulatory problems, it is very likely that the skin breakdown is simply being caused by unrelieved pressure. You should absolutely talk with the nursing home and ask them what their plan is to either prevent skin breakdown or to heal your loved one's skin breakdown. You should also talk with their doctor and ask their doctor if the skin breakdown is truly clinically unavoidable. Try and talk with a doctor that's not affiliated with the nursing home. If you talk with the medical director at the nursing home, he may give you an answer that is designed to cover up for the nursing home.

We talk to families every day who have a loved one in a nursing home that has suffered skin breakdown. These cases can be very serious. Bedsores can absolutely be fatal. If you are concerned that your loved one is not receiving appropriate care in a nursing home, you should think very strongly about moving them to a better nursing home.

If someone you love has been neglected or abused in a nursing home, please call us at The Dickson Firm at 1 800 OHIO LAW as we would be happy to talk with you and help you in any way that we can.