Bedsores
One of the most common issues that we see in the cases that we handle here at The Dickson Firm are cases where a nursing home resident has developed skin breakdown, or bedsores or pressure sores or decubitus ulcers. This often happens when a person, who previously was living at home independently, suffers a fall, suffers a fracture, goes to the hospital for treatment, sometimes including surgery, and is then discharged to a nursing home for rehabilitation. Once in the nursing home, the person has reduced mobility due to their fracture. Sometimes they have a cast. Sometimes they simply have weakness. And, as a result, they need assistance. Many residents need assistance just turning over in bed. Many residents need assistance getting in and out of bed. Many residents need assistance with walking.
How Do Bedsores Develop?
One of the reasons that most of us don't develop skin breakdown is that we're constantly moving around. If you're sitting in a chair for an extended period of time you will eventually become uncomfortable and you will shift your weight or you will get up and walk around. Even if you have a job that involves sitting at a desk all day, you get up to get a cup of coffee. You get up to go to the bathroom. You get up to talk with a coworker. We rarely sit for an extended period of time without at least shifting our weight. You may notice that if you've ever been stuck in an airplane seat on a long flight, that when the plane finally lands and you get up out of your seat, you might be uncomfortable.
For nursing home residents who are unable to move around on their own, if they are neglected by the staff, if the staff does not move them on a regular basis, they can develop skin breakdown.
Skin breakdown is caused by unrelieved pressure. If a person has pressure on their skin, particularly pressure over a bony prominence, like in the area of a person's buttocks and/or their sacral region, they will develop skin breakdown. The pressure prevents blood from properly circulating and feeding the tissues. And eventually, the tissues can be damaged.
Stages of a Bedsore
A stage one bedsore is a red area. The skin is not open. But there is damage to the skin. Often these bedsores are described as being non-blanchable. If you push on an area of your skin, you will see that it turns white. When you take your finger away, you will see that the skin turns back to red. That's the blood rushing back into that area. That's known as blanchable. Stage one bedsores are non-blanchable, meaning they are red and they don't turn white when you put pressure on them. This indicates damage to that area of the skin.
Stage two bedsores are open. They are not particularly deep, but the skin is broken.
Stage three bedsores are deeper. They involve multiple layers of the skin.
Stage four bedsores are deeper still. Some stage four bedsores are so deep that they go through the skin, the muscle can often go all the way to the bone.
Some bedsores are considered unstageable because they are covered with slough or scab and therefore, their depth cannot be measured.
Complications from Bedsores
Once bone is exposed, individuals are at risk for an infection called osteomyelitis. This happens sometimes when a person suffers a compound fracture, meaning a fracture where the bone has come through the skin. This can also happen when someone has a bedsore that is so deep that their bone is exposed to the air.
Your skin is a protective barrier keeping your body safe from infection. Once your skin is open, your risk for infection is increased greatly. Particularly, if you have a bedsore in your sacral region, or your buttock region, your risk for infection increases significantly. Further, if a resident is incontinent, and they have an open bedsore, this creates a significant risk for that person to suffer infection.
How to Prevent Bedsores
The way to prevent bedsores is to turn and reposition residents who are not able to turn and reposition themselves. If a resident cannot turn and reposition themselves, then the staff at the nursing home is required to turn and reposition them. There is a federal regulation directly on point that holds that if somebody comes in without any skin breakdown, they are not to develop skin breakdown unless that skin breakdown is clinically unavoidable. Further, if a resident comes in with skin breakdown, the nursing home is legally obligated to heal that skin breakdown unless that skin breakdown is clinically unavoidable.
The standard is for the staff to turn and reposition a resident every two hours. However, if the staff is faithfully turning and repositioning the resident every two hours so they're offloading the pressure to various areas of their body, and the person still develops skin breakdown, then the nursing home is required to turn and reposition them more often than every two hours. This applies to when they are in bed. And this applies throughout the night. Residents need to be turned and repositioned every two hours, 24 hours a day. If a resident is up in a chair, then they should be turned and repositioned on a regular basis. If someone is at particular risk for skin breakdown, particularly in the area of their buttocks, they should not be left sitting in a chair for any extended period of time.
Certain medical conditions can make people more susceptible to skin breakdown. If a resident has diabetes or peripheral vascular disease or other issues that affect their circulation, this can increase their risk of skin breakdown.
Nursing homes are required to perform a comprehensive assessment of their residents and then to develop a comprehensive care plan that addresses the needs of the resident. If they develop skin breakdown, the nursing home is obligated to update the care plan and try additional interventions to heal the existing skin breakdown, to prevent additional skin breakdown, and to prevent infection.
If the resident is mentally incompetent, the staff of the nursing home should regularly communicate with their family. The nursing home is obligated to report every change in their condition, including the development of any skin breakdown and any time the skin breakdown gets worse, to their family. The nursing home should also conduct care conferences with the family to discuss different interventions to prevent skin breakdown and/or to heal skin breakdown. The nursing home should also have regular contact with the resident’s doctor. If the resident has any change in condition, that should be promptly reported to the doctor so the doctor can consider additional orders relative to the care of the resident.
How Can I Help My Loved One?
It may be challenging, and even embarrassing, to monitor the skin of your loved one while they are in a nursing home. Many individuals are reluctant to inspect the body of their loved one. People are not inclined to inspect the skin of their parents. However, if you have any concerns that your loved one is developing skin breakdown, it is important to monitor the condition of their skin. Talk with the staff. Ask them questions. Also, listen carefully to your loved one. Are they complaining? Are they complaining that they have pain anywhere? Are they telling you that their butt hurts? Are they telling you that they have any discomfort? Do you notice any smells? If your loved one is incontinent, are they keeping your loved one clean? Are they cleaning them up promptly after bowel movements and other periods of incontinence?
We recommend that you visit your loved one at all different times of the day. Visit them first thing in the morning. See how early the nursing home gets them up? Does someone help them? Does somebody get them up and help them with bathing and toileting? Visit them during mealtimes. Is the staff person helping them eat? Visit them in the evening. Also, take note of where you find your loved one when you go to visit. Are you visiting late in the morning and they are still in bed? Are you visiting them at different times throughout the day and they're always in the same chair in their room? Is the nursing home getting them out of their room? Are they taking them to do activities? Is your loved one getting regular therapy?
Talk with your loved one's doctor. How often are they seeing your loved one? Are they performing a head-to-toe exam? Do they have any concerns?
Contact an Experienced Nursing Home Abuse and Neglect Attorney
Skin breakdown can be a very serious issue. It can cause your loved one extreme pain. It can require them to receive surgery. It can cause them a severe infection. It can even be fatal. It's imperative that you monitor your loved one's care to make sure they are not suffering skin breakdown, as this can be fatal.
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.