Placing a loved one in a nursing home or assisted living facility is not an easy decision.  Given the choice, nearly everyone would keep their loved ones home and personally care for them.  Unfortunately, however, some individuals are too sick and immobile and require the intense, round-the-clock care only nursing homes or assisted living facilities provide.

Most nursing homes and assisted living facilities provide excellent care people expect.   Sadly, though, some abuse and neglect their patients.  This can cause various injuries and dangerous situations.  In this blog, we will examine bedsores.  This is part one of a series.

What Are Bedsores?

Bedsores, or decubitus and pressure ulcers, result from extended skin pressure, which cease skin blood supply.  If the pressure goes on for more than two or three hours, the skin starts to die.   Bedsores typically develop along the body’s bony areas, such as the hips, ankles, tailbone, and heels, but they can also occur elsewhere on the body.  Patients who cannot change their positions or who spend a lot of time in bed or in a chair have the greatest bedsore risk.

Friction also causes delicate skin to become more susceptible to damage, particularly if it is also wet.  This occurs when skin moves against bedding or clothing.

Shearing can also pull on the skin.  Shearing takes place when two exteriors move in opposing directions.  This can happen when a bed is raised – the bed goes up and the patient slides down, causing the tailbone and skin to shear.

Bedsore Risk

Bedsore probability is higher when patients have difficulty moving and can’t easily change position while seated or in bed. Other risk factor include:

  • Incontinence
  • Conditions that cause loss of sensory perception (e.g. spinal cord injuries and neurological disorders)
  • Conditions that affect blood flow (e.g. diabetes and vascular diseases)
  • Poor hydration and nutrition

Bedsore Treatment

Bedsores can heal with proper treatment, but some, especially advanced ones, never improve.   Treatment includes:

  • Cleaning the wound and protecting it with dressings and medicated gauze.
  • Providing healthy nutrition.
  • Relieving pressure.
  • Negative wound pressure therapy.
  • Debriding the infected, dead, and damaged tissue (a surgical procedure).
  • Skin grafting healthy skin over the bedsore.

Bedsore Stages

The National Pressure Ulcer Advisory Panel established the following bedsore classification system:

Stage 1:  skin appears discolored or red and may feel warm or hard.

Stage 2:  skin is ruptured.  Sore is superficial.

Stage 3:  sore has deepened past the skin into the fatty tissue.

Stage 4:  sore has extended into the muscle and potentially the bone.

There are two additional, more serious classifications:

  • Unstageable: depth cannot be determined.
  • Suspected Deep Tissue Injury (SDTI): surface looks like Stage 1 or Stage 2, but underneath the bedsore is Stage 3, Stage 4, or Unstageable.

Preventing and Identifying Bedsores

Since bedsores are a common concern, nursing homes and assisted living facilities have guidelines to prevent and treat them.  Prevention involves:

  • Repeatedly repositioning the patient.
  • Making sure skin is dry and cool.
  • Customized mattresses and pillows.
  • Specialized pillows or mattresses.
  • Motion activity.
  • Daily skin inspections

Bedsore Complications

Complications may occur even with the finest attention and care.  Grade 3 and above bedsores can lead to life-threatening complications.  They include:

  • Septic arthritis (joint infections)
  • Osteomyelitis (bone infections): if not treated can spread to the blood (see septicemia) or the underlying joint or bone, and in rare cases, to the spine and brain (meningitis).
  • Cellulitis (skin layer Infections): if not treated, can spread to the blood (see septicemia).
  • Septicemia (blood poisoning): this can spread through the blood to other organs and eventually become fatal.
  • Gas gangrene: a rare infection that requires immediate debridement (surgery).  The most serious cases may require amputation of infected limbs.
  • Necrotizing fasciitis (flesh-eating bacteria): an extremely serious skin disease that leads to sudden tissue death.   Requires skin debridement (surgery).

We will continue to examine nursing home and assisted living facility bedsores in future blogs.

Thomas D. Bumgardner can help if you think a loved one is experiencing nursing home or assisted living facility abuse.  He takes action against those who abuse the elderly.

He can also help you make decisions about a living situation for an elderly family member.

Contact him at 704-887-4981 to learn more about how he can help you.