Pressure Ulcers: Guide By – Nursing Home Bed Sores Lawyer
Pressure sores are preventable. One common question people ask is: “Can you sue a nursing home for bed sores?” The answer is: if they were caused by neglect, absolutely! When bed sores develop or worsen, this is frequently a sign of elder abuse & neglect. As Los Angeles nursing home bed sores lawyer, Cherepinskiy Law Firm is an expert in this field, and his firm will zealously advocate for the rights of the pressure sore victims or their families.
Decubitus Ulcers and Other Terminology Applicable to Pressure Injuries
If assisted living facilities and nursing homes do not utilize proper preventative measures, older individuals who have cognitive impairments (e.g. dementia) and/or physical limitations (e.g. inability to reposition themselves in bed without assistance, incontinence, and poor blood circulation) are at a significant risk of developing bedsores. These pressure injuries are commonly known as “pressure sores”, “pressure ulcers”, “bedsores”, “bed sores” as well as the purely medical term “decubitus ulcers”.
What Causes Bedsores in Nursing Homes?
Lack of movement and pressure on the skin (typically, over a bony prominence) cause reduced blow flow which, in turn, leads to degenerating, red, and frequently painful skin areas or open ulcers – i.e. bed sores. Pressure sores can be worsened by friction, shearing (when skin and the bone underneath move in opposition directions), and exposure to feces, urine, and other irritating fluids and substances which are in contact with the person’s skin. The areas of the body that are most susceptible to bedsores are – the back side of the head, hips, sacrum (the triangular bone in the lower back located between the two pelvic hipbones), back, as well as shoulders, elbows, ankles, and hills. When evaluating cases, the nursing home bed sores lawyer would review the pertinent medical records describing the condition of these areas during the suspected period of neglect.
Bed Sore Stages
In 2016, the National Pressure Ulcer Advisory Panel updated the definitions of pressure injuries of the skin. With respect to their stages, decubitus ulcers are divided into 4 categories (“stages”) depending on the level of skin and tissue damage:
Stage 1 Bed Sore
A Stage 1 bed sore is formally defined as a non-blanchable erythema – an area of red but still intact skin, which does not lose redness when pressed. The affected area may become painful and differ in firmness or temperature when compared to adjacent tissue.
Stage 2 Bed Sore
A Stage 2 pressure ulcer involves partial-thickness skin loss with exposed dermis – i.e. the wound blisters or ruptures leading to the opening of the inner layer of the skin that contains nerve endings, blood vessels, hair follicles, and other structures. The wound frequently appears as a dry or shiny shallow sore without any visible slough (non-vital yellow skin) or eschar (dead tissue that falls off the surface of the skin).
Stage 3 Bed Sore
A Stage 3 bed sore is defined as a full-thickness skin loss — the skin is lost completely showing fat and the formation of new tissue (granulation). Sometimes, slough or eschar can be visible as well. Bones, muscles, and tendons are neither visible nor palpable.
Stage 4 Bed Sore
A Stage 4 bedsore occurs when there is a full-thickness skin and tissue loss – i.e. the ulcer becomes so deep that tendons, ligaments, muscles, or even bones become visible or palpable.
Unstageable Pressure Injury
In some cases, when the severity of the wound cannot be assessed due to the presence of slough or eschar, these ulcers are called “unstageable pressure injury”. The removal of sough and/or eschar reveals the extent of the tissue damage – typically, a Stage 3 or Stage 4 pressure ulcer.
Deep Tissue Pressure Injury (also referred to as “DTP” or “DTPI”)
This injury is defined is an area of persistent purple, deep red, or maroon discoloration of intact or non-intact skin, which does not lose redness when pressed (i.e. it is non-blanchable). A very severe injury (such as Stage 3, Stage 4, or unstageable pressure ulcer) is diagnosed when the wound is so deep that muscles, bones, tendons, ligaments, or necrotic (dead) tissue becomes visible.
Prevention of Pressure Ulcers
In terms of skin care, the main goal is to prevent pressure sores because, once they develop, healing can take months or even years. In fact, if bedsores are not treated, they can become infected and lead to gangrene, sepsis, septic shock, and even death.
Elder care institutions such as nursing homes and assisted living facilities must properly and comprehensively evaluate each patient / resident’s level of mental and physical functioning, including the risk of skin breakdown, mobility, nutrition & hydration, and cognitive status. In addition to ensuring adequate staffing levels, facilities must develop appropriate and individualized Care Plans providing for timely repositioning, skin care, proper nutrition, and other measures aimed at bed sore prevention. In cases involving pressure ulcers, a nursing home bed sores lawyer will be looking for evidence of elder care facilities’ failures to take steps to prevent bed sores from appearing or worsening.
Repositioning remains the “gold standard” method of pressure ulcer prevention. Bedbound nursing home patients and assisted living residents must be repositioned from their back to the sides every 2 hours, at a minimum. Repositioning relieves pressure over those areas that are over bony prominences and are, therefore, more susceptible pressure injuries – back of the head, ears, coccyx (tailbone), buttocks, hips, shoulders, elbows, heels, inner knees, and ankles.
Typical Areas of Human Body Which Are Susceptible to Pressure Sores
Those providing care to elderly individuals (assisted living caregivers and nursing home staff) have to use appropriate techniques when turning & repositioning and avoid friction-causing methods such as dragging residents / patients along their beds. If necessary, a special draw sheet must be used for repositioning.
Those who spend most of the day in a wheelchair must be provided assistance with repositioning on an hourly basis, and they should be encouraged / assisted to shift their weight at least 3-4 times per hour. Elderly individuals who are still able to ambulate on their own must be encouraged to walk or, at least, stand as much as possible. Standing & walking keeps pressure off vulnerable areas and prevents the formation of pressure sores.
Proper Skin Care
Caregivers must provide head-to-toe skin assessments of nursing home patients and assisted living residents on a daily basis. Special attention must be paid to the most vulnerable areas – back of the head, coccyx (tailbone), hips shoulders, elbows, heels, and ankles. When washing, a soft sponge or cloth should be used. Moisturizing creams and skin protectants should be applied to the skin every day. When washing elderly people, their bodies must not be scrubbed, and talc powder and/or strong soaps must be avoided.
Nutrition and Hydration
Consumption of proper amounts of calories, protein, vitamins, and minerals is crucial for maintaining healthy skin and preventing bedsores. Drinking plenty of water every day and staying hydrated is equally important. If nursing home patients and assisted living residents have physical and/or mental impairments, they must be provided with the appropriate encouragement, guidance and, if necessary, physical assistance with meals and fluid intake in order to ensure adequate nutrition and hydration.
Other Bed Sore Prevention Methods
The following clothes increase the risk of developing pressure sores and must be avoided: clothes that are very tight and/or clothes with buttons, zippers, and thick seams which can press on the skin. In addition, clothes should not wrinkle or bunch up in the areas that are susceptible to pressure injuries – e.g. coccyx (tailbone), hips shoulders, elbows, heels, and ankles.
After urination or a bowel movement, the area must be cleaned and dried very well. Excessive moisture in the genital and pelvic area can quickly lead to the formation of a pressure sore. Bedridden patients must never be allowed to lay for hours in their urine and feces which, unfortunately, does happen in some extreme cases of nursing home neglect involving incontinent patients.
Foam mattresses or those filled with gel / air help in preventing bed sores, as well as a soft cushion or foam placed between parts of the body that press against each other or the bed. When a patient is lying on a side, a pillow or a soft cushion helps with pressure reduction if placed between ankles and knees. If a resident is bedridden, when lying on his / her back, soft pillow or a foam cushion should be placed under the following areas: coccyx (tailbone), shoulders, elbows, and heels or calves. Bed sheets have to be smooth and dry (without wrinkles).
Any sharp or hard objects, such as pencils, pens, coins, must be removed from the patient’s bed. Finally, the head of the bed should not be elevated higher than a 30-degree angle for the following reason: if the head of the bed is raised higher than 30 degrees, it causes people to slide down which, in turn, causes shearing and increases the risk of skin breakdown.
Appropriate Staffing Levels Help with Pressure Ulcer Prevention
A nursing home – acquired bed sore can quickly lead to catastrophic consequences. Preventing bed sores in nursing homes must be administrators’ first priority. When a nursing home generates an adequate care plan, but it is understaffed – i.e. it simply does not have sufficient staff members to reposition patients, assist with nutrition & hydration, and provide other pressure ulcer preventative measures – the care plan becomes meaningless. The methods for pressure ulcer prevention must be used in conjunction with appropriate numbers of qualified staff members.
Treatment of Pressure Sores
Treating pressure ulcers is very difficult, and it requires a multi-modality approach. Less severe (lower stage) bedsores may heal within several weeks with appropriate treatment. However, very significant (high stage) open ulcers may take months or even years to heal, may require a surgery and, in some tragic cases, may never heal leading to a fatal outcome.
Several treatments are commonly utilized to promote the healing of pressure ulcers. An overview of these bed sore treatments, as provided by the nursing home bed sores lawyer at Cherepinskiy Law Firm, is as follows:
Pressure relief and reduction is the simplest method of pressure ulcer control. The pressure is removed from the sore by repositioning / moving a resident. Another pressure relief method involves the use of pillows, cushions, or foam pads to support and prop up the affected parts of the patient’s body.
Wound Cleaning and Dressing
Pressure ulcers must be clean and dry to promote healing. Relatively minor sores may be cleaned with water and the gentle application of mild (not strong) soap. Open pressure ulcers must be washed with a solution of saline every single time the wound dressing is changed. Timely changed and carefully applied wound dressings serve to speed up the healing process and protect wounds from infections.
Debridement of Dead Tissue
Dead or infected tissue prevents wound healing. Accordingly, necrotic (dead) tissue must be removed through the process of wound debridement.
Genital and pelvic area moisture prevents the healing of pressure ulcers, and in fact, makes the patients’ condition worse. Therefore, incontinence must be controlled as much as possible.
Antibiotics and Antibacterial Medications
If pressure ulcers do now show signs of healing within two weeks or appropriate wound care (timely wound cleaning and dressing), antibacterial medications may be prescribed to promote healing. If pressure sores become infected, then antibiotics must be administered either as oral medications or in the form of antibiotic creams and ointments.
Negative pressure wound therapy (which also referred to as the “vacuum-assisted therapy” or “wound VAC” procedure) can be a very effective treatment technique for bed ulcers. Due to its simplicity and effectiveness, this modality has seen increased use and popularity during the recent years. A piece of foam is inserted into the pressure ulcer, a perforated drain is placed on top, and the entire area is firmly covered. Then, the open end of the drain tube is connected to a vacuum-creating device, and fluid is drawn from the sore into a special reservoir. The removal of fluid reduces colonization of bacteria and the risk of infections, thereby facilitating wound healing and significantly improving healing time.
Unfortunately, some bed sores become so critical and severe that a surgery becomes inevitable. A surgical procedure called “flap reconstruction” involves taking a muscle, skin, or tissue from a healthy area of a patient’s body and grafting / placing it over the pressure ulcer. The goal of surgical intervention is to reduce the risk of further infection and other complications by cleaning and covering the wound.
Take Action! Promptly Contact a Los Angeles Nursing Home Bed Sores Attorney for a Free Consultation
Pressure ulcers are preventable wounds. Therefore, if a nursing home patient or an assisted living resident develops a pressure sore or it gets worse (i.e. deteriorates to a higher stage), it is frequently the sign of nursing home neglect or assisted living neglect. Untreated bed sores can become infected and lead to gangrene, sepsis, septic shock, and even wrongful death. When it comes to nursing homes, understaffing is typically one of the main reasons patients are neglected to the point when they develop bed sores. If a resident of an assisted living facility develops a pressure ulcer, usually, this means that the facility accepted or retained a resident who needed a higher level of care than this assisted living facility was licensed and able to provide.
If you suspect or believe that you or your loved one’s pressure ulcer(s) was /were caused or aggravated by the negligent or reckless misconduct on the part of a nursing home or an assisted living facility, it is crucial to immediately consult with a Los Angeles nursing home bed sores attorney. Please call or fill out an electronic contact form today to request a free consultation. Cherepinskiy Law Firm will work tirelessly to make sure the wrongdoers are brought to justice, and to obtain the maximum compensation through a resolution or a trial.
This firm provides legal services for the pressure sore victims and their families throughout California, including Los Angeles and Orange Counties, as well as Riverside, San Bernardino, and Ventura Counties.