One of the most common forms of elder abuse in nursing homes is the pattern of neglect which leads to pressure sores. Pressure injury sores are also known as decubitus ulcers or bed sores. The reason they are called “bed sores” is that pressure sores usually result on areas of the body which are considered the “pressure points” when a person is in bed on their back. These areas are the most prone to pressure sores and include: the back of the head, the shoulders, and more so to the rear end in the coccyx region and the heels of the feet. If a person is unable to ambulate and turn themselves in the bed it is essential that the facility staff assists with this basic activity. Nursing homes need to maintain adequate numbers of well trained staff to be able to provide care which is essential for good health, such as food, water, turning and repositioning, assistance with toileting to avoid urinary tract infections and infectious disease.
What are the Risk Factors for Pressure Sores?
• Inability to reposition in bed, chairs, etc. without assistance • Repeated infections, such as MRSA, C-Diff., VRE • Diabetes • Malnutrition or inadequate nutrition • Urinary incontinence • Past history of dehydration • Multiple chronic conditions such as UTIs • Use of medications such as: diuretics, antidepressants, psychotropics, or anti-anxiety medications, laxatives, or steroids
What are the Federal Regulations Which Pertain to Nursing Homes and Pressure Sore Prevention?
There are federal and state regulations which pertain to the care and treatment nursing home residents and measures which must be taken to reduce the risk of receiving pressure sores and required measures once a sore has started. The 42 CFR 483. Nursing Home Regulationswhich regulation overns nursing homes considers pressure ulcers to Be “AVOIDABLE” and therefore preventable: Pressure sores. Based on the comprehensive assessment of a resident, the facility must ensure that—(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. 42 CFR 483. Nursing Home Regulations Minnesota Statute 144A.04, Subd. 12. mandates that the position of residents unable to change their own position must be changed based on the comprehensive assessment and care plan.
Skin Assessments Wound Staging and PUSH Charts Can Reduce Pressure Sore Risk
Preventative measures are important to reduce pressure sores in nursing home residents, in addition, once there is any noticeable change in the condition of the skin the nursing home should be taking efforts to document the size, shape and other characteristics of the wound to assist with monitoring its progress towards healing or a worsening condition. Pressure Sore Staging is a critical part of proper wound care and treatment. The National Pressure Ulcer Advisory Panel, NPUAP has developed illustrations of the categories/stages of pressure injury ulcers (Category/Stage 1-4, suspected deep tissue injury, unstageable). These pressure sore illustrations can be downloaded from the NPUAP website directly to your computer at no cost, if for educational purposes.
- Category/Stage One Pressure Injury
- Category/Stage Two Pressure Injury
- Category/Stage Three Pressure Injury
- Category/Stage Four Pressure Injury
- Suspected Deep Tissue Injury
The NPUAP developed the Pressure Ulcer Scale for Healing (PUSH Tool) was developed by the National Pressure Ulcer Advisory Panel (NPUAP) as a quick, reliable tool to monitor the change in pressure ulcer status over time.
- PUSH Tool (web version)
- PUSH Tool (pdf version)
- Reprint Agreement (pdf)
- Information and Registration Form
- Instructions for Using PUSH
The CDC produces materials on the issue of pressure ulcers among nursing home residents. Here is additional information on bed sore identification, treatment and other pressure sore resources. Healthline has an article on the causes and treatments, which include unrelieved pressure, poor hydration, lack of nutrition, lack of movement, etc. If someone you love has suffered from a pressure sore or other serious injury due to poor care in a nursing home or other elder residential facility you need an experienced Attorney with a history of holding negligent nursing homes accountable. Contact attorney Kenneth L. LaBore who handles cases throughout Minnesota at 612-743-9048 or toll free at 1-888-452-6589. Ken can be reached by email at KLaBore@MNnursinghomeneglect.com.
This article is for educational purposes and is not legal advice only see an attorney for a legal opinion, please see my disclaimer.