Bed sores are also known as pressure ulcers or decubitus ulcers. They represent a significant threat to the health and well-being of nursing home residents, and are a focus of the care-planning process, most commonly using the Braden Scale as a tool for evaluating a resident’s risk of developing bed sores.
Intact skin is the most effective barrier to having infecting organisms enter your body. A skin breakdown such as a bed sore opens up the body to having bacteria which can cause infections like cellulitis and osteomyelitis.
Bed sores are graded on a scale of I through IV, with IV being the worst. These are the characteristics of each stage:
Stage 1 – a localized area of non-blanchable erythema. What this means in practice is that when you put pressure on a portio of your skin, it turns white, but then “pinks up” quickly. People suffering from a Stage 1 pressure ulcer do not “pink up” in that same way. Stage 1 pressure ulcers can be difficult to identify in people with darker skin tones. In a Stage 1 pressure ulcer, the skin is still intact.
Stage 2 – Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. Most often bed sores are first noticed when they are Stage 2 wounds because they have redness and depth to them. Generally, Stage 2 pressure ulcers by themselves do make not make for a viable nursing home abuse and neglect case and frequently these wounds heal without significant complication.
Stage 3 – Full-thickness loss of skin, in which adipose tissue (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant fat can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. Stage 3 bed sores are significant wounds because there has been a significant breach in skin integrity which presents a higher risk of infection.
Stage 4 – Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. Stage 4 bed sores are the most severe and present a significant risk that the resident will develop a bone infection called osteomyelitis. Stage 4 wounds are very difficult to get healed and many times will require aggressive measures such a surgery or placement of a wound vac to help get the wound healed.
Besides the 4 conventional stages of bed sores, there two other types of pressure ulcers that nursing home residents and their families should be aware of:
Unstageable pressure ulcer – This is a wound where the base of the wound cannot be seen because of the presence of dead tissue within the wound bed. By definition, these are at least Stage 3 or Stage 4 pressure ulcers.
Deep Tissue Injury – Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. These wounds often start off looking like a blister and then may open up rapidly to show tissue loss at much deeper levels, consistent with a Stage 3 or Stage 4 pressure ulcer.
In our practice, we commonly take on cases involving Stage 4 bed sores, unstageable pressure ulcers, and deep tissue injuries. There some circumstances where we would undertake a case which primarily involves a Stage 3 wound, but that would be an unusual case. We believe that these are important case to investigate and prosecute because the development of a bed sore is a sign of long-standing neglect. Contact our experienced Chicago nursing home lawyers for a free confidential evaluation your case and to learn more about what your rights are.