Print this page
866–809–5167
August 29, 2003 — In California, a jury awarded $3 million in damages last year against a nursing home for allowing an elderly woman to die of bedsores (Ollison v. Eskaton Homestead of Fair Oaks et al., Sacramento Superior Court, 00AS05801). Also in California, a settlement agreement involving eight nursing homes resulted in $360,000 of civil penalties for improper bedsore treatment and other medical violations. More recently, felony charges of involuntary manslaughter and neglect were filed against a Missouri residential care facility when a resident died of bedsore wounds (Bolivar Herald–Free Press, August 22, 2003).
These cases provide just a few examples of the cost and severity of problems caused by bedsores, known also as pressure sores or decubitus ulcers. In hospitals nationwide, the incidence of bedsores ranges from 2.7 to 29.5 percent, while in nursing homes and residential facilities that figure is 23 percent (Treatment of Pressure Ulcers, Clinical Guideline Number 3, Agency Health Care Research and Quality, Publication No. 95–0652: December 1994; scroll to #3, Pressure Ulcer Prevention).
Bedsores or pressure sores form when skin and tissue break down from constant pressure and bad circulation. They occur most often in the hip, lower back, and heel areas (see encyclopedia diagrams). At first, the skin becomes red and irritated. Eventually, open sores develop. If untreated, the condition leads to destruction of muscle and even bone (see decubitus ulcer formation).
Pressure sores fall into four categories for treatment and diagnosis purposes, according to the federal Centers for Medicaid and Medicare Services. Stage 1 is an area of skin redness that does not diminish once pressure is relieved. Stage 2 is a loss of skin layers that looks like an “abrasion, blister, or shallow crater.” In Stage 3, a full thickness of skin is lost, exposing tissue. This is described as a deep crater. In stage 4, a full thickness of skin and tissue is lost, exposing muscle or bone.
Bedridden nursing home residents may develop bedsores if they receive poor nursing care. They should be moved or repositioned every 2 hours to minimize rubbing, pressure, and friction. Lubricants and protective padding may also be helpful.
Incontinent patients are particularly susceptible to bedsores because exposure to moisture from urine increases the risk of skin damage. Doctors recommend that the patient’s skin be inspected each day for signs of redness or irritation. It should be kept clean and dry (Pressure Ulcers in Adults: Prediction and Prevention, Clinical Practice Guideline #3, Agency Health Care Research and Quality, Publication No. 92–0047: May 1992; scroll to #3, Pressure Ulcer Prevention).
Some experts believe that patients with poor diets may have a greater chance of developing bedsores or pressure sores. A national study involving 2,420 residents at 109 long–term care facilities is examining the role that malnutrition and other factors may play in increasing vulnerability to bedsores (J Am Geriatr Soc. 2002 Nov; 50(11): 1816–25).
Pillows and foam wedges can help relieve pressure that leads to bedsores. A lifting device such as a specialized trapeze minimizes friction against the skin when the patient needs to be moved or transferred.
Special beds have been used in place of those with standard mattresses to reduce pressure. Low air–loss beds have surfaces filled with air from air pumps, but allow small amounts of air to escape through a network of pores. There is some evidence that using a low–air–loss bed helps heal and reduce the size of pressure sores (Ostomy Wound Manage. 1995 Jun; 41(5): 46–8, 50, 52).
Alternating pressure mattresses have built–in pumps that continually redistribute air pressure. In one study, alternating pressure mattresses proved useful in reducing the incidence of bedsores when compared with standard hospital mattresses (Age Ageing. 1995 Jul; 24(4): 297–302).
Air–fluidized beds (brand name Clinitron) have air pumped through an area with ceramic–type beads. The patient feels as though he or she is being supported by a fluid. In one study, use of these beds reduced the size and incidence of bedsores when compared with alternating pressure mattresses (Ann Intern Med. 1987 Nov; 107(5): 641–8). No definitive studies have compared the effectiveness of air–fluidized beds with low–air–loss beds.
Air–fluidized beds are very heavy and not all structures can accommodate them. Because the beds cannot be raised and lowered, transferring patients in or out of them can be difficult. They are also generally more expensive than low–air–loss beds and alternating pressure beds (Treatment of Pressure Ulcers; Clinical Guideline #15, Agency Health Care Research and Quality, Publication No. 95–0652: December 1994; scroll to #15, Pressure Ulcer Treatment).
One nonprofit group, the National Decubitus Foundation considers air–fluidized beds “the only engineering solution that removes the cause of the pressure wound.” The group decries the present Medicare payment schedule and calls for the use of air–fluidized beds in most long–term care situations. It calculates how use of air–fluidized beds would actually cut costs as well as ease suffering.
You can locate medical journal articles about special beds, bedsore prevention, and bedsore treatment through the National Library of Medicine web site (search on bedsores, pressure sores, decubitus ulcers, or on the different special bed types). For more general information about bedsores or pressure sores, see the web sites of the National Pressure Ulcer Advisory Panel and the Gale Encyclopedia of Medicine. If you have questions about the legal rights of an elderly loved one and nursing home neglect, including bedsore problems, please contact us at Brayton Purcell. We are experienced in all areas of elder abuse law, including neglect and inadequate pain management issues.
This article can be found at , a web site sponsored by the law firm of Brayton Purcell for educational purposes. Please read our disclaimer and privacy policy.
© Brayton
Purcell LLP 2002–2008
All rights reserved.