Bedsores:

Stage 2

Bedsores are a major health concern for nursing facility residents, especially those with limited mobility. Bedsores pose a serious health risk, and if left untreated, they can cause significant and sometimes fatal health complications.

The CDC reports that around 11% of nursing home residents develop bedsores—stage 2 appearing most commonly in surveys. Early developing bedsores can be easy to miss. By the time the condition has progressed to stage 2, it’s more likely to produce a visible open sore and result in severe pain. Stage 2 bedsores can continue progressing to later stages and cause additional severe health conditions.

Bedsores are frequently a sign of nursing home neglect. If an elderly or disabled family member has developed bedsores as a resident at an assisted living facility, they may be a victim of neglect or mistreatment. You can protect your loved one by learning the signs of stage 2 bedsores and what to do if they develop.


What is a stage
2 bedsore?

A bedsore is a type of ulcer. Bedsores typically occur in immobile individuals, and they’re caused by prolonged friction or pressure to the skin from lying in a bed or sitting in a wheelchair.

Bedsores are categorized in four stages according to the degree of severity. There are four stages of bedsores. Each increasing degree indicates more severe damage and more urgent health concerns.

Stage 1 bedsores are characterized by skin discoloration. The affected skin may be warm or cold to the touch, and the individual might complain of pain, burning, or itching. However, in a Stage 1 bedsore, the overlying skin is still intact.

Stage 2 bedsores have progressed to cause damage to the skin. This may present as a shallow open wound, or as a blister or scab. Besides the damage to the skin, the surrounding area is also discolored. A bedsore that has reached stage 2 is extremely sensitive, so an individual who is conscious will likely experience a high level of pain.

What are the signs of
stage 2 bedsores?

Stage 2 bedsores are very noticeable and painful. They can have differences in appearance and formation, but stage 2 bedsores always affect the deeper layers of the skin. Usually, they are characterized by the presence of some type of open wound, but occasionally the skin surface may be intact even though the deeper skin tissues are damaged. Diagnosing a stage 2 pressure ulcer involves assessing its appearance, depth, and the degree of pain. For an accurate diagnosis, a doctor would need to examine the area.

The most common signs of a stage 2 bedsore include:

  • Intact or ruptured blister
  • Moisture or pus coming from the sore
  • Discolored or irritated skin
  • Dark scabs
  • Skin warm to the touch
  • High level of pain

Bedsores are often first diagnosed at stage 2 due to the appearance of a sore and the complaint of severe pain. 

However, sometimes individuals aren’t able to feel or communicate this pain. When a patient is unconscious or lacking sensation, there’s a higher risk of stage 2 bedsores continuing to progress into the next stages.

What parts of the body are commonly affected by stage 2 bedsores?

Bedsores are caused by sustained pressure or friction from a bed or chair. Pressure reduces blood and oxygen flow, damaging or destroying the affected tissue. Thus, the body parts most commonly affected are those that sustain the most pressure from a seated or reclining position. 

Bedsores are most commonly found on the:

 Buttocks        

   Hips           

 Legs

 Back or sides of the head         

    Ankles      

   Tailbone

    Lower back

   Arms

       Heels 

Any body part under sustained pressure can develop bedsores. Whether the individual spends more time seated in a wheelchair or lying in a bed will impact which areas are affected.

Who’s most at risk of developing
stage 2 bedsores?

Bedsores pose a high risk to the elderly and other people rendered immobile by health conditions. These painful ulcers are most common for bedridden individuals. 

People at highest risk of developing bedsores include those who are:

  • Unconscious
  • In a coma
  • Unable to feel pain
  • In a wheelchair
  • In a cast

Although individuals with these health conditions are most likely to develop bedsores, they can happen to anyone dealing with immobility over an extended period. 

Additional health factors that increase the risk of bedsores occurring are diabetes, poor circulation, and malnutrition. Incontinence can also be a contributing factor, as damp or wet sheets add to the likeliness of bedsores developing. 

When patients have an impaired ability to realize or communicate that bedsores are developing, then bedsores may not be detected in the initial stage, and are more likely to advance to stage 2 or beyond.

A primary contributing factor to stage 2 bedsores is inadequate care. Individuals residing in facilities with understaffing, poor care policies, or abusive or negligent staff are most likely to develop bedsores. This is also true for homebound individuals cared for by uneducated or negligent family members or in-home caretakers.

Treatment and Prognosis
of Stage 2 Bedsores

Once bedsores have progressed to stage 2, treatment by a medical professional is necessary for a full, safe recovery.

Treatment for stage 2 bedsores involves:

  • Changing body position throughout the day
  • Debridement (removal of dead or infected tissue)
  • Wound care
  • Antibiotics

Treatment for stage 2 bedsores may also involve changing dressings or applying topical ointments.

Additional treatment steps may be necessary if any complications arise. When bedsores are identified in stage 2 and given prompt medical treatment, full recovery is possible but not guaranteed. It’s possible for some patients to only experience partial healing of the damaged tissue.

In almost all cases, a stage 2 bedsore involves a break in the surface of the skin, often in the form of an open wound. This puts the patient at high risk of infection. If an infection develops, it can complicate healing and may spread into other tissues, potentially leading to serious health issues.

Are there long-term complications
of stage 2 bedsores?

Bedsores have four stages. Stage 1 can be painful, but it’s easier to miss and will likely progress to stage 2. A stage 2 bedsore is a serious health condition. If left untreated, it will continue to progress to stages 3 and 4, which pose severe health risks.

Stage 2 bedsores are characterized by damage to the epidermis and dermis, the two layers of the skin. A bedsore is categorized as stage 3 when the wound has developed into a sunken indentation. Stage 3 involves damage to the fatty tissues beneath the skin.

Stage 4 is the final and most severe bedsore progression. A stage 4 bedsore is identified by a large wound and a severe level of damage.

Left untreated, a stage 2 bedsore will continue to progress through the subsequent stages. Wound progression makes the individual susceptible to a host of health complications, including:

Bone and joint infections
Cancer
Gangrene
Necrotizing fasciitis
Cellulitis
Sepsis

If bedsores are left untreated for long enough, conditions like cancer and sepsis can lead to death. Likewise, if bedsores are discovered too late, treatment attempts may not be effective at reversing the damage.

Even when treatment is successful and life-threatening conditions are avoided, stage 2 bedsores can still have lasting consequences. Throughout the healing process the individual might experience:

Pain
Fever
Chills
Mental confusion
Increased heart rate
Weakness

The damage to tissues can take years to heal, and in some cases, it never heals entirely.

Are stage 2 bedsores
preventable?

Stage 2 bedsores are preventable. Regular turning and repositioning is the best way to prevent the emergence of bedsores. Nursing home staff and other caretakers must take sufficient steps to prevent the occurrence of bedsores. Best practices for preventing bedsores include:

  • Regular turning
  • Correct positioningGood hygiene and skincare
  • Good nutrition
  • Clean bedding

Caretakers of patients with reduced mobility should be aware of the potential danger of bedsores and regularly inspect for signs of skin irritation and redness.

The use of additional padding in beds and wheelchairs can help reduce the risk of excessive pressure. For those in wheelchairs, sitting upright with good posture and regularly altering positions can further help reduce skin discomfort and extended pressure on the same areas. For those in beds, cushioning between the legs or ankles can help reduce pressure and friction.

Poor nutrition is often a contributing cause of bedsores, so nutritional supplements for skin health can also play a role in prevention. Suggested supplements for bedsore prevention include:

  • Vitamin A
  • Vitamin C
  • Iron
  • Zinc

Bedsores rarely occur when a nursing home resident is given proper care. The presence of bedsores is highly concerning and a strong indication that neglect or abuse may be happening in a nursing facility.

Nursing Home Neglect and Abuse Laws

Nursing homes should have protocols in place for reducing the risk of bedsores and identifying and promptly treating them when they occur. Unfortunately, bedsores frequently affect nursing home residents. The CDC estimates over one in ten nursing home residents develop bedsores.

Insufficient patient care protocol, poorly trained or negligent staff members, and understaffing issues all contribute to nursing home residents developing bedsores. These are also signs of nursing home abuse and neglect.

Laws exist to protect nursing home residents from abuse and neglect. Usually these fall under elder abuse laws. Elder abuse laws are designed to protect individuals over a certain age, but usually also extend to include physically or mentally vulnerable adults of any age.

The Nursing Home Reform Act of 1987 set forth a federal standard of care for nursing home residents. Most states use this act as a basic guideline and add additional or more specific regulations to establish state-specific guidelines.

Most laws governing the definitions of and consequences for nursing home abuse and neglect are state laws. Although state regulations may differ in particulars, they share the general goal of ensuring that abuse and neglect do not occur in assisted living facilities.

When state and federal laws regarding nursing home neglect and abuse are violated, it’s crucial to protect the victim through prompt reporting.

How do I report suspected
nursing home neglect or abuse?

The World Health Organization (WHO) reports that an estimated 81% of elderly Americans have either experienced or witnessed elderly abuse. This tragically high percentage confirms that nursing home abuse and neglect occur all too often.

When abuse or neglect is suspected, it should be reported immediately. Doing so will initiate an investigation and prevent further abuse from happening to your loved one and other residents.

Reporting a nursing home for abuse can be a confusing process because different states may have different avenues for reporting. It may also be challenging if family members live far away from their loved one’s facility—in that case, it’s also more difficult to notice or document signs of abuse.

Usually, nursing home abuse can be reported by contacting:

  • State Department of Health 
  • Adult Protective Services (APD)
  • The Eldercare Locator
  • A nursing home abuse attorney

If severe health or safety concerns are an issue, you should immediately call 911. Emergency responders will visit the nursing home and assist if necessary.

Resources for Nursing Home Residents and Family Members

Nursing home abuse is a difficult and painful issue. It can be made even more difficult when concerned loved ones have unconfirmed suspicions that abuse is occurring.

Signs of abuse can be hard to see from afar, and behavioral changes associated with increasing age and declining health can be difficult to distinguish from changes caused by abuse.

If you or a loved one suspect that a nursing home facility is engaging in abusive or negligent practices, help is available. Below are some resources that can assist you in identifying nursing home abuse and neglect and how to take action when it occurs:

  • Medicare reporting
  • CDC: Elder Abuse
  • NIA: Signs of Elder Abuse
  • National Center on Elder Abuse (NCEA)
  • Department of Justice: State Elder Abuse Statutes
  • Elder Justice Roadmap
  • State mandatory reporting statutes

If you’re dealing with potential nursing home abuse or neglect, there are steps you can take to help your loved one.

First, know the signs of elder abuse. Altered behavior and physical injury are the most common signs that abuse may be occurring. Use resources (like those listed above) to find out how and where to report elder abuse based on your state’s laws and agencies.

Speaking with an elder abuse attorney is another way to gain advice and learn about actionable steps specific to your state and circumstances.

Elder abuse should never occur. When it does, laws and resources exist to help achieve justice for you and your loved ones.

Related Pages