Nursing home residents and their families should know that bedsores are entirely preventable and more noticeable as they progress from stage to stage. Recognizing bedsores at each stage can allow you to seek treatment as early as possible and avoid associated health complications.
The appearance of bedsores, also known as pressure sores, pressure ulcers, or decubitus ulcers, change as they worsen. Doctors diagnose and treat bedsores according to stages — the first of which is a noticeable discoloration of the skin and the last of which involves skin and tissue loss.
When bedsores go unnoticed or untreated, a person can suffer from these debilitating and painful ulcers for days or weeks, leading to skin infections, bone infections, or sepsis.
In nursing homes and assisted living facilities, the risk for bedsores is significant because of the inability of some residents to move on their own. But for a bedsore to reach an advanced stage, the nursing home or caregiver would have to be negligent in the care they provide to the resident.
Appearance of Bedsores by Stage
A stage one bedsore may look like a faint bruise.
The skin isn’t broken in early-stage bedsores, but darker skin is evident in the affected area. Bedsores may begin to develop after as few as two or three hours and may darken over the course of eight to 12 hours, and the skin will not change color when you press the area.
In addition to the color change, you may notice a difference in the way the affected skin feels as compared with the surrounding skin. It may feel either warmer or cooler, and either firmer or softer than the skin around it.
According to the National Pressure Injury Advisory Panel (NPIAP), the skin may turn purple or maroon after two days of pressure. In a stage 2 bedsore, the surface of the skin has been affected; it may blister or look like a scrape. Unfortunately, stage two bedsores often come with significant pain.
Stage two bedsores may develop on any part of the body with a thin layer of skin over the bones. For example, pressure on the shoulder blades while laying in a bed for too long may cause stage two bedsores to develop after just a few days. A spinal cord injury that causes a patient to remain immobile for too long may allow bedsores to form and worsen.
Treating pressure sores in stage two should involve removing pressure from the affected area, cleaning the surface of the skin and drying it, and conducting routine inspections of the site at least two times a day to ensure healing.
Proper hydration, beneficial skin creams, and a nutritious diet can improve the rate of healing of an open sore. Caregivers may flush the wound with salt water each time they change the bandage.
By the time bedsores reach stage three, the pressure ulcer deepens into several layers of skin and reaches the subcutaneous layer, or fat, beneath the top layers of the skin. The bedsore starts to look like a crater, and the damage begins to affect the underlying tissue closer to the bones.
Unfortunately, it may take a nursing home resident with stage three bedsores months to heal because of the compromised and weak immune systems common in the elderly.
According to the National Pressure Ulcer Advisory Panel, caregivers may see the subcutaneous level of skin and evidence of severe tissue damage, but the condition hasn’t yet reached the bones.
Treatment of stage three bedsores may include antibiotics when an infection is present and debridement, which is the surgical removal of the dead tissue. Nursing home residents may benefit from a special mattress designed to reduce pressure on vulnerable, bony areas of the skin.
Stage four pressure ulcers are deep and incredibly painful wounds. Experiencing any level of bedsores is likely evidence of nursing home abuse, but a resident who experiences a deadly level four bedsore has experienced significant neglect.
Stage four bedsores are so deep that caregivers may see muscle, bone, and tendons at the wound site. Bone inflammation or infections known as osteomyelitis may develop.
Wound care may include antibiotics when signs of infection exist, as well as debridement. These life-threatening wounds may take anywhere from several months to years to heal. Some who experience stage four bedsores may require skin grafts that cover the affected area with healthy skin.
Sometimes, the stage of a bedsore isn’t apparent, and a health care professional may call it unstageable. These bedsores are generally at least a stage three bedsore.
Treatment for unstageable bedsores includes everything required for the treatment of stage three, as well as possible additional treatments required at stage four.
When a bedsore exhibits eschar, which occurs when the skin sheds dead tissue into the wound, the health care worker may find it challenging to identify the bed sore’s stage.
Bedsores Indicate Nursing Home Abuse & Neglect
It’s important to know what a bedsore looks like because these injuries are a clear sign of nursing home abuse and neglect. Not only are bedsores incredibly painful, but they’re also deadly and may cause lifelong complications for vulnerable people.
Bedsores should never occur within the walls of a nursing home. These completely preventable wounds are the result of poor caretaking practices. They indicate negligence or, often, elder abuse.
Medical advice for preventing bedsores includes:
- Turning or repositioning every two hours while in a bed
- Changing position every 15 minutes while in a wheelchair
- Making sure wheelchairs, chairs, and beds have soft padding
- Engaging in regular cleaning and keeping the skin dry
When a nursing home establishes and follows a proper care plan for an immobile resident, it leaves no opportunity for bedsores to develop. Unfortunately, not all nursing home facilities adhere to resident care plans, whether for systemic reasons, such as understaffing, or the actions of one abusive staff member.
Nursing homes and medical professionals are obligated to provide a reasonable standard of care to the people who live in the facility. Bedsores at any stage are evidence that this standard of care is not being met. Learn to recognize a bedsore so that you can take action immediately if needed.