When a loved one develops pressure sores — also called bedsores, pressure ulcers, or decubitus ulcers — in a nursing home, families are sometimes told it was inevitable, a natural consequence of the resident's medical condition or immobility. That explanation is almost never true. Pressure sores are largely preventable, and when a nursing home resident develops them — or when existing sores worsen — it is typically a sign that the facility failed to provide basic, required care.
What Are Pressure Sores?
Pressure sores are injuries to the skin and underlying tissue resulting from prolonged pressure that cuts off blood supply to the area. They develop most commonly over bony prominences — the heels, tailbone (sacrum), hips, ankles, and the back of the head — in residents who cannot reposition themselves due to illness, paralysis, weakness, or cognitive impairment.
Medical professionals classify pressure sores into four stages of severity:
- Stage 1: Non-blanchable redness of intact skin — the earliest sign of damage
- Stage 2: Partial thickness skin loss — an open wound, blister, or shallow crater
- Stage 3: Full thickness skin loss — tissue damage extending to but not through underlying muscle
- Stage 4: Full thickness tissue loss — extending through muscle to bone, tendon, or joint capsule
Advanced pressure sores are excruciatingly painful, prone to life-threatening infection, and can take months or years to heal — if they heal at all. In elderly residents with compromised immune systems, they can be fatal.
What the Law Requires
Federal nursing home regulations (42 CFR § 483.25) are explicit: a facility must ensure that a resident who is admitted without pressure sores does not develop them, unless the individual's clinical condition demonstrates they were unavoidable. Similarly, a resident with pressure sores must receive care and treatment designed to promote healing, prevent infection, and prevent the development of additional sores.
The standard of care for pressure sore prevention is well-established in nursing practice:
- Repositioning immobile residents at least every two hours
- Using pressure-relieving mattresses and chair cushions
- Regular skin inspections and documentation
- Ensuring adequate nutrition and hydration (malnutrition dramatically increases risk)
- Keeping skin clean and dry, particularly for incontinent residents
- Implementing individualized care plans with specific pressure sore prevention protocols
Critical fact: When a facility claims a resident's pressure sores were "unavoidable," that defense is extremely narrow and difficult to sustain. The resident must have received all necessary care and services, and the facility must show that the sores developed despite these interventions. In practice, this defense rarely holds up under scrutiny.
Proving Negligence in a Pressure Sore Case
To successfully pursue a nursing home neglect claim based on pressure sores, an attorney will typically need to demonstrate:
- The facility had a duty of care to the resident
- The facility breached that duty by failing to implement or follow proper prevention protocols
- The pressure sores were caused by — or worsened by — that failure
- The resident suffered damages as a result (pain, medical costs, infection, death)
Key evidence includes the resident's medical records (particularly nursing notes documenting skin assessments and repositioning), the facility's care plan and whether it was followed, staffing records showing whether adequate staff were on duty, and any survey citations the facility has received related to pressure sore prevention.
The Catastrophic Consequences of Advanced Pressure Sores
Pressure sores that reach Stage 3 or Stage 4 often require surgical intervention, including debridement (removal of dead tissue) and in severe cases, surgery to repair damaged tissue. They are highly susceptible to infection — including sepsis, osteomyelitis (bone infection), and necrotizing fasciitis — all of which can be life-threatening in elderly patients.
For families who have lost a loved one to complications from pressure sores, a wrongful death claim may be appropriate in addition to or instead of a personal injury claim.
What Families Should Do
- Photograph the sores and document their progression over time
- Request all medical records, nursing notes, and care plans
- Ask the facility in writing what prevention measures were in place and why they failed
- Report the sores to the Kentucky Long-Term Care Ombudsman and state survey agency
- Consult with an experienced nursing home abuse attorney
At Rothacker Law PLLC, we understand the deep pain families feel when a loved one suffers a preventable injury in a facility they were trusted to provide care. Michael Rothacker is committed to holding negligent nursing homes accountable. Contact us today for a free consultation.
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