Bedsores are a lay person’s term for decubitus ulcers. Bedsores are injuries to the skin or underlying tissues that result from an inadequate blood supply caused by prolonged pressure on the skin. In many instances, bedsores occur at points of bony prominence such as the coccyx or sacral area.
There have been medical studies performed which generally ascribe bedsores to some form of neglect on the part of caregivers. This may come in the form of failure to turn a non-ambulatory patient or resident. It may also be due to lack of adequate nutrition and hydration. As a general proposition, physicians agree that except in cases of severe systemic disease such as renal failure or metastatic cancer, most bedsores are likely preventable.
The ramifications of a bedsore are multifaceted and uniformly negative. Bedsores which form on the heels of non-ambulatory residents frequently lead to the onset of gangrene and amputation. It logically flows that many of these situations will result in the death of a resident from overwhelming sepsis.
The economic cost to the health care system of bedsores is staggering. In the elderly population, bedsores are one of the most costly diseases to treat and can cost up to $40,000 depending on the stage of development.
Prevalence of Bedsores in Long-Term Care Settings
Approximately 10% of all nursing home residents have bedsores. This percentage climbs as high as 28% for patients receiving hospice care.
The Staging of Bedsores
Bedsores are typically staged numerically one through four. A Stage I bedsore generally does not involve skin breakdown, but is evidenced by redness of the skin that does not turn white or purple when you press on it (i.e. non-blanchable). A Stage II bedsore usually involves a partial loss of skin presenting as a shallow open wound or blister. A Stage III bedsore usually means that there has been a complete loss of skin, possibly exposing subcutaneous fat. A Stage IV bedsore is also characterized by a complete loss of skin, but also involves the exposure of bone, tendon or muscle. In certain instances, this can trigger infection of the bone which is known as osteomyelitis.
Prevention of Bedsores
Due to the extraordinarily high economic cost of wound care and the extreme physical and emotional stress brought on by bedsores, a great deal of literature and attention is now paid to prevention of bedsores.
42 CFR 483.25(c) of the Code of Federal Regulations mandates that if an individual comes into a skilled care facility without skin breakdown, skin breakdown should not occur.
The Minimum Data Sets (MDS) performed on patients upon entry to a nursing home has a section requiring detailed assessment of skin integrity. Once again, the idea is to prevent the development of bedsores before they start.
Despite what may seem to be the obvious case, i.e., frequent turning prevents bedsores, far more attention should be paid to nutrition and hydration which are most often associated with the onset of wounds particularly in nursing home residents.
Frequent assessment of a resident’s skin particularly in those areas of the body that are most vulnerable to breakdown likewise may help prevent or at least minimize progression of a bedsore.
Donna M. MacKenzie is a partner at Olsman Mueller Wallace & MacKenzie, PC in Berkley. She devotes a majority of her practice to representing individuals injured as a result of nursing home neglect and abuse. Mrs. MacKenzie’s recent honors include recognition as an Up & Coming Lawyer by Michigan Lawyers Weekly, a Rising Star by Super Lawyers, and a Pacesetter by the Michigan Association for Justice. She is on the executive board for the Michigan Association for Justice and serves on the board of governors for the American Association for Justice. Mrs. MacKenzie can be reached at (248) 591-2300 or [email protected].