Pressure Ulcers are a Sign of Nursing Home Neglect

Pressure sores (ulcers) can range from a small bruise to a gaping hole in the skin which goes all the way down to the bone.  Pressure sores commonly occur in elderly people who are immobile or have limited mobility.  Most of these people are in nursing homes.  The nursing homes are being compensated either by private pay, insurance, medicare or medicaid to render total care to the elderly residents including the care to avoid pressure sores and to render proper treatment so that the sore can heal.

What is a Pressure Sore?

There are numerous authoritative sources which discuss pressure sores.  One such source is the National Pressure Ulcer Advisory Panel (NPUAP) which defines a pressure ulcer as “...a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.”

Pressure sores are categorized by staging.  Generally, a Stage I is a redness without skin loss. A Stage II is a blistering involving partial skin loss.  A Stage III is a full thickness skin loss without exposure to the bone.  A Stage IV is a full thickness skin loss with exposed bone which many times has necrotic tissue.  There are also unstageable ulcers where the base of the ulcer is covered with scabs, crusting and necrotic tissue which must be removed before staging is possible.

Are Pressure Sores the Result of Neglect?

Many pressure sores are caused by neglect in caring for the resident.  A resident who is bedridden is more prone to develop pressure ulcers.  However, the nursing home has to render care so that the resident can avoid developing a bed sore and if a bed sore develops, that same is properly treated so that the sore is resolved.

It is important to recognize that the development of a bedsore can be unavoidable.  However, in order for a bedsore to be deemed unavoidable, the facility must establish that the resident has a clinical condition that makes the resident susceptible to pressure ulcers and that the facility took all steps to render necessary treatment and promote healing, prevent infection and prevent new sores from developing.

The Federal Regulations (OBRA), which govern nursing homes,  are incorporated into the N.J. Nursing Home Bill of Rights.  Federal Regulation 483.25 sets forth the duty of the nursing home as follows:

“Based on the comprehensive Assessment of a resident, the facility must ensure that:

  1. A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and
  2. A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.”