Pressure Sores
A pressure sore, also known as a bed sore, is a serious medical condition that is painful, dangerous, and often times avoidable with proper nursing facility care. Unfortunately, pressure sores are far too common in modern nursing home facilities. This overview provides some basic information about federal regulations regarding pressure sores, what pressure sores are, how pressure sores occur, and how to prevent pressure sores.
Federal regulation
If a nursing home receives federal funding, it must comply with federal regulations. Today, most nursing homes receive federal funding. Under the federal standards, a nursing home must provide each resident with "necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being." 42 C.F.R. § 483.25.
To assure that a resident is in the "highest practicable physical" well-being, a resident must be protected from unnecessary pressure sores. Therefore, the federal regulations state that facilities must ensure that "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." 42 C.F.R. § 483.25(c)(1).
If a resident enters a facility with a pressure sore, or develops an unavoidable pressure sore, a facility must assure that the resident "receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing." 42 C.F.R. § 483.25(c)(2).
Therefore, to understand a facility's duties fully with regard to pressure sores, we must understand what they are, how they occur, and what can be done to prevent them.
Definition of "pressure sore"
A pressure sore, which is commonly referred to as a bedsore, is a chronic ulcer of the skin that is generally caused by prolonged pressure on a certain area of the body in which the skin is close to a bone. Areas of the body where pressure sores commonly occur include near elbows, knees, heels, the lower back, and the tailbone. Pressure sores are painful, and often do not heal without special attention from a skilled caregiver.
Causes
Pressure sores are caused by constant pressure on a certain area of the body. The pressure causes skin to break down from poor circulation. At first, the skin will look red and irritated. As the sore further develops, an open sore may occur. If untreated, the sore may destroy skin and muscle. In some rare cases, sores that have remained untreated have developed systemic infections and led to death.
Some factors and conditions that may increase a resident's chances for developing pressure sores include:
- Moisture (which may be from unchanged undergarments and sheets that are wet or soiled)
- Sedation
- Decreased mental function, including dementia
- Immobility
- Failure of staff to reposition bedridden patients
- Malnutrition
- Low blood pressure
- Diabetes or other circulatory problems
- Dehydration
- Dry skin
- Lack of sensation, particularly in the extremities
Ways to reduce pressure sores
A policy focusing on prevention and early treatment are the best ways to reduce the occurrence of pressure sores and the severe problems that can accompany pressure sores. A nursing home facility should require care providers to practice preventive care. This includes developing a care plan focused on avoiding friction and trauma to the skin for any resident who is determined to be at risk. If a resident is bedridden, the nursing home staff should reposition the resident at least every 2 hours to minimize rubbing, pressure, and friction. The facility, also, should pay close attention to the condition of all of the resident's skin. Care providers should monitor skin color and texture daily. Finally, the nursing facility should use special pressure reducing beds, spacers, and other equipment when needed.
Conclusion
Ultimately, the nursing home staff is in the best position to prevent and detect pressure sores. However, a resident's friends and relatives may also play an important part in monitoring the resident's skin condition.
At times, a pressure sore may be impossible to prevent; however, the development of a pressure sore may also be evidence of poor facility care. At any rate, prevention and early diagnosis are the best ways to avoid pressure sores and the serious problems that pressure sores may cause. If you have concerns regarding the care of a nursing home resident, an experienced elder law attorney can provide answers to your legal questions.
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