Stage 4 Bedsores in Nursing Homes

What Are Bedsores or Pressure Ulcers?

Bedsores are also known as pressure ulcers, pressure sores, or decubitus ulcers. They are injuries to the skin and deeper tissues beneath the skin that are caused by continual pressure, usually by remaining immobile.

The Centers for Disease Control and Prevention (CDC) estimates that 1 in 10 nursing home residents develops the painful skin condition.

Bedsores often occur on bony areas of the body, like:

• Ankles
• Back or sides of the head
• Backs of arms or legs
• Buttocks
• Heels
• Hips
• Shoulder blades
• Spine
• Tailbone

There are four stages of bedsores, which range from the least severe (stage 1) to most severe (stage 4). Healthy skin can quickly advance to a stage 4 bedsore if not treated properly.

Since bedsores can be very painful, preventing them in vulnerable and frail nursing home residents is critical. Failure to do so can often be considered nursing home abuse.

Causes of Bedsores and Pressure Ulcers

Bedsores are often caused by a lack of movement. They can be common in people who are bedridden or use a wheelchair. People with mobility issues often need a fair amount of assistance. Sadly, those who don’t get help moving around are at risk for developing bedsores.

According to the Mayo Clinic, the three leading causes of bedsores include:

• Pressure: Limited mobility can cause continual pressure on certain parts of the body, which can reduce the blood flow needed to deliver oxygen and nutrients to the tissues beneath the skin. A lack of blood supply created by prolonged pressure can damage the skin and kill the tissue underneath.
• Friction: Repositioning the body can cause rubbing that breaks skin down. It can be worsened by rough clothing or sheets, especially in frail seniors who already have skin that has thinned with age.
• Shear: When skin moves in one direction while bones stay still or move in another direction, skin can stretch and tear. This is likely to happen in beds that elevate since the body can slide down the bed.

Bedsores can quickly worsen if they are not treated promptly. With proper care, stage 3 and 4 bedsores are almost always preventable. That’s why bedsores at more advanced stages can be a sign of nursing home abuse.

Stages of Bedsores

Bedsores fall into one of four stages based on their depth and severity. This staging system helps health care providers determine the best treatment to allow for the quickest recovery. If bedsores are caught early enough, they can heal in just a few days.

The four stages of bedsores are:

• Stage 1: Redness of the skin that does not go away when pressure is removed
• Stage 2: Thinning of the skin with a possible blister, abrasion, or shallow crater
• Stage 3: Complete loss of skin thickness with a deep crater and exposed tissue
• Stage 4: Exposed muscle or bone

Stage 3 bedsores have broken through the top two layers of skin, affecting the fatty tissue beneath the skin. They may resemble a crater and may also have an odor.

Stage 4 bedsores are the most serious and have a high risk for complications, including life-threatening infections. This is because they extend into deep tissues like muscle, tendons, and ligaments. In some cases, they can even reach cartilage or bone.

Stage 4 Bedsores or Pressure Ulcers

Stage 4 bedsores or pressure injuries can be extremely painful. Symptoms of bedsores at this advanced stage are most noticeable around the affected area. There may also be a dark substance in the open sore called eschar, which is hardened tissue that has died because of the wound.

Stage 4 Bedsores Signs and Symptoms

The signs and symptoms of stage 4 bedsores are very troubling. There may be signs of severe infection, exposed muscles, and even visible areas of bone.

Additional signs and symptoms of stage 4 bedsores include:

• Blisters, red edges, drainage, or pus near the affected area
• Exposed tendons, ligaments, muscles, and bone
• Heat at the site of the wound
• Odor
• Skin that has darkened or turned black

If you or a loved one have any signs or symptoms of stage 4 bedsores, seek medical advice as soon as possible. They can very quickly turn into life-threatening complications.

Who’s at Risk of Stage 4 Bedsores?

People who are paralyzed or have mobility issues are at greater risk of developing stage 4 bedsores, which puts elderly nursing home residents at particular risk.

Caregivers to those who are unable to move on their own must be especially careful to ensure blood is still flowing to areas that are compressed.

Some additional risk factors for stage 4 bedsores include:

• Conditions affecting blood flow (like diabetes) or linked to decreased mental awareness (like dementia)
• Dehydration or poor nutrition
• Fragile skin, especially in the elderly
• Infection
• Obesity
• Spinal cord injury
• Urinary or fecal incontinence

Stage 4 Bedsore Life Expectancy

With proper treatment, stage 4 bedsore life expectancy is high. According to the Merck Manual, 30% of stage 4 bedsores heal within six months, though some cases of stage 4 bedsores may take anywhere from several months to two years to fully heal.

Without treatment, however, the long-term prognosis for a stage 4 bedsore becomes poor. The following complications of stage 4 bedsores can be life-threatening:

• Bone, joint, and blood infections
• Cancer
• Cellulitis
• Sepsis

Stage 4 Bedsore Treatment Options

According to the CDC, 35% of nursing home residents with stage 2 or higher bedsores need wound care by trained professionals.

Treatment options for stage 4 bedsores often focus on: 

• Administering antibiotics and dressing the wound to prevent infection
• Keeping the wound moist to optimize healing conditions
• Relieving the pressure from the affected area
• Removing any damaged tissue from the area (during a debridement)

During treatment for stage 4 bedsores, emphasis should be placed on proper nutrition and hydration, which can be critical to support wound healing.

Unfortunately, surgery may be necessary in some cases to close the wounds if they are not healing properly with other treatments.

Get Help Pursuing Stage 4 Bedsore Lawsuit Settlement Amounts

Monitoring the care your loved one receives in a nursing home is of critical importance. Watching for stage 1 or 2 bedsores may help prevent the excruciating pain and needless suffering that can happen as bedsores worsen.

Because of the highly preventable nature of advanced bedsores, you may be able to hold the nursing home staff accountable for their negligence through a stage 4 bedsore lawsuit. Compensation from a lawsuit may also help you afford better care and life-saving medical treatments for your loved one.

As a national nursing home abuse law firm, Sokolove Law has decades of experience helping victims of nursing home abuse and their loved ones pursue justice and compensation for their injuries.

Over the last 45+ years, we’ve recovered over $280 Million on behalf of thousands of nursing home abuse clients nationwide.

Get a free case review or call (800) 995-1212 today to learn more about your options and see if Sokolove Law may be able to help.