Bedsore Causes in Nursing Homes

What Causes Bedsores in Nursing Homes?

Bedsores (also known as pressure sores or pressure ulcers) are skin wounds that occur when excess force is put on the skin over a long period of time. Sustained pressure reduces blood flow and damages tissue. Nursing home neglect can contribute when staff fail to assess risk, relieve pressure, or respond to skin changes.

Elders are at a higher risk of bedsores if they cannot easily move on their own. Bedsores typically develop when someone cannot reposition their body over a long period of time. Without movement, the skin loses blood flow and eventually decays.

Seniors with mobility issues may turn to nursing homes for care. Ideally, nursing homes and their staff should meet the needs of these residents to prevent pressure sores.

However, some nursing home staff members allow simple problems to harm their residents.

Common bedsore causes in nursing homes include:

• Friction between skin and a surface (such as a bedsheet)
• Pressure
• Shear (when skin moves away from the bone)
• Other factors, such as dehydration and malnutrition

When staff members fail to address common bedsore causes, they can — and should — be held responsible. While bedsores can lead to life-threatening complications, they can often be caught early on by competent nurses.

Bedsore Causes and Nursing Home Neglect

When a senior develops bedsores in a nursing home, it may be considered nursing home neglect. Neglect occurs when a nursing home and its staff fail to provide proper care, and a resident suffers serious harm as a result.

Bedsores can form if nursing home staff members fail to: 

• Adequately provide food and water, leading to malnourishment
• Properly move nursing home residents, causing friction
• Reposition residents to prevent excess pressure from creating skin ulcers

Bedsores from inadequate nursing home care can lead to deadly outcomes. For example, a Missouri man was admitted into a nursing home with a stage 3 bedsore in November 2018. Instead of caring for his wound, the staff made the problem worse, according to his wife.

Over the span of 22 days, the man developed additional bedsores and suffered from malnutrition and dehydration. He did not live to see December, dying just three days after leaving the nursing home.

Bedsore Causes: How Do Bedsores Form?

Bedsores may develop if fragile skin suffers from pressure or friction for an extended period of time. Below, find important bedsore causes that often affect nursing home residents.

Pressure

Prolonged pressure is one of the most common bedsore causes.

When lying or sitting for too long, skin can get compressed between the bone and the surface of a bed, chair, or wheelchair. This causes blood flow to slow or stop, depriving the skin’s tissue of oxygen and other nutrients.

Pressure usually causes bedsores in body parts that lack muscle or fat.

A lack of blood flow in these areas can cause the skin to die in just a few hours. After that, the damage spreads to deeper layers of tissue.

Elderly loved ones with limited mobility may sit or lie in one position for long periods of time, especially if nursing home staff members do not regularly check on them. This may put too much weight on one part of their body and lead to a bedsore.

Shear

Shear, another notable bedsore cause, describes the movement of two surfaces in opposite directions. Shear may harm nursing home residents if their skin moves in one direction while their bones move in another.

Shear puts stress on the blood vessels and keeps healthy tissue from receiving proper nutrients.

In nursing homes, shear may occur:

• When staff members move a resident: Elderly residents with mobility issues may need help moving from one location to another, such as from a wheelchair to a bed. However, staff members must use care during these moves, as the residents’ skin can shear if they are not moved gently.
• As a resident sleeps: If the patient slides down on the bed while they sleep, their tailbone will move while the skin over it will stay in place. Residents who require head elevation in bed may also be at risk of shear.

The care team should choose positioning that reduces sliding while meeting the resident’s medical and breathing needs. To reposition a resident, staff members should lift them rather than pull or drag them.

Friction

Elderly nursing home residents are at a high risk of bedsores from friction because their skin is typically more fragile and vulnerable to injury.

Like the other bedsore causes, friction can damage blood vessels, which prevents blood, oxygen, and other vital nutrients from reaching the skin.

Seniors with mobility issues should be repositioned to avoid harm from friction, sliding, or rubbing. Bed sheets should also be well maintained, as crumbs, particles, or folds in sheets can all cause skin irritation.

Other ways nursing home staff can prevent friction include: 

• Avoiding the use of multiple bed sheets or mattress pads, which can prevent beds from evenly distributing pressure
• Making sure residents wear comfortable shoes and clothes
• Regularly changing the residents’ clothing
• Keeping bedding clean, dry, and smooth, and using skin-protection products directed by the care team

If friction remains a constant problem, an occupational therapist can offer advice on how to best care for seniors.

Bedsore Risk Factors

The biggest risk factor for bedsore causes is limited mobility. If an elderly person has trouble moving on their own, it is all too easy for their skin to suffer from excess pressure, friction, and shear.

Other risk factors include:

• Poor Nutrition

  According to the Mayo Clinic, skin can become unhealthy and fragile without the right nutrition, leading to an increased risk of bedsores.

• Moisture

  Skin needs to be properly moisturized to stay healthy. However, excess moisture can raise the risk of friction and pressure sores. To avoid friction from moisture, skin should be kept clean and dry.

• Decreased Sensitivity

  According to Johns Hopkins University, bedsores can develop if a person cannot properly sense pain and sits in one position for long periods of time. Spinal cord injuries and nervous system diseases can damage a person’s sensitivity.

• Medical Problems Affecting Blood Flow

  The Mayo Clinic notes that certain health conditions can limit blood flow and increase the risk of bedsores. For example, a 2017 study found in an oncology-focused medical journal noted that surgical patients with diabetes were nearly two times more likely to develop a bedsore than those without.

Nursing home staff members should take special care with at-risk patients to avoid common bedsore causes and risk factors. Ideally, caretakers should regularly reposition residents with mobility issues, perform head-to-toe skin assessments, and note any medical problems that could make bedsore causes more likely.

Nursing homes that neglect these responsibilities should be held accountable, and you may be able to take action if you or a loved one developed a bedsore in a nursing home.

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Preventing Bed Sores in Nursing Homes

Pressure injuries can become difficult to treat, particularly when damage reaches deeper tissue. Prevention and early recognition are essential. Nursing home staff are responsible for following proper procedures, monitoring residents, and promptly treating bedsores.

Common signs of bedsores include:

• Reddish or discolored skin
• Lack of blanching (lightening of skin when pressure is put on it)
• Blisters
• Open wounds
• Skin that is unusually soft or firm
• Painful or irritated skin

When nursing homes fail to take proper care of their residents, they should be held responsible.

Get a free case review today to learn more about bedsore causes and the responsibility of nursing homes. Our team has important medical and legal resources on-hand to help you.

What Causes Bed Sores on the Buttocks, Heels, and Feet?

Bed sores often develop where body weight presses skin and soft tissue against a bed or chair. A person who sits for long periods may develop sores over the buttocks or tailbone. A person who lies in bed may develop sores on the heels or other bony areas. The location helps the care team identify where pressure needs to be relieved.

Older adults are at greater risk when they cannot reposition themselves, have reduced sensation, poor circulation, fragile skin, or inadequate nutrition. Moisture from incontinence can also make skin more vulnerable. Bedsores can develop in a hospital, nursing home, or at home. The setting alone does not explain the cause.

Why Are Bedsores Not Healing?

Continued pressure, infection, poor blood flow, and inadequate nutrition can interfere with healing. Ask the treating clinician to assess the wound and review the pressure-relief and treatment plan. A new open wound, pus, foul odor, warmth or swelling around the sore, or fever needs prompt medical attention. Do not wait for a legal review to obtain treatment.

Our bedsore guide explains the injury in more detail. A clinician should assess its depth and treatment needs.

Does a Bedsore Always Mean Nursing Home Neglect?

A bedsore calls for a careful review of care. Federal nursing home standards require appropriate prevention and treatment and recognize that a resident’s clinical condition can make some pressure ulcers unavoidable. The important questions are whether staff assessed the risk, followed a suitable care plan, monitored the skin, and responded when the condition changed.

Ask when the sore was first documented, what prevention measures were used, who assessed it, and how the treatment plan changed. Keep dated observations and records available to you. If you are concerned that poor care caused or worsened the wound, learn about legal options for bedsore injuries.