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Bedsore Causes in Nursing Homes

Bedsores Caused by Nursing Home Neglect

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A 2019 report by the Sun Journal details elders' experiences in a Lewiston, Maine nursing home, specifically describing one resident's death, which was attributed to a stage 4 bedsore. Sadly, this is not an isolated incident. Many underlying bedsore causes stem from nursing home neglect. Too often, nursing home residents suffer from preventable bedsores due to poor or improper care from staff members.

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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. The main cause of bedsores among seniors is nursing home neglect.

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
Did You Know

According to Johns Hopkins University, a bedsore can develop within 2 to 3 hours.

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.

Bedsores 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

Bedores 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.


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.

Bedsores often appear on the:

  • Ankles
  • Elbows
  • Heels
  • Hips
  • Shoulder blades
  • Spine
  • Tailbone
  • Toes

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, 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.

To avoid shear, nursing home residents should sleep with their heads elevated to a 30-degree angle (or lower). To reposition a resident, staff members should lift them rather than pull or drag them.


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
  • Using cornstarch baby powder to absorb moisture from damp bedsheets (talcum powder should not be used due to health concerns like yeast infections)

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.

Preventing Bed Sores in Nursing Homes

The bedsore causes listed above are all common but easily treatable problems. Nursing home staff are responsible for following proper procedures, monitoring residents for signs of bedsores, and promptly treating them.

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.

Nursing Home Abuse Support Team
Julie Rivers HeadshotReviewed by:Julie Rivers, MBA

Eldercare Advocate & Expert

  • Fact-Checked
  • Editor

Julie Rivers is an eldercare advocate with over 15 years of dedicated service to victims of nursing home abuse and neglect. Her journey in this field became deeply personal when she assumed the role of an unpaid caregiver during her mother’s battle with Alzheimer’s disease.

The Nursing Home Abuse Center (NHAC) was founded to bring justice to those affected by nursing home and elder abuse. Our mission is to educate and empower victims of abuse and their families to take a stand against this unlawful mistreatment. We work to return dignity back to those who have been broken down by nursing home abuse and neglect.

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