Stage 4 Bedsores

Learn About Stage 4 Bedsores

Quick Answer

Stage 4 bedsores are the most advanced stage, developing when stage 3 bedsores are not properly treated. At this point, a patient’s tissue loss may reach the ligaments, muscle, and even bone — potentially leading to deadly infections. This serious condition, claiming roughly 60,000 lives each year, is often the tragic result of nursing home neglect caused by overstaffing.

What Is a Stage 4 Bedsore?

Stage 4 bedsores are the most severe form of bedsores, or pressure ulcers, that a patient can develop, decaying tissue down to the muscles, ligaments, or even bone. These bedsores also put nursing home residents at high risk of infection.

In most cases, residents do not reach this painful, dangerous stage of infection if they receive proper care. Advanced-stage bedsores may be an unfortunate sign of nursing home neglect and overstaffing.

Quick Facts About Stage 4 Bedsores

  • Roughly 60,000 people die each year due to bedsore-related complications.
  • According to one federal report, care related to sepsis, which may result from stage 4 bedsores, was the most common reason given for transfers of nursing home residents to hospitals.
  • According to an analysis by private healthcare firm Definitive Health, about 6,000 of the Illinois nursing home residents hospitalized every year have sepsis. 1 in 5 doesn’t survive.

Diagnosing a Stage 4 Bedsore

A doctor determines the stage of a bedsore by its appearance. In the case of stage 4 bedsores, the large wound has passed the fatty tissue layer of a patient, exposing muscles, ligaments, or even bone.

In a few cases, however, healthcare professionals may not be able to immediately diagnose a late-stage bedsore just by examining it.

A stage 4 bedsore may be initially diagnosed as:

  • Unstageable: When a doctor cannot see the bottom of the sore, they must clean it out to properly stage it.
  • Suspected Deep Tissue Injury (SDTI): This diagnosis happens when the surface of a patient’s skin looks like a Stage 1 or 2 sore, but it is actually deeper underneath.

Causes of Stage 4 Bedsores

When nursing home staff are not properly trained or become too busy, tired, or overworked, residents suffer. Residents who need help with mobility may lie in bed or be left in a wheelchair for hours with no relief, causing bedsores.

In these cases of neglect, bedsores may not be properly treated, eventually developing into stage 4 bedsores.

Certain patients may be particularly prone to bedsores and have a more difficult time healing.

Residents are at higher risk of having issues with bedsores if they have:

  • A cast on
  • Circulation problems
  • Diabetes
  • Limited mobility
  • Poor nutrition

Symptoms of Stage 4 Bedsores

Most of the symptoms of stage 4 bedsores are related to bacterial infection — a common problem with such serious pressure ulcers.

Symptoms of stage 4 bedsores include:

  • Exposed tissue or bone
  • Blackened skin
  • Drainage and pus
  • Fever
  • Hot skin
  • Odor
  • Red edges
  • Swelling around the sore

If a resident or loved one notices any of these symptoms, they should immediately seek medical care for their bedsores.

If left untreated, stage 4 bedsores may lead to:

  • Severe pain
  • Infection
  • Renal failure
  • Amyloidosis
  • Sepsis and septic shock
  • Death

According to an article in The Western Journal of Medicine, renal failure and amyloidosis are the most common causes of death for patients suffering from chronic bedsores.

Treating Stage 4 Bedsores

Stage 4 bedsores should be treated as soon as possible, as they put a nursing home patient at high risk of dangerous infections.

Treatment of stage 4 bedsores may include:


  • Debridement

    Removing any damaged, infected, or dead tissue from the bedsore


  • Skin Grafts

    Covering the affected area with healthy skin


  • Antibiotics

    Giving patients bacteria-destroying medicine to treat infections

At such an advanced stage, it can take anywhere from 3 months to 2 years for the most severe bedsores to heal.

Preventing Stage 4 Bedsores

The most serious bedsores can be prevented by successfully treating stage 3 bedsores or by stopping less advanced stages of bedsores from forming in the first place.

Nursing home staff can help prevent stage 4 bedsores by:

  • Keeping residents mobile
  • Making sure residents are well-fed and hydrated
  • Treating early-stage bedsores as soon as possible
  • Carefully monitoring earlier stage bedsores to ensure they are healing

When nursing home residents suffer from the painful and dangerous final stage of bedsore progression, it is commonly due to nursing home neglect. Loved ones should immediately confront nursing home staff or, if they suspect neglect, contact their local ombudsman.

Severe Stage 4 Bedsores From Nursing Home Neglect

Not all bedsores are caused by nursing home neglect — however, like many nursing home injuries, late-stage bedsores are largely preventable with proper care.

Severe bedsores may develop in nursing home residents because of:

  • Dehydration or malnutrition, which can prevent healing or worsen sores
  • Failure to notice or treat earlier stage sores due to skipped or rushed care
  • Improper care of residents with mobility issues
  • Improper treatment of stage 3 bedsores

Stage 4 bedsores subject patients to extreme pain, high risk of infection, invasive surgeries, and even death. In many cases, nursing homes could have avoided this suffering by hiring enough staff to properly care for residents.

If you or your loved one has developed severe bedsores due to nursing home neglect, you deserve justice. Fill out our simple free case review form to see if you may be entitled to financial compensation.

Author:Avatar
The Nursing Home Abuse Center Team

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.

Last modified: December 6, 2019

View 7 Sources
  1. Johns Hopkins Medicine. (n.d.). Bedsores. Retrieved November 26, 2019, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/bedsores
  2. WebMD Medical Reference. (2018, November 25). What Are the Stages of Pressure Sores? Retrieved November 26, 2019, from https://www.webmd.com/skin-problems-and-treatments/pressure-sores-4-stages#1
  3. DeMarco, S. (n.d.). Wound and Pressure Ulcer Management. Retrieved November 26, 2019, from https://www.hopkinsmedicine.org/gec/series/wound_care.html#wound_healing
  4. Mayo Clinic Staff. (2018, March 9). Bedsores (pressure ulcers). Retrieved November 26, 2019, from https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893
  5. Lyder, C. H., & Ayello, E. A. (2008, April). Pressure Ulcers: A Patient Safety Issue. Patient Safety and Quality: An Evidence-Based Handbook for Nurses (12). Retrieved November 26, 2019, from https://www.ncbi.nlm.nih.gov/books/NBK2650/
  6. Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: Current understanding and newer modalities of treatment. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India, 48(1), 4–16. Retrieved November 26, 2019, from doi:10.4103/0970-0358.155260
  7. Kaiser Health News. (2018, September 6). Avoidable Sepsis Infections Send Thousands Of Seniors To Gruesome Deaths. Retrieved November 26, 2019, from https://www.healthleadersmedia.com/clinical-care/avoidable-sepsis-infections-send-thousands-seniors-gruesome-deaths
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