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Stage 4 Bedsore

Learn About Stage 4 Bedsores

Quick Answer

A stage 4 bedsore is the most advanced stage. Muscle, bone, and tendons may be visible through a hole in the skin, putting the patient at risk of serious infection or even death. A stage 4 bedsore is a sign of nursing home neglect since it is preventable with proper care. If your loved one has suffered from bedsores in a nursing facility, you may have legal rights. Find out right now with a free case review.

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What Is a Stage 4 Bedsore?

Close-up of a caregiver's hands gently holding an elderly patient's hands on a hospital bed.

A stage 4 bedsore is a deep wound reaching the muscles, ligaments, or bones. It is the most severe form of a bedsore (also called a bed sore, pressure sore, pressure ulcer, or decubitus ulcer.)

Bed sores stage 4 are the worst-case scenario: the blood supply has been so severely cut off that the wound tunnels down through all layers of the skin and exposes bone.

They often cause extreme pain, infection, and even death. Many patients must undergo invasive surgeries to survive stage 4 bedsores.

Did You Know

Bedsores cause over 60,000 deaths each year, according to the Agency for Healthcare Research and Quality (AHRQ).

Sadly, a stage 4 pressure ulcer is often a sign of nursing home neglect. Residents of nursing homes may develop these sores if caregivers fail to treat earlier pressure ulcer stages.

A stage 4 pressure ulcer usually means a nursing home resident has remained in the same position for an extended period of time.

If your loved one developed a stage 4 bedsore while in a nursing home, taking legal action may allow you to get justice for their suffering.

The Nursing Home Abuse Center partners with top nursing home attorneys across the country. Together, they have recovered over $273 million for nursing home abuse and neglect.

Get a free case review right now to see if we can help your family.

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What Does a Stage 4 Bedsore Look Like?

A stage 4 bedsore is the largest and deepest of all bedsore stages. Characterized by severe tissue damage, a stage 4 pressure ulcer may look like a reddish crater on the skin.

Muscles, bones, and/or tendons may also be visible at the bottom of the stage 4 pressure ulcer.

Illustration of pressure ulcers for stages 1 - 4 with life-threatening infections at stage 4 bedsore.

When infected, bed sores stage 4 may have a foul smell and leak pus. Additionally, the sore may be surrounded by dead tissue that’s dark or yellowish in color.

Stage 4 Bedsore Causes

Bed sores stage 4 are caused by factors like pressure, shear (when skin pulls in opposite directions), and friction that cut off the blood supply to the skin.

Without proper treatment, this loss of blood flow can cause the skin to die and a wound to form, eventually turning into a stage 4 bedsore.

“Being bedridden, unconscious, unable to sense pain, or immobile increases the risk that a bedsore will develop. The risk increases if the person is not turned, positioned correctly, or provided with proper nutrition and skin care.”

—Johns Hopkins Medicine

Nursing home residents may develop bedsores if staff members:

  • Cannot adequately care for each resident due to understaffing
  • Don’t treat dehydration or malnutrition, which can prevent healing or worsen sores
  • Fail to notice or treat earlier-stage bedsores due to skipped or rushed care
  • Leave residents with mobility issues lying in beds or wheelchairs for hours on end

Therefore, bed sores stage 4 are usually the result of improper care by staff members when they occur in nursing homes. This is especially true for advanced cases, which are preventable when earlier-stage pressure injuries are properly treated.

Learn your legal rights if you or a loved one suffered from a stage 4 bed sore.

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Who’s at Risk of Developing a Stage 4 Pressure Ulcer?

Generally, anyone with a lower-stage bedsore is at risk of developing bed sores stage 4 if the wound is not treated.

Each year, over 2.5 million people in the United States develop pressure ulcers, according to AHRQ. However, some patients may have other health conditions that make them more prone to this type of injury.

Learn more about who is at increased risk for stage 4 bedsores below.

Have Limited Mobility

Movement is the key to preventing bedsores at any stage. According to the National Pressure Ulcer Advisory Panel (NPUAP), “a number of contributing or compounding factors are associated with pressure injuries; the primary of which is impaired mobility.

If nursing home residents cannot move on their own, they may sit or lie in the same position for hours. This can cut off blood flow to their skin and cause a bedsore. Once a bedsore forms in a person with limited mobility, it can quickly advance to a stage 4 pressure ulcer.

Live in Understaffed Nursing Homes

Nursing home residents with mobility issues must rely on staff members to prevent bedsores. Sadly, some care facilities may fail to prevent bedsores due to nursing home understaffing and poor training. In these cases, nursing home neglect is almost always at play.

Have Alzheimer’s or Other Dementia

If residents with cognitive impairments develop a bedsore, they might be unable to tell anyone due to their condition. They’ll need to have someone else find it and help them get proper care.

“It is important for anyone caring for a person with dementia to know about pressure ulcers.”

—Alzheimer’s Society

Residents with these conditions may also have trouble sensing pain. This means a bedsore may go unnoticed before it advances to a stage 4 pressure ulcer.

Other Factors

Nursing home residents are at higher risk of developing a stage 4 pressure ulcer if they have blood flow or circulation problems that require diabetic care or if they wear a cast.

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Can You Sue for a Stage 4 Bedsore?

Yes. You may be able to file a lawsuit for a stage 4 bedsore. If a nursing home or other care facility fails to protect residents from harm, victims and their loved ones can sue for nursing home neglect.

This is because a stage 4 pressure ulcer that was allowed to progress through all the other stages into its most severe and final stage (bed sores stage 4) is likely to be a sign of neglect.

Did You Know

A jury awarded over $10 million to a Florida nursing home resident who developed a stage 4 pressure injury that required surgery. Learn more about nursing home lawsuit compensation now.

Remember: Bedsores are almost always preventable. A care facility must monitor for signs of pressure injuries and take preventative measures so they do not worsen.

When a wound becomes a stage 4 pressure ulcer, it can be excruciating and cause great suffering. It can even lead to death.

A skilled personal injury lawyer specializing in nursing home abuse or neglect can help you understand your legal rights.

Get started right now by finding out if you can file a stage 4 bedsore lawsuit.

Symptoms of a Stage 4 Pressure Ulcer

Most symptoms of bed sores stage 4 are related to bacterial infections in nursing homes, a common complication. This is because bacteria can easily enter the body through open sores, like a severe bed sore.

Bed sores pictures stage 4 with blackened skin, red edges, and pus.

Symptoms of a stage 4 bedsore include:

  • Blackened or darker skin
  • Drainage and pus
  • Fever
  • Hot skin
  • Odor
  • Open wounds exposing tissue or bone
  • Red edges
  • Swelling around the sore

If you notice any of these stage 4 pressure ulcer symptoms in your loved one, seek immediate medical care.

You may also want to connect with a nursing home abuse lawyer to see if you can take legal action.

Diagnosing a Stage 4 Pressure Ulcer

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

However, in some cases, health care professionals may not be able to immediately diagnose a late-stage bedsore by examining it.

A stage 4 bedsore may be initially diagnosed as:

  • Suspected Deep Tissue Injury (SDTI): This diagnosis occurs when the surface of a patient’s skin looks like a stage 1 or 2 bedsore, but it actually affects deeper tissues underneath. Although it looks less severe, SDTIs are likely to be stage 3 or stage 4 pressure ulcers.
  • Unstageable: When a doctor cannot see the bottom of an open sore, they must clean it out to properly stage it. However, some bedsores remain unstageable.

If you were told your loved one has stage 4 bedsores while living in a nursing home, don’t wait to take action. Negligent facilities should be held accountable for these excruciating and preventable injuries.

Get a free legal case review right now to see if we can help.

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Get a free legal case review if you or a loved one has suffered abuse or neglect.

Get a Free Case Reviewor call (855) 264-6310

Stage 4 Bedsore Treatment

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

Treatment options for a stage 4 pressure ulcer may include:

  • Antibiotics

    Giving patients bacteria-destroying medicine to treat infections

  • Debridement

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

  • Skin Grafts

    Covering the affected area with healthy skin

It can take anywhere from 3 months to 2 years for bed sores stage 4 to heal, according to the Model Systems Knowledge Translation Center (MSKTC).

Can a Stage 4 Pressure Wound Be Prevented?

Yes. Like many nursing home injuries, late-stage bedsores (such as bed sores stage 4) are largely preventable with proper care.

They can be avoided by treating a stage 3 bedsore or lower-stage bedsores from forming in the first place.

The top 5 ways to prevent stage 4 bedsores are:

  1. Treating early-stage bedsores promptly with proper wound care practices
  2. Carefully monitoring earlier-stage bedsores to ensure they are healing
  3. Contacting health care providers if a patient’s wound is not improving
  4. Keeping residents mobile by walking and repositioning them
  5. Making sure residents have access to regular meals, water, and skincare

Sadly, research shows many nursing homes do not report bedsores to Medicare even though they are required to by law. This can make it especially hard for negligent nursing homes to be held accountable for failing to prevent stage 4 bedsores.

40% of bedsores in long-term residents were not reported to the Nursing Home Compare database.”

—U.S. News & World Report

This is alarming because many families rely on Medicare’s rating tools to choose a nursing home or assisted living facility for their loved ones. How can people be expected to find safe facilities for their loved ones if critical data is hidden?

It is unacceptable if your loved one develops a stage 4 bedsore while in the care of a nursing home. Find out if you may be able to hold the facility accountable through a lawsuit with a free legal consultation now.

Contact us for a free consultation by calling (855) 264-6310 or Click to Live Chat right now.

Complications From Stage 4 Bedsores

Individuals with a stage 4 bedsore are at high risk of life-threatening complications.

A stage 4 bedsore may lead to the following conditions if left untreated.


This is an incurable condition where protein builds up in the body and prevents organs from functioning properly.


According to Johns Hopkins Medicine, those with a stage 4 bedsore are at a very high risk of infections. These infections can affect the skin, bones, blood, and other organs.

For example, osteomyelitis (bone infection) and cellulitis (skin infection) can be caused by bacterial infections stemming from stage 4 pressure ulcers.

Renal Failure

This occurs when the kidneys can no longer remove waste from the body, causing damage. It can be fatal if left untreated, but recovery may be possible.

Sepsis and Septic Shock

Sepsis may occur when the body overreacts to a serious infection, like an infection stemming from a stage 4 bedsore. The immune system gets overstimulated and attacks a healthy part of the body.

Severe cases of sepsis can lead to septic shock, which occurs when blood pressure drops due to an infection. Septic shock can be deadly as major organs may shut down.


Many of the conditions listed above can be fatal if left untreated. Renal failure and amyloidosis are the most common causes of death for patients suffering from chronic bedsores, according to The Western Journal of Medicine.

It may be considered wrongful death if a nursing home resident dies after developing bed sores stage 4.

Stage 4 Bedsore Life Expectancy

The life expectancy for stage 4 bed sores depends on several different factors. How long a person lives often depends on their overall health. Additionally, if the bedsore is treated properly before signs of infection appear, it is possible to fully recover.

However, without specialized medical care, blisters that have advanced through the stages of pressure sores to stage 4 are more likely to cause complications or even death.

“Once a bedsore develops, it can take days, months, or even years to heal. It can also become infected, causing fever and chills.”

—Johns Hopkins Medicine

Bedsores that lead to sepsis cause thousands of deaths per year, according to the National Institutes of Health (NIH).

The best defense is recognizing and treating pressure sores before they reach stage 4.

Get Legal Help for a Stage 4 Bedsore

When a resident of a care facility suffers from a stage 4 bedsore, it is often due to nursing home neglect. Fortunately, families have options if neglect or abuse has caused stage 4 bed sores.

Here are steps you can take if your loved one has a stage 4 bedsore:

  1. Seek immediate medical care by insisting they be transferred to a hospital.
  2. When they are released from the hospital, consider relocating them to another nursing home to recover.
  3. Report the stage 4 bedsore to your state’s ombudsman or your local Adult Protective Services (APS).
  4. Connect with a top nursing home neglect law firm near you to file a legal claim and pursue compensation.

Over 17,000 lawsuits involving bedsores are filed each year. The best way to find out if you can sue for a stage 4 bedsore is to contact a nursing home abuse lawyer.

Our legal partners have recovered over $273 million for victims of nursing home abuse and neglect.

The Nursing Home Abuse Center partners with top nursing home attorneys who can help families in all 50 states. Together, they have recovered over $273 million for nursing home abuse and neglect.

Find out if our legal partners can help you file a stage 4 bedsore lawsuit to access the funds you need for your loved one’s care.

Call us at (855) 264-6310 or get a free case review right now to get started.

Stage 4 Bedsore FAQs

How serious is a stage 4 pressure sore?

A stage 4 pressure sore is extremely serious and is the most severe form of pressure ulcer. At this stage, the sore has deepened to a significant wound that exposes muscles, bones, and tendons, making it highly susceptible to infection.

These infections can be severe enough to cause life-threatening conditions like sepsis, bone infection (osteomyelitis), and even systemic infections that can lead to organ failure and death.

Due to the depth and severity of the damage, healing from a stage 4 pressure sore is a lengthy and complex process that often requires advanced medical interventions, including surgery, aggressive infection control, and possibly even reconstructive procedures like skin grafts.

The pain and suffering associated with stage 4 pressure ulcers are considerable, impacting the patient’s overall quality of life and requiring intensive care and management.

What is most likely to cause bedsores?

Bedsores usually form on the bony areas of the body, such as the tailbone, shoulder blades, hips, heels, and ankles.

They are most likely to occur in people with a limited ability to move on their own, including people who spend most of their time in a wheelchair or lying in bed.

What is a stage 4 pressure ulcer?

A stage 4 pressure ulcer is another term for stage 4 bed sores. Different medical professionals and care facilities may use the terms interchangeably.

However, it is important to understand that they are the same and are almost always caused by neglect, which is a form of nursing home abuse.

Can a stage 4 bedsore be prevented?

Yes. Stage 4 bedsores can be prevented with proper care. This includes repositioning and providing soft padding, adequate nutrition, and good skincare.

Treating a pressure ulcer as soon as it starts is critical, or it could quickly progress to a stage 4 bedsore.

If your loved one developed a stage 4 bedsore in a nursing facility, it was likely caused by negligence, and you may have legal options. Find out right now with a free case review.

Can bedsores cause sepsis?

Yes. Sepsis occurs when the body’s response to an infection damages its own tissues and organs. A stage 4 bedsore can introduce bacteria that lead to serious infections, potentially triggering sepsis.

A joint study from the Chicago Tribune and Kaiser Health News found that nursing homes consistently fail to treat bedsores and other conditions that lead to sepsis. In one case, a resident died after developing a serious bedsore that led to sepsis.

His daughter later filed a nursing home lawsuit, claiming his death caused by sepsis could have been prevented.

What is the life expectancy of a Stage 4 bedsore?

Patients can live for months or even years after developing a stage 4 bedsore. Factors such as proper medical care and preventing complications can help patients live longer.

That said, roughly 60,000 people die each year due to bedsore-related complications. Over 50% of those who develop bedsores in hospital settings die in a year or less, according to a 2020 study.

Is stage 4 bedsore curable?

Yes. However, it depends on when treatment is sought and other factors. According to the medical textbook Merck Manual, 30% of stage 4 bedsores will heal in six months.

Some bedsores may not properly heal due to complications like bacterial infections despite proper care. In these cases, doctors can check for secondary complications and treat them alongside the bedsore.

What is the treatment for bed sores on the buttocks at stage 4?

Treating bed sores on the buttocks at stage 4 involves a comprehensive approach, focusing on both healing the wound and addressing the underlying causes to prevent further deterioration.

Here are 8 typical treatment strategies for a stage 4 pressure ulcer:

  1. Debridement: Removal of dead or infected tissue
  2. Infection control: Use of antibiotics to manage infections
  3. Advanced dressings: Use dressings that maintain a moist environment for healing
  4. Negative pressure wound therapy (NPWT): Applies vacuum to promote healing
  5. Pressure relief: Regular repositioning and specialized support surfaces
  6. Nutritional support: High-protein diet and essential vitamins and minerals
  7. Surgery: Surgical interventions for cleaning, reducing, or closing the wound
  8. Pain management: Techniques to manage pain associated with the ulcer

Given the complexity of stage 4 pressure ulcers, a multidisciplinary approach involving doctors, nurses, dietitians, and possibly physical therapists is typically required to manage the condition effectively.

Are stage 4 bedsores always a sign of nursing home abuse?

Most likely. Since bedsores can usually be prevented with proper care, they may be a sign of elder abuse or nursing home neglect. This is especially true when a bedsore is allowed to progress through the earlier stages of bedsores all the way to stage 4.

Can I sue for a stage 4 bedsore?

Yes. If you have a valid legal claim, suing for a stage 4 bedsore may be possible. This is because stage 4 bedsores are almost always preventable, so you may be able to hold the staff accountable by filing a nursing home neglect lawsuit.

The presence of stage 4 bedsores usually means warning signs were ignored in the earlier stages of bedsores. Instead of intervening, negligent nursing home staff allowed the wound to progress to this excruciatingly painful and deadly stage.

Call us right now at (855) 264-6310 to find out if we can connect you with a top nursing home lawyer near you.

How long does a bedsore lawsuit take?

A bedsore lawsuit can often be settled out of court in a few months if both parties agree to the terms. However, if the case goes to trial, it could take a year or more, depending on its complexity and court schedules.

What compensation can be expected for a stage 4 bedsore lawsuit?

Compensation in a stage 4 bedsore lawsuit can range from tens of thousands to several million dollars.

Payouts from stage 4 bedsore lawsuits typically cover medical expenses, pain and suffering, and possibly punitive damages in cases of severe negligence.

The amount depends on the specifics of each case, including the severity of the injury and the costs incurred. For an accurate estimate, consulting with an experienced nursing home attorney is recommended.

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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