What Is a Stage 4 Bedsore?
Stage 4 bedsores are the most severe form of bedsores, also called pressure sores, pressure ulcers, or decubitus ulcers. A stage 4 bedsore is characterized by a deep wound that reaches the muscles, ligaments, or even bone. They often cause residents to suffer extreme pain, infection, invasive surgeries, or even death.
A stage 4 bedsore may be an unfortunate sign of nursing home neglect. Residents of nursing homes may develop these sores if the staff fails to treat earlier-stage sores.
Thankfully, financial compensation may be available if your loved one develops a stage 4 bedsore while living in a nursing home. Get a free case review to see if you can pursue compensation to help pay for medical treatment.
Get a free case review to learn if you can access financial aid and hold abusive nursing homes accountable.
What Do Stage 4 Bedsores Look Like?
Characterized by severe tissue damage, a stage 4 bedsore is the largest and deepest of all bedsore stages. They look like reddish craters in the skin, and muscles, bones, and/or tendons may be visible at the bottom of the sore.
An infected stage 4 bedsore 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
Stage 4 bedsores typically form if earlier-stage pressure injuries are not properly treated.
All bedsores are caused when factors like pressure, shear, and friction cut off blood supply to the skin. Without proper treatment, the loss of blood can cause the skin to die and a wound to form.
A stage 4 bedsore is the worst-case scenario: the blood loss is so severe that the wound tunnels down through all layers of the skin and exposes bone.
Nursing home bedsores are often the result of improper care from staff. When the caregivers at assisted living facilities are not properly trained or are overworked, residents may suffer.
Residents who need help with mobility may lie in bed or be left in a wheelchair for hours with no relief, causing bedsores.
Who’s at Risk of Stage 4 Bedsores?
Anyone with a lower-stage bedsore is at risk of a stage 4 sore. However, some patients may be more prone to this type of injury.
At particularly high risk are those:
- With limited mobility: Movement is the key to preventing bedsores of any stage. If an older person 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.
- Who are 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 issues like understaffing and poor training.
- Who have Alzheimer’s or dementia: If residents with mental impairments develop a bedsore, they might not be able to tell anyone due to their condition. They’ll need to have someone else find it and help them get the proper care. Residents with these conditions may also have trouble sensing pain.
- Affected by other factors: Residents are at higher risk of bedsores if they have blood flow or circulation problems, diabetes, or poor nutrition or if they wear a cast.
Symptoms of Stage 4 Bedsores
Most of the symptoms of a stage 4 bedsore are related to bacterial infections, a common complication.
Symptoms of a stage 4 bedsore include:
- Blackened 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 bedsore symptoms on your elderly loved one, seek immediate medical care.
Diagnosing a Stage 4 Bedsore
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.
In some cases, however, 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:
Unstageable
When a doctor cannot see the bottom of an open 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 affecting deeper tissues underneath.
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 deadly health problems.
Treatment of stage 4 bedsores 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 an advanced stage 4 bedsore to heal, according to the Model Systems Knowledge Translation Center (MSKTC).
Can a Stage 4 Bedsore Be Prevented?
Yes. Like many nursing home injuries, late-stage bedsores are largely preventable with proper care. They can be prevented by treating stage 3 bedsores or lower-stage bedsores from forming in the first place.
Nursing home staff can help prevent stage 4 bedsores by:
- Carefully monitoring earlier-stage bedsores to ensure they are healing
- Contacting health care providers if a patient’s wound is not improving
- Keeping residents mobile by walking and repositioning them
- Making sure residents have access to regular meals, water, and skincare
- Treating early-stage bedsores as soon as possible with proper wound care practices
Legal Case ReviewComplications From Stage 4 Bedsores
Those with a stage 4 bedsore are at high risk of life-threatening complications.
If left untreated, a stage 4 bedsore may lead to:
Amyloidosis
This is an incurable condition where protein builds up in the body and prevents organs from functioning properly.
Infection
Those with a stage 4 bedsore are at a very high risk of infections, according to Johns Hopkins Medicine. These infections can affect the skin, bones, blood, and other organs.
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, such as an infection stemming from a stage 4 bedsore. The immune system gets overstimulated and attacks healthy body parts, which can lead to long-term health problems.
Severe cases of sepsis can lead to septic shock, which occurs when the body’s blood pressure drops significantly due to an infection. Septic shock is potentially deadly, as it can cause major organs to shut down.
Death
Many of the conditions listed above can be fatal if left untreated. 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.
It may be considered a wrongful death if a nursing home patient dies from an untreated bedsore.
Nursing Home Neglect and Stage 4 Bedsores
When a resident suffers from a stage 4 bedsore, it is often due to nursing home neglect.
Residents may develop bedsores if staff members:
- Cannot properly care for every resident due to understaffing
- Don’t treat dehydration or malnutrition, which can prevent healing or worsen sores
- Don’t properly care for residents with mobility issues
- Fail to notice or treat earlier stage sores due to skipped or rushed care
If nursing home neglect may have caused a stage 4 bedsore, residents and families have options.
They can:
- Contact an ombudsman or Adult Protective Services (APS)
- Reach out to a nursing home abuse lawyer
- Fill out our free case review form to learn about legal compensation
Common Questions About Stage 4 Bedsores
Can bedsores cause sepsis?
Yes. Sepsis develops when the body tries too hard to fight infection. A stage 4 bedsore can trigger the infections that lead to sepsis.
In 2014, an elderly nursing home resident from Chicago died after developing a serious bedsore that led to sepsis. His daughter later filed a nursing home lawsuit, claiming his death could have been prevented.
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.
How long can you live with 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.
Can stage 4 bedsores heal?
This depends on when treatment is sought and other patient variables. 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 those alongside the bedsore.
