Bed and Pressure Sores in Michigan Nursing Homes

Our nursing home attorneys at Buckfire & Buckfire, P.C. handle neglect cases arising from bedsores or pressure sores in nursing home patients. Upon admission to the nursing home and throughout the admission, the nursing home staff is required to assess a resident’s risk of developing bedsores. With proper care and monitoring, bedsores should either be prevented or timely diagnosed so that prompt treatment can be administered. Patients who suffer from bed and pressure sores in Michigan nursing homes or assisted living centers have legal rights. Nursing homes can be negligent if they do not properly assess the patient for the likelihood of developing a bed sore, if they do not turn the patient on a regular schedule or do not bathe the patient on a regular schedule, and finally, if they do not treat the patient after the diagnosis of a bedsore.

What Are Bedsores?

Bedsores, also known as pressure sores, are one of the most common signs of nursing home neglect. In fact, according to the Centers for Disease Control and Prevention (CDC), as many as 1 out of 10 residents in nursing homes have a bedsore. With proper care and monitoring, bedsores should either be prevented or timely diagnosed so that prompt treatment can be administered. Nursing home lawsuits arise against facilities when patients are not properly treated or when a delay in treatment causes the condition to become much worse.

Bedsores often occur in persons who cannot move around easily. The skin and tissue underneath bread down from continued pressure and poor circulation. When the skin breaks down, it becomes red. Open sores develop after the skin changes. In severe cases, the bedsores causes destruction of muscle or even bone underneath the skin.

Bedsores are classified by stages based upon the physical characteristics of the wound. Stage 4 bedsores are the most serious level of pressure sores. Our Buckfire & Buckfire, P.C. attorneys advise all victims of nursing home abuse to document all aspects of their injuries via photographs. Not only do you want to photograph the bedsore itself but also the progression of it as well. Bedsores or pressure sores can develop quickly so it is very important to document the progression on a daily basis.

As a patient you have the right to request to photograph or videotape your injuries. A nursing home staff member does not have legal basis to not allow you to do so.

Michigan nursing homes can be negligent if they do not properly assess the patient for the likelihood of developing a bed sore, if they do not turn the patient on a regular schedule or do not bathe the patient on a regular schedule, and finally, if they do not properly treat the patient after the diagnosis of a bedsore.

The Four Stages of Pressure Ulcers

Pressure ulcers and bed sores are an injury to the skin and underlying tissue, they can array from slight reddening of the skin to severe tissue damage and sometimes infection. Infections can turn serious and extend into muscle and bone. The four stages used to describe pressure sores are listed below.

Stage 1: Sores are not open wounds. The skin may be painful, but it has no breaks or tears. The skin appears reddened and does not blanch (lose color briefly when you press your finger on it then remove your finger). In a dark-skinned person, the area may appear to be a different color than the surrounding skin, but it may not look red. Skin temperature is often warmer. And the stage 1 sore can feel either firmer or softer than the area around it.

Stage 2: The skin breaks open, wears away, or forms an ulcer, which is usually tender and painful. The sore expands into deeper layers of the skin. It can look like a scrape, abrasion, blister, or a shallow crater in the skin. Sometimes this stage looks like a blister filled with clear fluid. At this stage, some skin may be damaged beyond repair or may die.

Stage 3: The sore gets worse and extends into the tissue beneath the skin, forming a small crater. Fat may show in the sore, but not muscle, tendon, or bone.

Stage 4: The pressure sore is very deep, reaching into muscle and bone and causing extensive damage. Damage to deeper tissues, tendons, and joints may occur.

During stages 3 and 4, residents can experience little or no pain due to significant tissue damage. Serious complications, such as infection of the bone, like osteomyelitis or blood, like sepsis, can occur if pressure sores progress.

At times, a pressure ulcer or sore on a Michigan nursing home resident does not classify into one of the four stages. In this instance the sore is called a deep tissue injury (DTI). A deep tissue injury occurs when a pressure sore is suspected, but cannot be confirmed. There are also pressure sores that exist where the stage is not clear. In these cases, the base of the sore is covered by a thick layer of other tissue and pus that may be yellow, gray, green, brown, or black. The stage cannot be determined because the base of the sore cannot be seen by the doctor. These sores are classified as “unstageable.”

Treating Pressure Sores in Michigan Nursing Homes

Michigan nursing homes should have a proper care process in place for treating pressure ulcers or sores when they develop. Below are the basic steps that should be followed to manage a pressure ulcer or sore.

Assessment: The purpose of this step is to provide a rational basis for deciding whether there is a need, risk, or problem and what to do about it. The nursing home’s staff and practitioners collect relevant information about the resident (history, signs and symptoms, known medical conditions, personal habits and patterns) After assessment is done, the medical staff should also do the following:

- Evaluate and organize that information to identify whether the individual has a specific need, condition, or problem
- Describe and define the nature (onset, duration, frequency) of the risk, condition, or problem.

Diagnosis: The nursing home’s staff and practitioners attempt to identify causes of a condition or problem, or explain why causes cannot or should not be identified.
Treatment & Management: The nursing home’s staff and practitioners use the above information to decide how to manage a resident’s condition, symptom, or situation. Where causes may be identifiable and correctable, they seek and address them or explain why they could not or should not have done so.
Monitoring: The nursing home’s staff and practitioners evaluate the individual’s progress over time in relation to a risk, need, problem, condition, or symptom, consider the effectiveness of interventions, and make a systematic determination about what to do next.

In patients with significant predisposing factors, it is important to assess the patient’s risk for pressure sores and develop a prevention plan as soon as possible. The most widely used plan by medical providers for predicting a patient’s likelihood to develop pressure sores is the Braden Scale.

The Braden Scale considers various factors to determine the risk of a patient for pressure ulcers or bed sores. These include the patient’s mobility, ability to sense pain, nutritional status, and mental status.

Risk Factors For Developing Pressure Ulcers

There are many common major risk factors a patient in a Michigan nursing home has for developing pressure ulcers. These include:

Degenerative neurologic disease
Cerebrovascular disease
Central nervous system (CNS) injury
Depression
Drugs that adversely affect alertness
Neurologic disease/injury
Fractures
Pain
Restraints

Factors That Affect Pressure Ulcers Healing

A Michigan nursing home should be properly trained to treat a patient when they do in fact suffer from a pressure ulcer. Unfortunately, there are factors that will prevent a pressure ulcer from healing. These factors whether it be the fault of the nursing home staff, such as malnutrition, it can also include the health status of the resident as well. Some of the most common factors that affect healing include:

Malnutrition and Dehydration
Diabetes
End – stage renal disease
Thyroid disease
Congestive heart failure
Peripheral vascular disease
Vasculitis and other collagen vascular disorders
Immune deficiency states
Malignancies
Depression and psychosis
Drug that affect healing
Contractures at major joints

Infected Bed Sore Symptoms

Infected bed sores are a life threatening condition. Most bed sore infections are sepsis infections, which are caused by bacteria in the bloodstream. These bacteria frequently enter the body through open wounds, like bed sores, that are not properly diagnosed and treated early on in the process. Nursing home patients are often more vulnerable to a sepsis infection because their immune systems are worn down. Sepsis is a serious illness, which in severe cases can lead to death. Other serious medical conditions can be caused by sepsis as well, including, organ failure.

Many infected bed sores have the following symptoms:

Fever above 101.3 F (38.5 C) or below 95 F (35 C)
Heart rate higher than 90 beats a minute
Respiratory rate higher than 20 breaths a minute
Probable or confirmed infection
Slough appearance

The nursing home staff, including both doctors and nurses, should be highly qualified and able to identify and diagnose these symptoms immediately. If untreated or not properly treated, the bed sore infection will worsen and cause significant injury or even death.

When Is a Pressure Ulcer Caused by Neglect?

If your loved one is suffering from a pressure ulcer, you may be wondering many things about the care they are receiving at the Michigan nursing home you chose for them. Nursing homes are supposed to provide the best possibly care and your loved one should feel that they are in good hands. If your loved one recently developed a pressure ulcer or bed sore, some questions you should ask yourself are:

Did the facility consider care related process problems that may influence or contribute to the development or healing of a pressure ulcer?
Did the staff consistently implement the interventions identified in physician orders and the care plan? Were the facility’s interventions consistent with your loved one’s needs, risk factors, related conditions, goals, values and wishes?
Did the staff monitor the evolution of existing pressure ulcers?
Did the staff adjust interventions based on the wound’s evolution, underlying causes, medical complications, the resident’s overall condition and prognosis, and other related factors?
Did the staff use relevant pressure reduction methods in accordance with established principles?
Did the staff turn and reposition the resident routinely?

How To Prevent Nursing Home Pressure Ulcers

Maintain personal hygiene
Try to assure adequate nutrition and hydration
Evaluate and manage urinary and fecal incontinence
Position to alleviate pressure over boney prominences and shearing forces over the heels and elbows, base of head and ears
Try to reposition every two hours when in bed and every hours when in a chair
Use appropriate positioning devices and foam padding; do not use donut-shaped devices.
Try and avoid placing the patient on his or her trochanters or directly on the wound.
Maintain the lowest head elevation possible.
Use lifting devices such as draw sheets or a trapeze.
Try to prevent contractures.
Do not massage reddened areas over bony prominences.

Call a Michigan Nursing Home Attorney to Discuss Bed and Pressure Sores

Patients who suffer bed and pressure sores at a Michigan nursing home or in other medical care centers do have legal rights to sue the facility. These injuries and conditions are completely preventable with proper nursing practices and medical supervision. Patients, or their family members, should contact the team at Buckfire & Buckfire, P.C. immediately to determine their legal rights for bedsore injuries. Call our office now. We will start working on your case immediately gathering all the evidence and witness statements to win and prove your case.