One of the most common types of nursing home abuse cases that our lawyers handle involve bedsores. Bedsores, also known as decubitus ulcers, form when bony prominences of the body are subjected to prolonged pressure with a mattress, bedding or a medical device. Most commonly, bedsores occur on the sacrum, which is the lower back just above the buttocks. Other common locations for bedsores include the feet, ankles, toes and elbows.
Bedsores can be horrific. If not treated, they can lead to unrelenting pain, disfigurement, hospitalization, surgical procedures, severe infection and death. Our Jacksonville nursing home abuse attorneys have seen cases of bedsores so large and deep that the affected body part is hard to recognize.
A nursing home must take precautions to prevent bedsores and must respond promptly if a bedsore does develop.
First, a resident must be assessed regarding his or her risk of skin breakdown. The “Braden” assessment scale is the most common method for determining this risk. The Braden scale uses a point system for various risk factors including: the resident’s sensory perception (if a resident has a limited ability to feel pain, he or she will be less likely to move, or seek help moving, in order to relieve the pressure point); exposure to moisture (if a resident is likely to have consistently moist skin in an area, for ex., a person with urinary incontinence who is not using a catheter, that person is much more likely to develop a bedsore in the moist area); vascular status (a resident with restricted blood flow is more likely to develop bedsores); activity levels (residents who are bed-bound are more likely to develop sores than those who are more mobile); and nutrition (residents with nutrition challenges such as kidney disease which limits their protein intake are more likely to develop bedsores).
It is necessary that a nursing home complete the Braden scale for every resident. For those with medium or high risk scores, preventative measures must be taken. A deflating air mattress can be used which, as it loses air, changes the areas of the body that are impacting the bed. Further, nutrition must be monitored and blood tests should be performed to demonstrate that protein consumption is optimal (measured by albumin and pre-albumin levels). Further, changing the resident’s position should be performed on every shift and documented in his or her chart. Finally, frequent examinations of all skin areas must be made with charting reflecting any areas of concern. Any areas of concern should be brought to the attention of the resident’s doctor so that all measures can be put in place to prevent the sore from worsening and to promote healing.
For some people, bedsores are inevitable. Sometimes, when a person is near the end of life, his or her skin may be one of the first organs that fails. In these circumstances, a nursing home is not negligent if non-healing bedsores develop. However, it is critical that the nursing home chart all of the steps taken above and have the doctor chart regarding both the efforts being made and the support for the notion that the resident is experiencing bedsores that cannot be prevented or healed despite best efforts.
Unfortunately, the scenarios most often seen by our nursing home neglect lawyers for cases in the Jacksonville area, involve little to no compliance with: performing a proper Braden assessment; creating an appropriate care plan to address skin breakdown risks; following through with required precautions; and responding appropriately once a bedsore develops. When we review a case, we study the records to look for such entries. If they are not there, we then have the case reviewed by an expert witness who is a registered nurse. If that expert finds neglect, then we are ready to start the pre-suit notice process.