When an individual who is bed- or wheelchair-bound is neglected by their caretakers, they can develop deep decubitus ulcers on their skin. Ulcers are preventable when proper assistance is provided. Unfortunately, many people who require care at a facility or from a home caregiver are at risk of developing pressure ulcers, often causing unnecessary and debilitating pain and serious injuries that can become deadly if left untreated.
In this blog post, we will delve into the issue of decubitus ulcers. Specifically, we will go over the common causes that lead to ulcers, the dangerous and sometimes deadly repercussions of ulcers, and how an experienced attorney can provide the legal help a victim needs if they developed ulcers because of a caregiver’s reckless or negligent actions.
What Is a Decubitus Ulcer?
Decubitus ulcers, also referred to as bedsores or pressure ulcers, are areas of broken skin that develop on individuals who:
- Cannot move by themselves, especially if they have a neurological disease, are thin, or have a blood vessel disease;
- Are confined to their bed for a long time; and/or
- Use a bedside chair or a wheelchair.
Decubitus ulcers are common in nursing homes, hospitals, and in those requiring at-home care. When a decubitus ulcer forms, it is usually in the area where the weight of the individual’s body presses their skin against the firm surface of the bed or wheelchair. This pressure cuts off the skin’s blood supply temporarily and injures the skin cells. Unless this pressure is quickly relieved and blood flows to the skin again, the skin will begin to show signs of injury.
Common Areas Where Decubitus Ulcers Occur
If an individual is confined to a bed, the most common areas these decubitus ulcers appear are on the:
- Spine;
- Lower back;
- Tailbone;
- Shoulder blades;
- Hips;
- Heels;
- Elbows;
- Ears (from lying on the side); and
- Back of the head.
If a person is confined to a wheelchair, decubitus ulcers are most common on the bottom of the feet and the buttocks area. It is important to realize that the pressure does not have to be very intense for decubitus ulcers to show up. For most individuals, the skin is protected from being injured by pressure through a person’s continuous movement throughout the day, even when they are asleep.
Factors That Can Contribute to a Decubitus Ulcer
In general, a decubitus ulcer will begin as a red patch. If this red patch is not protected and additional pressure is applied, it can quickly progress into a blister or an open sore. In severe cases, damage can extend through the skin and tissue and expose bones or muscles.
Even though pressure on the skin is often the leading cause of a decubitus ulcer, other factors can contribute to the problem.
These factors include:
- Moisture left unattended: If there is any wetness from urine, feces, or sweat between the bed and the skin, it is more likely to cause a significant injury. This makes prompt and consistent care especially important if an individual is incontinent.
- Lack of movement: If an individual cannot lift themselves off the bed or roll from side to side, they are more likely to experience a decubitus ulcer. Without making adjustments throughout the day, the pressure on certain areas of the body may cause damage.
- Friction: Friction often results in the skin stretching and the blood vessels kinking, which can impair blood circulation in the skin. Generally, friction occurs when an individual is confined in bed, and they slide against the bedsheets.
- Problems with circulation: Those with circulatory problems from long-term diabetes or localized swelling may be more likely to develop decubitus ulcers. This is often because the skin’s blood flow is already compromised, even before the pressure is applied to the skin.
- Improper nutrition: If an individual does not get enough vitamins, minerals, and protein, they are more likely to develop a decubitus ulcer.
- Getting older: Those who are 85 years and older are more prone to decubitus ulcers because the skin becomes more fragile as we age.
- Less sensation: People who have nerve problems and a decreased ability to feel discomfort or pain are more likely to get decubitus ulcers. This happens because of an inability to feel the effects of prolonged pressure on their skin.
Decubitus ulcers often lead to serious and intense pain. However, they can also result in more significant medical complications, such as blood infections and bone infections, which can become deadly without proper medical treatment.
Why Are Pressure Ulcers so Common?
Pressure ulcers are common in the ill and elderly in the United States and around the world. There are various reasons why they are so common, including staffing issues in hospitals and care facilities and the seriousness of an individual’s medical condition.
If an individual is seriously ill cannot move by themselves, they are at risk of developing pressure ulcers. This can be exacerbated if they can’t tell their caretakers that they are uncomfortable or in pain. Caretakers are therefore responsible for helping high-risk patients move regularly. In some cases, this may only consist of shifting the patient from one side to the other, but even this can significantly improve patients’ chances of avoiding pressure sores. Staff must also make sure the individual’s skin stays dry and clean, and that they are receiving adequate nutrition.
There are two main reasons that staff members don’t provide proper care to prevent ulcers:
- Improper training; and
- Understaffing in the care facility.
Too often, hospitals and nursing homes don’t provide their staff with proper training on how to prevent pressure ulcers. Nurses and caregivers may let that part of the job slide in favor of attending to other things they see as more pressing and imminent. They may also simply be unaware of what they can do to prevent ulcers.
In addition, many healthcare facilities are understaffed. If there are not enough caregivers to go around and provide proper care for all patients, some things may slip. Because pressure sores are not always well understood and may be seen by staff as less significant than other health issues, the staff may not take the time or have the bandwidth to take the proper steps to prevent them.
In these situations, it often falls to a patient’s loved ones to recognize that there is an issue and advocate for their loved one, or help their loved one move to a different facility.
Symptoms of a Decubitus Ulcer
Most decubitus ulcers are classified into four different stages, depending on the severity of the skin damage.
These stages include:
- Stage 1: The skin is red – The earliest sign of a decubitus ulcer is skin damage, which often appears as a red patch of skin that does not turn white when you press a finger on it. In individuals with darker skin, this patch may appear purple or blue and may be harder to see. Additionally, the skin around this patch may be itchy, tender, firm, and feel cold or warm.
- Stage 2: The skin is blistered or broken – Once the skin is injured, it can blister or develop an open sore on the outer layer of the skin. There may be mild swelling and some oozing resulting from the injury.
- Stage 3: The skin is broken, and there is an open wound – In stage three, the decubitus ulcer becomes a crater that goes below the skin’s surface.
- Stage 4: The ulcer is deep – In stage four, the crater deepens and may reach all the way to the bone, tendons, joints, and muscles.
Because decubitus ulcers can lead to broken skin, they are incredibly vulnerable to infections.
Signs that can indicate that an infection has developed include:
- Pus coming from the ulcer;
- A bad-smelling odor coming from the ulcer;
- Heat, increased redness, and tenderness in the surrounding skin; and
- A fever.
How Long Does a Decubitus Ulcer Last?
Numerous factors can influence how long it takes a decubitus ulcer to heal. Typically, it will depend on the type of treatment the individual receives, the severity of the sore, the individual’s overall health, age, ability to move, and nutrition intake. For instance, a stage two decubitus ulcer can often heal within one to six weeks. However, a stage three ulcer can take six months to get better, while a stage four decubitus ulcer may never fully heal.
What Is the Outlook for a Decubitus Ulcer?
In general, the outlook for decubitus ulcers is good. As long as an individual gets the treatments they need, most ulcers can resolve within a few weeks. In more severe cases, an ulcer may require reconstructive surgery to repair the damaged area. However, if an ulcer goes untreated, it can lead to infection and, in severe cases, death.
Some of the most common infections that result from decubitus ulcers include:
- Sepsis;
- E. Coli;
- Cellulitis;
- Septic arthritis;
- Osteomyelitis;
- Staphylococcus aureus; and
- Methicillin-resistant Staphylococcus aureus (MRSA).
Any decubitus ulcer can become infected if the skin is broken. However, the risks are much higher when the sore is located around the tailbone or the buttocks, especially when the individual is incontinent. Stool and urine can contribute to the skin breaking down, and once the skin breaks, moisture and other irritants can increase the risk of infection.
What to Do if Decubitus Ulcers Were Caused by a Negligent Caregiver
In the United States, decubitus ulcers are becoming increasingly common, as elder abuse is on the rise. Even worse, most medical care experts agree that there is no justification for ulcers to develop in nursing care facilities or hospitals, because prevention is straightforward. Unfortunately, decubitus ulcers often develop because of a caregiver’s negligence.
Medicare and Medicaid regulations set a certain minimum standard of care for long-term care facilities. A facility’s failure to meet the level of care required by 42 CFR 483, Subpart B is a violation of the regulations intended to protect residents. Section 483.25(c)(1) requires that a facility and its staff ensure that a resident who does not have pressure sores when they enter the facility does not develop them unless they are unavoidable. It also states that a resident who develops pressure sores must receive the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.
According to the National Council on Aging, almost one in ten Americans who are 60 years or older have experienced some sort of elder abuse. In fact, studies show that nearly five million seniors are abused each year. Yet, only one in 24 cases is reported.
If you believe a decubitus ulcer developed because of a caregiver’s negligence, it’s important to seek out legal help. Working with an experienced bedsore attorney can help you get through this challenging ordeal and recover the financial relief you or your loved one deserves.
Fight for the Justice You Deserve With a Skilled and Knowledgeable Bedsore Lawyer
If you or a family member has suffered a decubitus ulcer because of a caregiver’s intentional or reckless actions, you deserve compensation for the harm you have endured. Do not wait any longer. Contact an experienced bedsore attorney today to schedule a free case consultation and let us show you how we can fight for the recovery you deserve.