Bed Sores &
Pressure Ulcers

What Are Pressure Ulcers?

Pressure ulcers — commonly called bed sores or decubitus ulcers — are injuries to skin and underlying tissue caused by prolonged pressure, typically over bony areas of the body like the tailbone, heels, hips, elbows, and back of the head. They develop when a resident is left in the same position for too long without being turned or repositioned.

In healthy adults who can shift position on their own, pressure ulcers rarely develop. In nursing home residents — many of whom are bedbound, immobile, malnourished, or have conditions that impair circulation — pressure ulcers can develop within hours if basic care isn't provided.

The Four Stages of Pressure Ulcers

The medical community uses a standard staging system. Understanding the stages helps families recognize what they're seeing:

Stage 1

Reddened skin that doesn't blanch (turn white briefly) when pressed. The skin is intact but warmer, firmer, or softer than surrounding tissue. Often the first warning sign — and a prompt for immediate repositioning and skin-care interventions.

Stage 2

Partial skin loss. The ulcer appears as a shallow open wound or blister. Painful and often the first stage families actually notice, because the skin is visibly broken.

Stage 3

Full-thickness skin loss extending into the fat layer beneath. The wound resembles a deep crater. At this stage, the ulcer is almost never the result of unavoidable decline. It represents a failure of basic nursing protocols — repositioning, skin inspection, moisture management, nutrition.

Stage 4

Full-thickness tissue loss with exposed muscle, tendon, or bone. Life-threatening complications including osteomyelitis (bone infection), sepsis, and death are common. A stage 4 pressure ulcer in a facility resident is a medical emergency and a significant warning sign of systemic care failure.

The staging system also recognizes unstageable ulcers (covered by dead tissue that obscures depth) and deep tissue injury (discoloration suggesting damage beneath intact skin). Both warrant the same serious response as stage 3 or 4.

Why Pressure Ulcers Are Almost Always Preventable

Nursing homes have well-established, industry-standard protocols for preventing pressure ulcers. These include:

• Repositioning every two hours for bedbound residents, more frequently for high-risk residents
• Skin assessments on admission and periodically thereafter, with documentation
• Pressure-reducing surfaces — specialized mattresses, cushions, heel protectors — for residents assessed as high risk
• Moisture management — prompt cleaning after incontinence, barrier creams, and dry bedding
• Nutrition and hydration support — malnutrition and dehydration make skin fragile and wounds harder to heal
• Risk assessment tools like the Braden Scale, used to identify which residents need intensive prevention efforts

When a facility follows these protocols, pressure ulcers are rare. When they don't — typically because of understaffing, poor training, or indifference — they become common. Federal and NJ regulations require these preventive measures, and facilities that skip them face both regulatory consequences and civil liability.

When a Bed Sore Case Has Legal Merit

Not every pressure ulcer in a nursing home is a legal case. Some residents arrive with existing wounds. Some have medical conditions that make ulcers harder to prevent. But when a stage 3 or stage 4 ulcer develops after admission — or when an existing ulcer worsens dramatically while under facility care — the following questions drive the legal analysis:

• Did the facility conduct and document proper skin assessments?
• Was a risk-assessment tool like the Braden Scale actually applied?
• Was a prevention plan put in writing and followed by staff?
• Was the resident repositioned as required, with documentation?
• Were family members notified promptly when a sore developed?
• Was appropriate medical treatment provided once the ulcer was identified?

Medical records usually tell the story. Properly trained staff document repositioning, skin checks, and interventions. When those entries are missing — or when they appear to have been created after the fact — that's often the evidence that drives a case.

What to Document if You See a Bed Sore

If you discover a pressure ulcer during a visit, the window for preserving evidence is short. Concretely:

• Photograph it with a ruler or common object for scale, and with the date visible
• Note the exact date and time you observed it and who was on duty
• Ask staff when it was first identified, by whom, and what interventions have been implemented — then verify against the medical record
• Request the complete medical record in writing, including skin assessments, turning schedules, nursing notes, and the care plan
• Insist on a medical evaluation by the physician, not just nursing staff — stage 3 and stage 4 ulcers require physician-level care
• Do not sign anything presented by facility administrators, especially anything characterized as a release, acknowledgment, or consent

How We Evaluate Bed Sore Cases

Jeff reviews bed sore cases in the context of his broader elder law practice — meaning he understands not just the legal standards but how nursing facilities actually operate day-to-day. Evaluation typically involves reviewing medical records, comparing documentation to the resident's observed condition, and identifying whether the facility followed standard prevention protocols.

If the case has merit, we'll tell you what a claim looks like, what the likely timeline is, and what recovery might involve. If it doesn't — because of documentation that supports the facility's position, or because another factor better explains the outcome — we'll tell you that honestly. A case review costs nothing.

For related topics, see our overview of nursing home abuse and neglect in NJ, broader neglect patterns, and nursing home falls.