Decubitus Ulcers

(commonly known as pressure ulcers, pressure sores or bed sores)

A sign of potential nursing home neglect or abuse is developing decubitus ulcers. Decubitus ulcers occur when bony prominences place pressure onto the skin causing breakdown. Common areas for these ulcers to occur are the heels and buttocks or tailbone. 

Decubitus ulcers are categorized or "staged" as follows:
Stage I Decubitus Ulcer- the skin is reddened, but not yet broken. The redness will disappear when the area of pressure is relieved. However, extreme care must be taken to ensure that the area does not progress to a Stage II. Intervention includes pressure relieving foam or air mattresses and frequent repositioning. Proper fluid and nutritional intake is crucial.

Stage II Decubitus Ulcer - a partial thickness of the skin has sustained injury usually in the form of a blister which may or may not be open. The wound must be covered, protected and kept clean. Infection is a concern. A Stage II wound will heal rapidly if the appropriate interventions are taken. Pressure relief and proper fluid and nutritional intake must be given.

Stage III Decubitus Ulcer - skin breakdown is now involved through all layers of the skin. A Stage III ulcer usually occurs when a Stage I or II ulcer has not received the appropriate aggressive treatment and interventions to prevent worsening. Infection may lead to sepsis, a life-threatening infection. A Stage III ulcer requires trained medical intervention.

Stage IV Decubitus Ulcer - the ulcer now extends through all layers of skin and involves muscle, tendons and bone. The depth of the wound is more important than the actual diameter of the wound, since bone involvement can lead to amputation. Major surgical intervention to remove necrotic (dead) tissue and/or bone is usually required.

Prevention of Decubitus Ulcers
The best treatment for decubitus ulcers is prevention, which includes:

• Turning schedules for residents who are unable to reposition themselves
• Not allowing residents to remain in wheelchairs for extended periods of time
• Pressure-relieving foam heel protectors, foam or air bed mattresses and wheelchair pads
• Appropriate fluid intake, nutrition and vitamin therapy
• A regular program to inspect each resident's skin integrity and implementation of aggressive preventive daily care.

A facility MUST ensure that a resident who enters a nursing home free from pressure ulcers does not develop them while a resident of the facility, unless it is shown to be clinically unavoidable. The nursing home must have a heightened awareness for residents who are "at risk" for these types of problems and take appropriate measures to prevent their occurrence. Residents who are incontinent of bowel or bladder must be kept clean at all times to prevent skin breakdown. After a pressure ulcer has developed, it must be aggressively treated to prevent worsening. Pressure ulcers can lead to serious infection and death.

The information provided on this site relative to decubitus ulcers is meant as a brief overview. Specific Federal and State laws and regulations apply and each case is unique and fact-intensive.