$3,100,000Pressure sore death
$2,333,000Fall involving traumatic brain injury
$1,500,000Bedsore settlement
$1,499,000Dementia patient injury
$1,250,000Repeated fall injuries

Stage 4 Bed Sore


Pressure ulcers are a severe problem in nursing homes, with one study finding that nearly half of all nursing home residents have pressure ulcers. These wounds can be excruciating and often lead to infection, invasive surgeries, and death.

The personal injury attorneys at Nursing Home Law Center can help. We provide a free case review and consultations to nursing home residents and their families affected by pressure ulcers.

Our nursing home abuse attorneys at have years of experience fighting for the rights of nursing home residents, and we’re ready to help you too. Call us at (800) 926-7565 or use the contact form today to schedule a free legal case review.

What are Stage 4 Bedsores?

Stage 4 bedsores, also called pressure wounds, pressure ulcers, and decubitus ulcers, are caused by prolonged pressure to any part of the body or friction to the skin.

The compromised state of the person can be due to:

  • Age
  • Impaired sensory perception (numbness)
  • Impaired mobility (paralysis)
  • Illness

These lead to a decrease in blood supply and nutrients, making the person susceptible to stage 4 bedsores.

According to the CDC (Centers for Disease Control and Prevention), health statistics show that most patients are at risk of severe bedsores, especially those with a neurological impairment who cannot feel pain.

A High Incident Bedsore Rate

The Department of Human Services shows that pressure ulcers in long-term care facilities are high, with a study finding that 44% of care home residents have at least one stage 3 or 4 pressure wound.

Stage 4 bedsores are also seen in patients confined to bed for extended periods, especially if they are obese or have a compromised immune system.

Other factors that may reduce blood flow or blood supply leading to pressure ulcers include poor skin integrity (thickening skin), smoking, paralysis, and prolonged exposure to moisture.

Were you or a loved one injured by a facility-acquired bedsore?

Nursing Home Negligence: Common Causes of Pressure Ulcers

A resident’s health is compromised when they develop bedsores from the failure to provide the standard of care that is reasonable and necessary. Nursing home neglect includes, but is not limited to, providing preventive measures against the development of bedsores, which can lead to serious complications.

Bedsores are caused by pressure and friction on the skin. They can develop on any part of the body that is in contact with a surface for an extended period.

The causes include:

  • Pressure from external sources
  • Shearing-the sliding of the skin’s surface over an object such as bedsheets
  • Moisture-related skin breakdown
  • Poor nutrition

The most common areas for bedsores to develop are the back, hips, and heels. Bedsores can cause significant pain and discomfort for the resident. They can also lead to serious health complications, like infection and sepsis.

Contributing factors of stage 4 bedsores include:

  • Providing Substandard Skin Care: Failing to assess a resident’s skin daily who is high-risk for bedsores can result in skin breakdown, especially on bony areas like the ankles, elbows, and shoulders.
  • Not Changing Bed Sheets Regularly: Not changing bed sheets regularly can cause the resident to become sweaty and increase the risk of bed sores due to skin breakdown.
  • Allowing the Resident to Remain in One Position for Too Long: Immobility can restrict the flow of blood, oxygen, and nutrients, causing significant damage and risk of serious infection.
  • Not Checking Bedridden Patients Frequently: Nursing home patients with limited mobility often do not have sufficient strength to shuffle their body to readjust their position to alleviate pressure on the skin and deep tissues.
  • Using Inappropriate Mattress and Bed Linens: The staff should provide a low air loss mattress with fitted sheets to avoid compromising the skin and creating undue pressure on the body.
  • Incorrect Wheelchair Positioning: Improperly positioning a wheelchair-bound patient can increase the risk of bedsores. The staff should ensure that the patient’s weight is evenly distributed and that they are not sitting in one position for too long.
  • Poor Nutrition: Malnourished residents are at a higher risk of developing pressure ulcers because they have a reduced ability to fight infection and heal wounds. The staff should ensure that residents are receiving adequate nutrition and hydration.
  • Dehydration can lead to dry skin, increasing the risk of bedsores. The staff should ensure that residents are receiving adequate hydration.
  • Urinary Tract Infections can cause sepsis, leading to bedsores. The staff should ensure that residents with urinary tract infections receive proper treatment.
  • Poor Hygiene: Failing to maintain good hygiene can lead to skin breakdown and infection. The staff should ensure that residents are bathed regularly and that their bedding is changed frequently.
  • Smoking: Smoking cigarettes can reduce blood flow and slow the healing process, making residents more prone to developing bedsores.
  • Alcohol Consumption can have a similar effect as smoking cigarettes, making residents more prone to developing bedsores.
  • Certain Medications can also weaken the skin and make it more susceptible to developing bedsores.
  • Age and illness can also increase a person’s chances of developing bedsores.

The National Center on Elder Abuse states that bedsores are often the result of nursing home staff failing to provide adequate care. The Centers for Medicare and Medicaid Services (CMS) has established many skincare protocols for treating pressure sores at all four stages.

Nursing staff allowing a facility-acquired pressure ulcer to progress to a stage 4 bedsore could be the first sign of elder abuse or neglect. If left untreated, a stage 4 pressure ulcer could become a deadly wound if infection or gangrene reaches the deeper tissues.

The Beginning Stages of BedSores

A pressure sore appears as warmer or reddened, darker skin than the surrounding area in its initial stage. However, the pressure sore could develop into a skin ulcer with a yellow or white color in an advanced stage.

Johns Hopkins reports that pressure ulcers are the second most common type of hospital-acquired infection. Stage 4 bedsores are the most serious due to significant dead tissue damage.

The Stages of Pressure Sores in a Nursing Home

According to National Pressure Ulcer Advisory Panel (NPUAP), multiple pressure ulcer sore stages include:

Stage 1 Pressure Sores

Early-stage bedsores involve the topmost layer of the skin and are considered minor pressure injuries requiring minimal treatment by competent health care providers to restore the area to healthy skin.

Stage 2 Pressure Sores

Stage 2 pressure ulcers involve damage to both the epidermis and dermis skin layers, leading to fatty tissue bleeding. With this type of pressure wound, there may be tenderness and pain in the affected area, and a slight depression for the underlying dead tissue is forming a crater.

Stage 3 Pressure Ulcers

Stage 3 pressure ulcers now appear as a deep tissue injury exposing the dermis and subcutaneous fat. These pressure ulcers cause extreme pain and could lead to severe infection. In some cases, the crater exposes:

  • Bone
  • Tendon
  • Muscle fatty tissue

Stage 4 Pressure Ulcers

A stage 4 bedsore destroys all deeper tissues beneath the skin and can be life-threatening. Fat may show in the sore along with muscle, tendon, or bone.

These stages of pressure sores are essential to understand because they provide a guideline for healthcare professionals when treating patients. Nurses should also be keenly aware of these stages and report any changes in the patient’s condition to health care providers immediately.

In addition to the four stages of pressure injuries, nursing home residents can also develop unstageable bedsores and suspected deep tissue injuries.

Suspected Deep Tissue Injury

At this stage, the skin surface appears as a stage 1 or stage 2 pressure wound on the skin’s surface, hiding a significant injury underneath the skin surface, similar to stage 3 or stage 4 bedsores.

Unstageable Pressure Ulcers

The opened wound appears was significant debris in the crater that is likely necrotic (dead) tissue, dried blood, or other substances blocking the diagnostician’s view needed to accurately stage the wound.

Some Common Symptoms

The symptoms of stage 4 bedsores which are typically called pressure sores, can include:

  • Blisters on pressure point areas on the body
  • Bright red, purple, or black discoloration of the affected area
  • Skin breaks open with no blisters present
  • The sensation of intense pain in the affected area
  • A large wound that has a white or yellow color
  • An open wound that does not bleed

A failure to recognize and treat stage 4 bedsores in nursing homes could be the first sign of nursing home abuse, mistreatment, or negligence. Treatment is essential in the early stages of stage 4 bedsores to save the patient’s life.

Why Are Stage 4 Bedsores So Dangerous?

Stage 4 bedsore at this stage indicates that the skin has been so damaged by being unrelieved from pressure or shear factor for extended periods that the dermis and underlying layers have essentially died. At this stage, life-saving medical treatments in an emergency room or hospital setting are typically necessary to avoid serious complications.

If left untreated, stage 4 bed sores will lead to life-threatening infections. Severe tissue damage can destroy muscles and bone (osteomyelitis, a bone infection), leading to septic shock and death in severe cases.

Stage 4 bedsores with life-threatening complications t ypically result in permanent damage where the wound can never heal completely.

If a newly developing bed sore is treated properly, it may heal within a few weeks. However, if left untreated, a stage 4 pressure sore could take months or years to heal and may lead to serious health complications, such as:

  • Serious infection
  • Osteomyelitis (bone infection)
  • Sepsis (blood infection)
  • Blood poisoning
  • Cellulitis
  • Abscesses
  • Gangrene
  • Amputation
  • Death

Locations for Stage 4 Bedsores

Any location on the body can experience a stage 4 bedsore. However, pressure wounds commonly appear on bony areas such as the heels, spine, and hips. They can also occur on many other sites, including the buttocks and shoulders.

In many cases, the location of the stage 4 bedsore is based on the patient’s health condition or limited mobility issues. Any individual remaining in one position for an extended period of time could be at significant risk of developing pressure ulcers. The most affected areas include:

  • Heels
  • Buttocks
  • Shoulders and shoulder blades
  • Elbows
  • Back of the head

Preventing Pressure Ulcers

Nurses involved in patients’ skin care protocols should follow proper precautions to ensure that stage 4 bedsores don’t develop. The following are some safety measures used to prevent pressure ulcers:

  • Adequate repositioning for the patient every 2 hours using pillows or other positions that redistribute pressure
  • Use of beds that redistributes weight and assist in proper blood flow
  • Use of foam wedges
  • Keeping the skin clean and moist with lotion while observing cracks, blisters, or redness in the skin
  • Proper nutrition

Nursing Home Staff Must Conduct Skin Assessment at Admission and Every Three Months

Bedsores are a common issue in nursing homes. They can develop when a person is inactive or confined to a bed or chair for long periods of time. The increased pressure on the skin from lying in one position for an extended time can cause the skin to break down and form a sore.

Nursing home staff members must conduct skin assessments when a resident is admitted to the facility and then every three months. A skin assessment is important to ensure that any bedsores are caught early, before they have a chance to become more serious.

If a bedsore is detected, the nursing home staff will take steps to treat it. It may include repositioning the resident, using special mattresses or cushions, and applying dressings or bandages to the area.

It is important for nursing home residents and their families to be aware of the risk of bedsores and to recognize any signs of developing pressure wounds. If you have concerns about your loved one’s skin health, speak with the nursing home staff.

Failing to conduct routine skin assessments based on currently accepted professional principles could indicate nursing home abuse and neglect. Failing to follow the procedures and protocols outlined in the patient’s care plan that leads to stage IV bedsores could indicate negligence.

Treating Pressure Sores

Medical treatment for stage 4 bedsores will include debridement (removal devices like mattresses, cushions, etc.).

Skincare is another crucial aspect of treating pressure sores. The damaged area tends to be black or dark brown due to clotting, restricting blood circulation underneath the healthy skin tissue.

The proper treatment could include:

  • Antibiotics, pain relievers, and other medication
  • Sterilized gauze and dressings
  • Skin grafting
  • Vacuum-assisted closure (negative pressure wound therapy)
  • Hyperbaric oxygen therapy

Proper treatment might take several months for a patient suffering from stage 4 severe bedsores to experience healing, especially if there are other health conditions. However, many patients’ pressure injuries completely heal and return to normal activities.

Health Prognosis for Nursing Home Residents with a Stage 4 Bedsore

A study done at the Department of Veterans Affairs showed that patients with stage 4 ulcers had a higher mortality rate if they were age 75 or older, had an acute illness, and suffered malnutrition.

Many patients with degrading sores will recover completely. However, for others, stage 4 ulcers could have a deadly outcome.

According to the National Institutes of Health, stage II and stage III sores have a better prognosis than those with stage 4 bedsores and are at a very high risk of infections.

Examples of a poor health prognosis for individuals with progressive serious pressure wounds include:

  • Serious stage 4 bedsore on heels of a patient with multiple sclerosis.
  • A large wound on the heels of a patient with Crohn’s disease.
  • Stage III decubitus ulcers, sacral area of a patient with spinal cord injury.
  • Dermatitis on the right ankle h armed a bed-ridden patient for three months due to pressure from the edge of the mattress and friction from the sheet. Dermatitis started as a blister and progressed to stage II before being recognized.
  • Patient with leukemia in remission lying in bed. Decubitus ulcer (stage 4 pressure sore) on the scrotum, with necrosis, where the skin dies, undermining the scrotal skin. The skin ulcer was caused by a benign tumor which prevented the patient from rolling over in bed until it was surgically removed several weeks later.
  • Positioning devices prevent the development of stage 4 bedsores and nursing home abuse residents with mobility challenges.
  • A patient with chronic lung disease lies in bed at home with a pressure sore on the bottom of the foot.
How much is your nursing home lawsuit worth

What is My Stage 4 Bedsore Injury Case Worth?

The evidence, facts, and medical conditions involved in every stage 4 bedsore event make every case unique. Because of that, it is difficult to identify the case’s merits and value without an extensive assessment.

However, our personal injury attorneys use your specific valuation tools to determine a claim’s value. Typically, we will determine the value of your case on certain factors, including:

  • Cost of medical expenses and hospitalization bills
  • Pain and suffering endured as a result of the injury
  • Mental and emotional distress
  • Payment of any future medical treatment
  • Funeral & burial costs in wrongful death cases

Our abuse attorneys at Nursing Home Law Center provide a free legal case review for any individual or loved one who has been the victim of nursing home abuse or neglect.

How Long Does a Personal Injury Case Take?

We understand how difficult this question can be to answer. It is not always easy to predict how long a case might take because many factors are involved. Typically, the time it takes to resolve a matter depends on:

  • The severity of your pressure injuries
  • Strength of the evidence supporting your claim
  • Any complicated legal issues or procedures that come up during the litigation process

A personal injury case involving a simple car accident typically takes a few months to resolve. In contrast, a case involving nursing home abuse, neglect, or wrongful death may take several years.

Call us today if you suspect abuse or neglect at a nursing home or assisted living facility! We have years of experience helping families get justice for victims abused by nursing home abuse pressure ulcer management in America!

Our team of experienced attorneys will fight hard on your behalf so that you can focus on what matters most – getting better wound care for your loved ones while holding abusers accountable!

Don’t wait another day. Contact our office right now to start working together towards justice today!

Nursing home abuse lawyers ready to work on your behalf

When Stage 4 Bedsores Lead to Wrongful Death

Have you lost a loved one to a stage IV pressure sore? You can file a wrongful death lawsuit to sue the facility based on nursing home abuse or negligence. However, proving elder abuse can be complicated.

Why should you hire a lawyer? A lawyer can provide immediate legal help to navigate the complex legal process and fight for the financial compensation you deserve.

An attorney from our law offices will also:

  • Determine all potential defendants: There may be numerous people and entities responsible for causing the resident’s early death, including the nursing home staff, doctors, and other medical professionals who treated the resident, as well as the company that manufactured or supplied the bed or mattresses that caused the bedsores.
  • Gather evidence: The attorney must collect all available evidence to support the family’s case, including medical records, incident reports, photographs of the bedsores, and witness statements.
  • Investigate the incident: The attorney will need to investigate how and why the resident developed bedsores and whether they could have been prevented.
  • Negotiate with the insurance company: The attorney will need to negotiate with the insurance company on behalf of the family to get a fair settlement offer.
  • File a lawsuit: If a settlement cannot be reached, the attorney will file a lawsuit against all defendants.
  • Prepare for trial: The attorney will prepare for trial by gathering evidence and building a case against the defendants.
  • Represent the family in court: The attorney will represent the family in court and argue their case before a judge or jury.
  • Appeal if necessary: The attorney will appeal the decision to a higher court if the family does not receive a favorable verdict.
  • Obtain compensation for damages: The attorney will seek compensation for damages suffered by the family due to their loved one’s death, including medical expenses, funeral expenses, and pain and suffering.
  • Hold those responsible accountable: By winning a wrongful death lawsuit, the attorney can help ensure that those responsible are held accountable for their actions and that similar accidents are prevented in the future.
  • Help prevent future accidents: By winning a wrongful death lawsuit, the attorney can h elp ensure that those responsible are held accountable for their actions and that similar accidents are prevented in the future. This can help protect other nursing home residents from being injured or killed due to negligence or misconduct by nursing home staff.
  • Provide closure for the family: A successful wrongful death lawsuit can provide closure for the family and allow them to move on with their lives after experiencing such a tragic loss from nursing home abuse.

Hire a Nursing Home Abuse Lawyer to Resolve a Compensation Claim

We aim to give you immediate legal assistance and representation as soon as possible after your injury.

When you come in for your free case review, our experienced nursing home abuse attorneys will go over the details of your case and answer all your questions. In addition, we will provide you with highly confidential legal advice tailored to your case and specific circumstances.

Call an abuse lawyer at (800) 926-7565 to schedule a free, no-obligation consultation with an attorney specializing in personal injury cases. Let us provide legal help and discuss receiving financial compensation for your damages.



Nursing Home State Laws

Nursing home abuse lawsuits must be pursued according to the laws set forth by the state where the facility is located. In this section, our attorneys have compiled the relevant laws, regulations and local organizations for each state so you can get an idea of how the law impacts your situation. Should you decide to move forward with a case, you will also find information about locating an experienced attorney who can assist your family.

Client Reviews

Jonathan did a great job helping my family navigate through a lengthy lawsuit involving my grandmother's death in a nursing home. Through every step of the case, Jonathan kept my family informed of the progression of the case. Although our case eventually settled at a mediation, I really was...

- Lisa

After I read Jonathan’s Nursing Home Blog, I decided to hire him to look into my wife’s treatment at a local nursing home. Jonathan did a great job explaining the process and the laws that apply to nursing homes. I immediately felt at ease and was glad to have him on my side. Though the lawsuit...

- Eric