Is it Mandatory for Nursing Homes to use Pressure Relieving Mattresses?

By Nursing Home Law Center

As of now, only one state in the country has enacted legislation mandating the use of pressure relieving mattresses in nursing homes. That state is New Jersey. Within three years all nursing homes in New jersey must make the switch from their normal mattresses to pressure relieving mattresses. No other state has passed nor introduced such legislation.

What Are Bedsores?

Bedsores, also called decubitus ulcers, result from continuous pressure on skin and underlying tissue. This pressure restricts blood flow, which causes the skin to die and the ulcer to develop. This is not normally an issue as people move around and shift their weight. However, when patients in a hospital bed or a nursing home patient remains immobilized for long periods, they risk damage to their skin and pressure sores can develop.

While immobilization is the classic cause of bedsores, other patients are also at risk. At-risk patients include:

• Smokers. Smokers have a naturally reduced ability to heal, which puts them in greater danger of developing bedsores, and of those bedsores becoming more severe.
• Diabetics. Many diabetics have reduced sensation in their bodies, especially the extremities. Medical professionals urge diabetics to consistently check their feet for developing problems, for instance. This reduced sensation means they can begin to develop a bedsore without realizing it, putting them at greater risk.
• Patients with incontinence. If a patient is sleeping in his or her own feces or urine, there is a far greater risk of skin damage.
• Patients with atheroma. Atheroma is a peripheral vascular disease that affects circulation in the arms and legs. Naturally, this will increase the chances of developing a pressure sore.
• ICU patients. Patients in intensive care units are very sick and often not conscious. Their lack of movement can lead to bedsores.
• Patients with a spinal cord injury. The reduced sensation from a spinal cord injury means patients may be unaware that a bedsore is developing and can leave them unable to shift their weight on their own.

Bedsores develop over time, going through four stages from initial, less severe, to life-threatening.

• Stage I. The skin is red but not broken. It may be swollen, hard and warm.
• Stage II. A blister develops, or possibly an abrasion.
• Stage III. The sore has gone through the skin and minimally damaged the underlying tissue.
• Stage IV. The bedsore is deep and has exposed the bone, muscle and ligaments underneath. A stage IV bedsore is life-threatening.

How Can Nursing Home Staff Prevent Bedsores?

Preventing bedsores requires effort on the part of hospital or nursing home staff. Frequently changing the position of the patient, to imitate the natural position changes of mobile people when they sleep or sit down, is essential. Dehydration is often a factor in pressure sores, so keeping the patient hydrated and properly nourished is important.

A more recent development in technology now offers us a third possibility. Nursing professor Janet Beitz used an algorithmic method based on clinical evidence to develop an effective surface which can prevent or reduce incidences of bedsores.

"A standard mattress is not designed to prevent or treat pressure ulcers because it is the kind of mattress you sleep on at home," she says.

There are pressure-redistributing mattresses that achieve the same result as shifting one's position in bed. Friction management devices can also prevent the breakdown of the skin while others control moisture.

New Jersey's State Bill S-1517 mandates that nursing home operators begin to switch over to pressure relieving mattresses within one year. By three years' time they must have completed the changeover.

No other state in the country has enacted or even proposed such legislation. It remains to be seen whether any will follow New Jersey's lead or what the effects of New Jersey's legislation will be.

Related Information

• Scientific Approach Used to Eliminate Development of Decubitus Ulcers
Are pressure relieving mattresses required to be used in nursing homes?
• Hospitals Use Mattresses to Reduce Bed Sores

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