Among the most common health issues for nursing home patients are ulcers, which can develop due to various circumstances specific to these settings. Let’s discuss two types of ulcers prevalent in nursing homes: pressure ulcers and diabetic ulcers. 

What Are Pressure Ulcers?

Pressure ulcers, sometimes called bedsores, develop when sustained pressure reduces blood flow to specific areas of the body. Often, a pressure ulcer will develop where a bone protrudes. Since blood flow is reduced in pressure ulcers, the skin and tissue nearby are damaged. 

Nursing home residents tend to develop ulcers if bedridden or not being assisted enough by nursing staff. 

Common Locations and Stages

Although pressure ulcers can occur almost anywhere on the body from sustained pressure, some locations are more likely to develop damaged skin and tissue. Usually, these are spots with bony prominences. These areas include the spine, head, heels, hips, elbows, ankles, shoulder blades, and ears. An untreated pressure injury could lead to further complications. 

A pressure ulcer has four stages. In stage one, the skin may be red and warm to the touch but is still intact. A stage two pressure injury has partially damaged skin and a shallow, open sore that could present a scrape, bruise, or blister. 

A stage three ulcer is a deep, open wound reaching the fat layer. The final stage of a pressure ulcer involves dead tissue or skin that could extend to the muscle, bone, tendon, or joint. 

Impact on Nursing Home Residents

Pressure injuries can have a devastating impact on a nursing home patient’s health. First, they may experience limited mobility because of the damage caused by the ulcer. Second, they could face emotional distress because of the declining health caused by the injury, primarily if it occurred due to staff negligence. 

Pressure ulcers can also lead to infections and intense pain if they are not treated promptly, resulting in a lower quality of life for the patient. For these reasons, nursing facility staff must prioritize pressure injury prevention. 

What Are Diabetic Ulcers?

Diabetic ulcers can only occur in diabetic patients. This ulcer-related complication results from elevated blood glucose, poor circulation, and nerve damage (neuropathy). Neuropathy reduces sensation, making injuries hard to notice, while poor circulation impairs healing. 

Limited blood flow to a diabetic wound can cause slow wound healing. If the wound cannot heal properly, it could develop into a diabetic ulcer. 

Common Locations and Characteristics

A diabetic ulcer is most likely to occur in the lower extremities. Most patients with diabetes will experience diabetic foot ulcers on their heels, the balls of their feet, and the tips of bent toes. 

Peripheral nerves are connected to the network that starts from the brain and spine, so conditions that involve nerve damage to this network are categorized as peripheral neuropathy. A diabetic foot ulcer is often circular or oval and may be accompanied by brown or red skin discoloration.

Impact on Individuals with Diabetes

The risk factors for foot ulcers are high because of decreased foot sensation. That means a diabetic patient may not feel immense pain in their ulcer, so they may not take steps to address it. However, the complications associated with diabetic foot ulcers or other similar injuries are devastating and could include infection, amputation, and even death. 

Distinguishing Between a Diabetic and a Pressure Ulcer

Understanding the difference between a diabetic foot ulcer and a pressure injury is essential to determine the proper treatment for the patient. These conditions are different, so they should not be treated using the same methods. 

However, each can lead to further complications if untreated, significantly impacting the quality of life of the nursing home resident. Let’s talk about distinguishing these two types of ulcers. 

Key Differences in Causes

The primary difference between the two ulcers is the cause. A pressure ulcer develops due to extended pressure on an area with a bony prominence, such as the elbow or shoulder. 

Diabetic ulcers associated with diabetes mellitus result from a combination of factors, including neuropathy, poor circulation, and a skin wound. Determining the cause of an ulcer will clarify what type of treatment is required for wound care. 

Location and Appearance

There are also some differences in appearance and location for these ulcers. Pressure ulcers usually occur in an area with a bony prominence because there is already reduced blood flow. Additionally, the bone being closer to the skin means more pressure from body weight. 

Shoulders, heels, hips, elbows, and the back of the head are common sites for these ulcers. There may also be a foul odor associated with these ulcers. Diabetic ulcers usually form on the legs or feet, so there could be some overlap for pressure injuries on the plantar surface. 

These injuries also differ visually. Pressure ulcers typically present with redness, blisters, pus, swelling, and skin that’s either hot or cool to the touch. Diabetic ulcers, while also potentially red, often feature peeling or cracking skin. Given some similarities in symptoms, it’s crucial to consider all characteristics carefully to ensure an accurate diagnosis. 

Legal Implications for Nursing Homes

Nursing homes are responsible for providing care for their patients and preventing harm. Allowing ulcers to go untreated may be considered abuse or negligence by the staff, which can have legal implications. 

Responsibility to Prevent Both Types of Ulcers

Medical staff have a legal duty to uphold a professional standard of care and prevent these ulcers in their patients. Since nursing home residents are at a high risk of these conditions, great care must be taken to prioritize prevention. This intervention can be done with consistent medical attention and proper care practices. 

Staff should frequently monitor pressure points for bedridden patients to ensure they are not developing any ulcers that could lead to further complications. Similarly, diabetic patients should be closely monitored for foot and leg ulcers. 

Negligence and Liability for Ulcer Development

The facility and staff may be liable if an ulcer develops on a nursing home resident. When an ulcer leads to suffering and legal damages, victims may have grounds to file negligence claims against the facilities or staff members in question. Proving liability will depend on the evidence available, the type of harm suffered, and the strength of your legal team.

When to Consult a Nursing Home Lawyer

Nursing home lawyers specialize in advocating for residents at a higher risk of developing ulcers. Every medical professional is expected to uphold a standard of care and provide quality treatment to each patient. 

Victims can hold these healthcare providers accountable for their actions when they fail to do so. Here are a few scenarios when contacting a nursing home lawyer. It makes sense to ask about your legal options. 

Suspicion of Neglect or Mismanagement

Often, we are most concerned about our loved ones who live in nursing homes. If you notice your loved one has developed an ulcer and you think it may be because of negligence, you should seek legal counsel. 

Even if they already had the ulcer, neglect could worsen their condition and lead to severe complications. Contact a legal professional if you notice any worrying signs of neglect or mismanagement. 

Questions About Liability and Compensation

When you are ready to file a claim against a nursing home for yourself or on behalf of a family member, it is important to ask questions and understand the process first. You need to know what liability is in a nursing home case and the types of compensation you can earn. 

Suppose the facility is found liable for mistreating elderly patients. In that case, potential damages may include medical expenses, lost income, physical pain and suffering, emotional distress, and even loss of enjoyment of life. 

Contact a Nursing Home Lawyer Now

If you are worried about a loved one developing ulcer in a nursing home or potential nursing home negligence, you should research your legal options in case a lawsuit becomes necessary. The Nursing Home Law Center team can answer your questions about civil claims and guide you through the process for a greater chance of maximum compensation. 

Contact us today for a free consultation at 800-926-7565 or complete the online form. 

Decubitus ulcers, commonly referred to as bedsores or pressure ulcers, develop in individuals who are chair-bound or bed-bound for an extended period. Many ulcers begin forming in as little as a week when lying or sitting in the same place. On average, bed sore developing skin ulcers become serious in less than a month of being bound to a chair or bed.

Bedsores on the skin are caused by continuous pressure and irritation at any specific location on the body. However, bedsores tend to be common on prominent bony areas including the buttocks, hips, elbows, back of the head, shoulders, lower back, and heels. Bed sores can be minimized when taking preventative measures including changing body position whenever possible to relieve pressure.

Most Common Bed Sore Occurrences

Bedsore-developing ulcers are often a common occurrence in hospital patients. Research indicates that as many as five percent of individuals admitted to a hospital, nursing home, or healthcare facility can develop a pressure ulcer within a week or two. The most common bedsore occurrences happened for a variety of reasons including:

• The patient is not very mobile and unable to change body position
• The patient is seriously ill, such as patients in ICU (intensive care unit)
• Individuals suffering a spinal cord injury and are unable to feel or move the legs and/or arms
• Individuals with a poor diet
• Individuals wearing a plaster cast for a broken limb, a body brace, or a prosthesis (artificial limb)
• Smokers
• Individuals suffering from diabetes who lose the ability to sense pain or major discomfort
• Individuals suffering incontinence of feces or urine where the skin remains damp, increasing the potential of damage
• Individuals suffering from heart failure or COPD (chronic obstructive pulmonary disease)
• Those with rheumatoid arthritis, Parkinson’s disease, or Alzheimer’s disease
• Individuals who have recently undergone hip surgery or nursing a broken hip
• People with poor circulation in the arms and legs (peripheral vascular disease) where the arteries are narrowed by atheroma

Identifying a Bed Sore

Decubitus ulcers often appear in various stages depending on severity. Medical care identifying or grade the sore, based on the depth of the ulcer.

• Grade #1 – The patient’s skin appears permanently red but has no crack or break in the surface. Often times, the area feels warm and hard to the touch, and slightly swollen. Individuals with dark skin often have bedsores that are blue or purple in color.
• Grade #2 – The bedsore appears superficial much like an abrasion or blister.
• Grade #3 – The decubitus ulcer penetrates throughout the entire thickness of the patient’s skin where obvious damage appears in underlying tissue.
• Grade #4 – This type of ulcer is the most severe, where the sore is deep with significant damage to the bone and muscle beneath.

Preventing Bed Sores

The National Institutes of Health (NIH) recommends consulting a healthcare provider as soon as possible whenever a noticeable bedsore appears. This is because surgery is usually required to repair and heal this kind of wound. The healing process of a decubitus ulcer often involves:

• The ulcer is becoming smaller in size
• The sore starts to develop pink tissue along its edges while increasing in size toward the center
• During the healing process, noticeable healing signs include bumpy or smooth surfaces of new tissue growth
• Bleeding can be present at the site indicating good blood flow circulation to the damaged area to promote and escalate healing

However, many bedsores do not heal without medical treatment. Often times, noticeable signs of necessary medical care can appear. These signs can include:

• Significant drainage at the ulcer site or an increase in its size
• Increase redness at the site or black areas beginning to form
• A noticeable odor and/or extensive drainage with a green color at the sore site
• Any indicator of a fever

Healthcare Provider Neglect

Anytime a bedsore is neglected in a hospital, nursing facility or assisted living home, it can be life-threatening. Many victims of abuse or neglect can develop an infection that can easily spread to the bone, heart and blood. Serious neglect of the decubitus ulcer can lead to amputation or autonomic dysreflexia (overactive autonomic nervous system).

Placing a loved one in a nursing home for necessary care requires a level of trust. Unfortunately, whenever the trust is violated, the loved one can suffer a variety of serious injuries including debilitating bedsores. When this happens, it is important that family members hold the nursing home accountable for their negligence and abuse.

The legal team at Nursing Home Law Center LLC at (800) 926-7565 is experienced in nursing home negligence cases involving serious injuries. We offer free consultations to evaluate the circumstances surrounding all treatments or lack of treatment to assist in obtaining financial compensation for your loved one.

• http://www.nlm.nih.gov/medlineplus/pressuresores.html#cat3
• http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000147.htm