Stage 4 Bed Sore in Nursing Facilities

Experienced Lawyers for Stage 4 Pressure Ulcers in Nursing Homes 

Summary:

A stage 4 bed sore is the most severe form of a pressure ulcer, exposing muscles, bones, and tendons to the open air. Patients are vulnerable to life-threatening complications if left untreated. If your loved one has suffered from pressure ulcers in a nursing home, you may be eligible for a nursing home neglect lawsuit. Contact us today for a free case review.

What Is a Stage 4 Pressure Injury?

A stage 4 bedsore is the most serious of the four bed sore stages, involving destruction of all skin layers. This deep injury exposes the underlying bone, muscles, and tendons, which can lead to deadly bone infections. 

What Does a Stage 4 Pressure Sore Look Like?

Stage 4 pressure ulcers visually look like crater-like, deep wounds. The wound surface may be covered in black, dead tissue or yellowish slough. If this covering is removed, it may be possible to see underlying tissue, such as muscles or bones. The skin surrounding the area will be red, swollen, or hot to the touch. There may also be pressure ulcer tunneling, which is an area of damage that extends beyond the open wound and into other tissue.

What Causes Stage 4 Pressure Ulcers in Nursing Facilities?

Common causes of bed sores include:

• Missed or Inadequate Repositioning: Healthcare providers must regularly reposition immobile patients to relieve pressure. If this is not done, or is not done correctly, it can result in a skin infection.
• Unsafe Transfers: Sliding in a bed or chair can create shear forces. Over time, this may result in painful wounds.
• Inadequate Skin Checks: CMS pressure injury guidance requires staff to check skin integrity, as this can help identify early-stage bedsores. With immediate medical care, stage 4 bedsores can be prevented.
• Poor Moisture Management: Staff must keep skin clean and dry by attending to a resident’s hygiene and removing soiled linens. Failure to provide this basic support can lead to pressure injuries.
• Lack of Pressure-Relieving Surfaces: Mattresses, cushions, and heel protection are crucial for preventing nursing home injuries in immobile residents, but many nursing homes fail to provide these basic tools.
• Lack of Proper Wound Care: Nurses and CNAs may not escalate an early bedsore to a doctor or wound specialist, potentially leading to a stage 4 bedsore.
• Missed Care Plan Tasks: Staff may fail to provide proper treatment, such as regular dressing changes.
• Failure to Address Infections: An infected bed sore can lead to serious complications such as joint infections, but facilities may not order labs or prescribe antibiotics in a timely manner.
• Staff Miscommunication: Understaffing or shift change breakdowns may mean that residents do not receive repositioning, toileting assistance, or bedsore treatment.

What Are the Risk Factors for Developing Severe Pressure Ulcers?

Risk factors for developing bedsores include the six aspects of the Braden Scale. This scale comprises six subscales: sensory perception, exposure to moisture, activity level, mobility, adequate nutrition and hydration, and friction or shear. A resident’s scores on these subscales determine their vulnerability to bedsores, with lower scores indicating greater risk. 

Limited Mobility

Immobility can compromise blood flow and lead to localized pressure on certain body parts, such as the buttocks or heels. Residents with paralysis or who are recuperating from nursing home falls must be regularly repositioned or provided with pressure-relieving mattresses to prevent pressure ulcers. 

Lack of Proper Nutrition and Hydration

Healthy skin requires proper hydration and nutrition. Malnutrition or dehydration can compromise the immune system and damage the skin barrier. Sadly, these conditions are common elements of nursing home abuse.

Certain Diseases and Conditions

Diseases that may compromise an individual’s overall health and lead to bedsores can include:

• Diabetes: High blood sugar compromises the bedsore healing process and can lead to reduced sensation in affected areas, making bedsores worse.
• Alzheimer’s: In later stages, patients may have reduced mobility or muscle rigidity that locks them into the same position every day. They may also become incontinent, increasing the risk of infections.
• Neuropathy: A resident who cannot feel pain in certain areas cannot take proper care of themselves and may not realize they have a bedsore.
• Vascular Disease: Compromised blood vessels cut off oxygen to the area, potentially causing pressure ulcers.
• Anemia: Iron-rich blood delivers oxygen to tissues, so low iron levels can result in poor healing and tissue death.
• Immunosuppression or Chronic Steroid Use: Individuals with compromised immune systems are more vulnerable to blood infections and other complications.

How Bedsores Progress to Stage 4

Injuries progress through the four pressure ulcer stages because medical staff fail to identify signs of early bedsores and promote healing. Stage 1 sores may be dismissed as a simple rash, while Stage 2 sores may be misinterpreted as a blister. By Stage 3, the patient’s wound may have begun weeping exudate, and there may be necrosis, but staff may still ignore the injury. Without immediate intervention, this bedsore may progress to Stage 4 and cause life-threatening complications.

What Are the Symptoms of a Stage 4 Skin Ulcer?

Stage 4 bed sore symptoms include:

• Crater-Like Wound: This deep wound may expose bone, fat, muscle, or tendons.
• Necrotic Tissue: Black spots indicate dead skin or other tissue.
• Slough/Escar: This is a yellow, sticky covering that will harden into a leathery eschar.
• Foul Odor and Drainage: An infected stage 4 bedsore will have a foul odor, pus, or cloudy drainage.
• Inflammation: The area around the injury may be hot, swollen, and red. As the infection spreads, red streaks may extend from the wound.
• Undermining and Tunneling: The damage may extend further from the visible injury. Undermining occurs when the tissue around the wound forms a “shelf” of skin in the top layer, while tunneling involves small channels of destroyed tissue extending outward.

How Are Stage 4 Pressure Ulcers Diagnosed?

Stage 4 bedsores are diagnosed through a visual and physical examination to determine the extent of the injury. They will assess the size, damage to the underlying structures, and any tunneling, and may also order MRIs or X-Rays to rule out bone infections. Some stage 4 bedsores may be misclassified as deep tissue pressure wound injuries or as unstageable bedsores.

Stage 4 vs Unstageable vs Deep Tissue Pressure Injury

An unstageable bed sore is one that cannot be classified because it is covered by eschar or slough, making it difficult to determine the extent of the damage. It may be a stage 3 or stage 4 bedsore. In contrast, a deep tissue injury progresses rapidly under the surface, but the skin may remain intact.

How Are Stage 4 Bedsores Treated?

Stage 4 bed sore treatment includes the following:

• Offloading and support systems like pressure-relieving mattresses
• Pressure injury debridement to remove dead tissue
• Antibiotics to treat infections
• Advanced dressings that promote healing and prevent infections
• Negative pressure wound therapy to increase blood flow and encourage tissue growth
• Surgical interventions like reconstructive surgery or skin grafts

Can Stage 4 Pressure Ulcers Be Prevented?

In most cases, stage 4 bedsores can be prevented with proper care, including:

• Regular repositioning and offloading
• Skin checks
• Moisture management 
• Proepr nutrition and hydration
• Support surfaces like mattresses and cushions

Complications From Stage 4 Bedsores

Common complications from stage 4 bed sores include:

• Amyloidosis: This condition is caused by abnormal proteins called amyloids that clump and form deposits. It can be painful and limit mobility.
• Calcification: Calcium can accumulate in dying tissue, forming hard, painful deposits in the wound that must be removed or softened with hydrogels. Calcification significantly complicates healing and requires intensive medical support.
• Infection: Patients may develop osteomyelitis, an infection of the bone, or septic arthritis in joints. 
• Renal Failure: Sepsis from a bloodstream infection or widespread inflammation may cause the kidneys to shut down.
• Death: If not quickly treated, bedsores can be fatal. 

Every year, more than 2.5 million people in the United States develop pressure ulcers, resulting in significant pain and costly medical treatment. 

Can You Sue for a Stage 4 Bed Sore?

Yes, you can sue for a stage 4 bed sore, as it is often a result of long-term nursing home abuse. An experienced nursing home abuse lawyer from Nursing Home Law Center can explain the process of suing for a pressure sore, including what evidence is necessary and how negotiations proceed. 

Laws and Legal Protections

Nursing home residents are protected by various laws that require facilities to provide a safe environment and adequate medical care. 

The Federal Nursing Home Reform Act (OBRA 1987)

At the federal level, the Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987, establishes national standards for homes that receive Medicare and Medicaid funding. 

This includes regulations requiring facilities to develop a comprehensive care plan for each resident, with specific measures to prevent and treat bed sores. Failure to comply with these standards can result in penalties and loss of funding.

The Elder Justice Act

Part of the Affordable Care Act, the Elder Justice Act, is designed to combat elder abuse, neglect, and exploitation. 

It requires states to create systems for reporting abuse and to establish programs for preventing senior abuse, including the development of training programs for nursing home staff members to recognize and prevent pressure wounds.

The Health Care Financing Administration (HCFA)

HCFA regulations outline requirements for wound management, infection control, and the prevention of pressure ulcers, setting a minimum standard for assisted living home care across the nation.

These laws collectively create a framework that holds senior care homes accountable for their treatment of residents, especially when it comes to preventing injuries like skin ulcers. If your loved one has suffered from neglect or abuse in a nursing center, understanding these laws can help you pursue legal action and ensure the facility is held accountable.

How to File a Stage 4 Bedsore Lawsuit Against a Nursing Home

To file a stage 4 bedsore lawsuit, follow these steps:

1. Seek Medical Treatment: These pressure ulcers are medical emergencies and require immediate treatment, including strong antibiotics and a procedure called debridement, where dying tissue is removed.
2. Report the Abuse: Contact your state’s long-term care ombudsman and Adult Protective Services. Not only does this allow the state to investigate the nursing home or assisted living facility, but it also documents your concerns.
3. Gather Evidence: Take photos of the pressure sore and the healing process. Secure medical records, communications with the facility, and hospital diagnostics.
4. Contact a Nursing Home Lawyer: We provide free case reviews and will help you review your legal options.
5. File a Legal Complaint and Negotiate: After calculating medical expenses and non-economic damages, we will negotiate with the nursing home for a fair settlement.

What Damages Can Victims Recover in a Nursing Home Abuse Lawsuit?

Nursing home abuse and neglect compensation for a stage 4 bedsore can include:

• Medical bills for hospitalizations
• Medications and antibiotics
• Wound care specialist consultations
• Surgeries and outpatient procedures
• Out-of-pocket expenses like pressure mats
• Rehabilitation
• Relocation, if necessary
• Emotional distress
• Pain and suffering
• Loss of enjoyment of life
• For wrongful death, funeral and burial expenses

What Is the Average Settlement for a Stage 4 Bedsore?

The average payout for a stage 4 bedsore is $6,116,979, while the median recovery is $1,000,000. Settlements and verdicts range from $55,169 to $114,000,000. 

Several factors can influence the value of a Stage 4 bedsore claim, including:

• Whether the wound led to sepsis, amputation, or wrongful death
• Resident’s age, health condition, and life expectancy
• Documentation of care plans and whether pressure sore prevention protocols were followed
• Evidence of understaffing, neglect, or falsified medical records
• Duration of pain and suffering before healing or death
• Expert testimony on whether the bedsore was avoidable
• Availability of punitive damages for reckless or systemic neglect

Stage 4 Bedsore Settlements Recovered by Our Team

• $12,800,000: Mia was a long-term nursing home resident with Alzheimer’s who had developed muscle rigidity and required regular repositioning. Staff failed to reposition her on a regular basis, resulting in stage 4 bedsores. After she passed away, her family discovered that nurses had documented early-stage bedsores but stopped charting once the injury grew too severe.
• $3,245,000: Hannah was in a long-term hospital to heal from a sports injury that left her with spinal cord injuries. Because of her injuries, she was immobile and required regular transfers. Over time, these shear forces caused multiple pressure ulcers, one of which progressed to a stage 4 bedsore. 
• $2,150,000: Alfred was recuperating in a nursing home after suffering a severe fall at home. He was in traction due to a broken hip, meaning he needed regular repositioning and offloading support. Because of miscommunications and neglect, he developed a stage 4 bedsore on his shoulder that ultimately caused his death from sepsis. 

How Nursing Home Law Center Handles Stage 4 Bedsore Lawsuits

A bed sore lawyer from our team will thoroughly investigate your case to understand how the stage 4 bedsore developed, who may be liable, and what damages resulted from the injury. The process involves the following:

• Investigation: We will review medical records, witness statements, and facility documentation to determine when the pressure ulcer began to develop and what interventions were ordered.
• Document Review: Our attorneys will construct a timeline of events based on the available documentation.
• Expert Testimony: We will confer with medical professionals who can provide their unbiased opinion on what appropriate treatments would have been based on the case facts.
• Damage Valuation: Our attorneys will assess damages like medical costs and physical pain to determine a fair settlement value.
• Demand Letter: Once we have gathered all necessary information and receipts, we submit a demand letter to the facility’s insurance company.
• Negotiation: The insurance company submits a lower counteroffer, and we continue negotiating until you are satisfied.
• Legal Filing: Some cases involve complex legal theories, multiple liable parties, or conflicting evidence. The insurance company may also refuse to provide a fair settlement offer. In these cases, we will file a lawsuit with the relevant court.
• Litigation Process: A lawsuit involves discovery, where all parties share information, and hearings, which are meant to help both sides come to an agreement. If the case proceeds to trial, we will represent you in front of a judge and jury.

Book a Free Case Review

A stage 4 bedsore causes significant pain and stress on families, but our nursing home abuse attorneys are here to help. We provide experienced, compassionate legal advocacy for loved ones of nursing home abuse victims, helping them explore their options and manage all third-party communications.

Nursing Home Law Center works on a contingency-fee basis, meaning you do not owe us legal fees unless we recover financial compensation. To schedule your free case review, call us at (800) 926-7565 or use our online contact form. 

FAQs

How long can you live with a stage 4 bedsore?

Life expectancy for a stage 4 bedsore depends on the person’s health, comorbidities, and the timing of medical intervention. A study found that the 180-day mortality rate was 68.9%, with an average life expectancy of 47 days. However, this study is older, and wound management techniques have improved, resulting in longer life expectancy for patients. 

Can stage 4 pressure ulcers lead to sepsis?

Yes, stage 4 bedsores can lead to sepsis. These wounds expose bone, muscle, ligaments, and other tissues to outside air, which can result in widespread infections. 

Are stage 4 bedsores always a sign of nursing home neglect?

Stage 4 bedsores are strongly correlated with nursing home neglect. Appropriate pressure ulcer interventions can completely prevent the wound from progressing to this stage.

Failures that can cause these severe sores include:

• Failure to check the skin or identify early-stage sores
• Lack of a turning plan or failure to follow a repositioning schedule
• Delayed wound consults and ineffective treatments
• Inadequate staffing 
• Miscommunication between staff, such as failure to confirm that repositioning was done
• Inadequate hygiene and moisture management

How long does a stage 4 bedsore lawsuit against a nursing home take?

A stage 4 bedsore lawsuit can take one to three years. The timeline depends on several factors, including:

• Settlement Versus Verdict: Trials take longer as they depend on the court’s schedule.
• Available Evidence: A strong case will have ample evidence that proves liability.
• Number of Liable Parties: If only one insurance company is involved, negotiations may be more straightforward.
• Clarity of Liability: We must be able to point to clear negligence and who was involved.
• Treatment Timeline: Insurance companies typically wait to negotiate until damages can be calculated clearly. If there are treatment complications, then it may take longer to settle. 

Our attorneys will keep you updated on your case’s progress and work for a swift resolution through strong case management. 

Where do stage 4 pressure ulcers typically appear in nursing home patients?

Stage 4 bedsores develop in areas where bone and skin are in constant contact with a surface, leading to prolonged pressure and tissue damage. Nursing home patients who are bedridden or have limited mobility are at the highest risk, but where do stage 4 bedsores present themselves on the body?

• Tailbone and buttocks – The most common area for a stage 4 bedsore due to prolonged sitting or lying down.
• Shoulder blades and back of the head – Frequent in bedridden residents who are not given the right care and repositioned regularly.
• Ankles and heels – Develop to stage 4 when legs remain in the same position for long periods without support.
• Hips and lower back – Often caused by improper repositioning or inadequate cushioning.

Without frequent movement, pressure relief, and skin monitoring, these areas are vulnerable to deep, stage 4 bedsores that reach subcutaneous tissues and expose muscle, tendons, and bone, leading to severe pain and life-threatening infection risks.

References: Law.com