How a bedsore forms

A bedsore starts when weight presses on the same spot for too long. Blood cannot reach the skin there. The skin and the tissue under it begin to die.

Bedsores often form over bony spots. Think of the tailbone, hips, heels, ankles, elbows and the back of the head. People who cannot move on their own are at highest risk. So are people who are thin, incontinent, or not eating and drinking enough.

Doctors and nurses call these pressure ulcers or pressure injuries. They rate them in stages. An early sore looks like a red patch that does not fade when pressed. A late sore is an open wound that can reach muscle or bone. Deep sores can become infected.

What the law expects a nursing home to do

Federal rules set the standard for homes that take Medicare or Medicaid. A resident should get care, consistent with professional standards, to prevent pressure ulcers. The resident should not develop one unless their condition made it unavoidable (42 CFR 483.25).

That rule puts a question at the center of every bedsore case. Was this sore avoidable? The answer is in the details of the care.

Some residents are very sick, and a sore may form despite good care. That is a real defense. It is also why the records matter so much.

The records that tell the story

In a bedsore case, the paper trail often shows whether care happened. Key records include:

• The care plan, and whether it listed bedsore risk.
• Turning and repositioning logs.
• Wound notes, measurements and photos taken by staff.
• Weight and meal records.
• Notes of calls to the doctor and to family.
• Staffing records for the days the sore got worse.

Gaps matter. So do notes that look copied from day to day. Federal rules let a resident, or their representative, see records within 24 hours on a workday and get copies with two workdays’ notice (42 CFR 483.10).

What you can do this week

1. Ask a nurse to show you the sore. Take a photo with the date. Photograph it again as it changes.
2. Ask how often your loved one is turned, and ask to see the log.
3. Ask to join the next care plan meeting. You have that right as a representative.
4. Ask that the doctor be told and that a wound care plan be written.
5. Request the medical records in writing. Keep a copy of your request.
6. If the sore is deep, smells, or your loved one has a fever, ask for medical care right away.

If you believe the sore comes from neglect, you can report it to the Missouri Adult Abuse and Neglect Hotline at 1-800-392-0210. It is open 7 a.m. to 8 p.m., seven days a week, and you can also report online through the state health department.

Deadlines for a bedsore claim

Missouri treats nursing homes as health care providers (RSMo 538.205). A claim generally must be filed within two years (RSMo 516.105). A health care professional’s written review is also required soon after filing (RSMo 538.225). If a bedsore led to a death, the family’s wrongful death claim generally has a three-year deadline (RSMo 537.100).

Your first meeting about a nursing home injury is free. Everything else is discussed in person. Harjot Singh Padda, JD will look at the photos and records with you and explain whether a claim makes sense.

Common questions

Related reading

• Nursing home neglect in St. Louis
• Dehydration and malnutrition
• Medical malpractice
• Wrongful death claims