Skin Breakdown and Wounds: Identification, Treatment, and Communication

Is your residential care facility taking the right steps to manage risks associated with skin breakdown and wounds? Many seniors are susceptible to bedsores and related injuries. If you don’t identify and treat them quickly, these wounds may lead to infection and other serious health consequences. To protect your residents and reduce your liability, it’s important to follow best practices.

Understanding Skin Breakdown and Wounds

Skin breakdown injuries are decubitus ulcers or pressure ulcers, more commonly known as bedsores.

According to Mayo Clinic, bedsores are injuries to the skin as well as to the tissue below the skin. They develop when there has been pressure on the skin for a long time. As a result, bedsores frequently affect people who spend most of their time in a bed or chair or who have medical conditions that make it difficult for them to change position or move. According to Johns Hopkins Medicine, people with diabetes and other chronic illnesses, people who are undernourished, smokers, and people with fragile skin are also at risk.

Mayo Clinic says bedsores may develop over hours or days and commonly occur on bony areas (such as heels, ankles, hips, and the tailbone) and where a bed or chair presses against the skin. Common symptoms include:

• Changes in the color or texture of skin
• Swelling
• Pus-like draining
• Sore areas
• Areas that feel cooler or warmer than the rest of the skin

Although all bedsores are an urgent medical condition that requires immediate attention, their severity varies. According to Johns Hopkins Medicine, bedsores are classified into four stages:

• Stage 1 bedsores are red, blue, or purple areas that look like a bruise and may be warm. The resident may report itching or burning.
• Stage 2 bedsores are open sores that look like an abrasion or blister. The skin around the wound may be discolored, and the resident may report pain.
• At Stage 3, bedsores have deepened, appearing like a crater. The skin around the wound may have dark patches.
• Stage 4 is when bedsores have spread to the muscle, bone, or joints. This may result in osteomyelitis (a serious bone infection) and sepsis (a life-threatening blood infection).

Stage 3 and 4 bedsores are sometimes covered with black, dead tissue or yellow, gray, black, or white, thick tissue. As a result, it may be difficult to see how severe the injury has become.

When Are Residential Care Facilities Liable?

When a resident experiences negative health outcomes related to skin breakdown or wounds, facilities may face liability stemming from a number of allegations. The most common include failure to:

• Identify a resident as being at risk for wounds
• Identify skin breakdown in the early states
• Obtain proper treatment for wounds in progress – for example, failure to refer the resident for wound care, to turn and reposition, or to monitor weight loss and protein levels
• Comply with state regulations – for example, California Code states that residents with stage one or two pressure injuries must be diagnosed by a physician or an appropriately-skilled professional

Tampa Bay Times says an assisted living facility in Florida was ordered to pay $12.5 million in a case involving a resident who died due to a bedsore. The facility was accused of being negligent in the care it provided.

How to Protect Residents and Reduce Bedsore Liability

• Conduct resident risk assessments. Risk assessments provide essential information to determine care, alerting staff to risks to ensure they’re able to take appropriate measures. You should perform subsequent risk assessments periodically as well as after any change in the resident’s health condition.
• Comply with state regulations. Review the relevant laws in your state and stay alert for regulatory changes.
• Create and enforce strict policies regarding bedsores. These policies should include steps that staff should take to prevent bedsores (such as helping at-risk residents move), procedures for checking at-risk residents for bedsores, and how to secure medical care for residents who show signs of bedsores.
• Practice good recordkeeping and maintain resident files. It’s important to note any relevant factors in a resident’s file (such as whether the resident is high risk) and to record the actions you take to prevent bedsores.
• Follow physician directions. A resident who shows signs of a bedsore should receive medical attention. Make sure the team members involved in resident care are aware of any directions from the medical provider.
• Conduct regular staff training. Staff members need training on how to recognize the signs of bedsores and what to do if they identify symptoms.

MedlinePlus has information on preventing bedsores and checking for bedsores daily.

Mayo Clinic has information on prevention, causes, and symptoms.

The Indian Journal of Palliative Care has published research on preventing bedsores.

PCALIC can help you manage risks associated with skin breakdown and other threats to resident safety. We provide residential care facility insurance as well as resources to help you manage risks and protect the residents in your care. Learn more.