Nursing Home Bedsore Attorney

How Pressure Injuries Are Classified

Pressure injuries are commonly described as Stage 1 through Stage 4, but the classification system also recognizes unstageable pressure injuries and deep tissue pressure injuries.

• Stage 1: The skin remains intact but shows persistent, non-blanchable redness or discoloration.
• Stage 2: There is partial-thickness skin loss with exposed dermis. The injury may appear shallow or blister-like.
• Stage 3: There is full-thickness skin loss that extends into deeper tissue and may expose fat.
• Stage 4: There is full-thickness skin and tissue loss with exposed or directly palpable deeper structures such as muscle, tendon, cartilage, or bone.
• Unstageable pressure injury: Tissue damage is present, but the full depth cannot be confirmed because the wound bed is obscured.
• Deep tissue pressure injury: Damage beneath the skin may appear as persistent deep red, maroon, or purple discoloration before the full extent of the injury is visible.

The stage can help describe severity, but the stage alone does not establish when the wound developed or whether the facility was negligent. The resident's medical condition, risk factors, care plan, wound progression, and documentation all matter.

The Federal Pressure-Ulcer Standard for Nursing Facilities

For Medicare- and Medicaid-certified nursing facilities, 42 CFR 483.25(b) requires care consistent with professional standards of practice to prevent pressure ulcers. A resident who does not have pressure ulcers should not develop them unless the resident's clinical condition demonstrates that they were unavoidable.

When a resident already has a pressure ulcer, the facility must provide necessary treatment and services consistent with professional standards to promote healing, prevent infection, and prevent additional pressure ulcers from developing.

That federal requirement applies to participating nursing facilities nationwide. It does not make every civil lawsuit the same in every state. State statutes, case law, procedural rules, and damages law still affect whether a claim exists and how it must be pursued.

Our article on what causes bedsores in nursing homes and when a facility may be liable provides additional background on these care issues.

Care Failures That May Contribute to Pressure Injuries

A bedsore investigation often focuses on what happened before the wound appeared and how the facility responded afterward.

Potential concerns can include:

• Failure to identify a resident's pressure-injury risk
• Inconsistent repositioning or pressure relief for a resident with limited mobility
• Inadequate skin inspections or delayed recognition of skin breakdown
• Failure to follow an individualized care plan
• Poor nutrition or hydration management when those issues affect skin integrity
• Incontinence or hygiene problems that contribute to skin damage
• Delayed wound assessment, physician notification, or treatment
• Staffing problems that interfere with the facility's ability to provide planned care

Understaffing can be particularly important when records show that essential care was repeatedly delayed or missed. Our discussion of how nursing home understaffing can contribute to neglect and preventable injuries explains why staffing records may become relevant in a nursing home case.

None of these issues, standing alone, automatically proves liability. The question is whether a failure in care caused or worsened the resident's injury under the law governing the claim.