There is much litigation surrounding malpractice, negligence, or abuse of the elderly in nursing homes. Of those, bedsores are a prominent topic.

Maybe this is because of how commonly they can occur under poor treatment or, that the consequences of leaving them untreated can be so severe, that they can be fatal.

To view more information on this, please read our article: What Happens when Bedsores are Left Untreated.

This article will explain what causes pressure ulcers, common reasons they develop, and the liability that nursing homes may face for causing these sometimes fatal injuries.

What are bedsores?

Bedsores are injuries to skin and underlying tissue resulting from a prolonged pressure on the skin.

They are also called pressure sores, pressure ulcers or decubitus ulcers.

Bedsores can appear anywhere on the body, but they most often develop on skin that covers bony areas of the body, including heels, ankles, hips, and the tailbone.

To find out more about bedsores, including who’s most likely to develop bedsores please read our Bedsores FAQs.

Common reasons pressure ulcers develop

The following are just some of the reasons a bedsore can develop.

  • Friction, sliding, rubbing: When the skin rubs against another material, like a bedsheet. This can cause damage to blood vessels and deprive skin of blood, oxygen, and necessary nutrients.
  • Pressure: When the skin is compressed between bone and surfaces for too long, and the blood flow stops, depriving the skin tissue of nutrients and oxygen. Lack of blood flow to the skin can cause the skin to die in just a matter of hours.
  • Not enough muscle or fat: to protect the skin from the bone.
  • Shear: skin moving away from the bone or skin moving in opposite directions – this can occur if staff members aren’t careful and gentle when moving a patient.
  • Dehydration/Malnutrition: without proper nutrition, the skin can become unhealthy and fragile, especially in the elderly population. This makes the skin more susceptible to pressure sores.
  • Failure to regularly reposition residents: So the same area of the skin is under pressure for an extended period of time.
  • Unsanitary conditions: Unclean bed sheets, beds that cannot evenly distribute pressure, as well as uncomfortable clothes and shoes can all lead to the development of pressure ulcers due to friction.
  • Moisture imbalance: While the skin must remain moisturized to stay healthy, if the skin is not clean and dry, the risk of friction is increased.
  • Decreased Sensitivity: A resident with decreased sensitivity or medical conditions relating to blood flow is at a higher risk of developing bedsores, as they will likely be unable to detect pain caused from staying in one place too long.

Identifying bedsores

Bedsores are diagnosed by inspecting the skin of those most at risk.

They are then labeled from Stage I to Stage IV according to the appearance.

At Stage I, the area is red and warm to the touch. Stage I is often accompanied by complaints of a burning, painful, or itching sensation.

At Stage IV, the area is severely damaged and a large wound is present. At this stage, the bones, muscles, joints, and tendons may also be involved. The risk for infection is very high with Stage IV.

  • Unusual changes in skin color or texture
  • Swelling
  • Pus draining from the wound
  • Temperature changes in the infected area
  • Tender areas
  • Blisters
  • Open wounds

Are there laws protecting my loved ones if they develop bedsores?

Yes, all nursing homes in Arizona and across the US have a duty of care to their residents.

Neglecting to residents to an extent that they develop bedsores or failing to treat bedsores is not acceptable.

Under Quality of Care rules (42 C.F.R. §483.25(c) (2011)) every nursing home facility must ensure that:

  • A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and
  • A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.”

The Federal Nursing Home Reform Act (“FNHRA”) – enacted by Congress in 1987, after a review from the Institute of Internal Medicine on the conditions of nursing homes states that nursing homes must:

“Provide each resident with sufficient fluid intake to maintain proper hydration and health.” (42 CFR §483.25) 

The presence of pressure ulcers, as well as the use of physical restraints and urinary catheters, have all decreased since the act passed. These are potential signs that the NHRA was effective in improving the quality of care at nursing homes.

ARS 46-451(A)6.  “Informed consent” means any of the following:

  • A written expression by the person that the person fully understands the potential risks and benefits of the withdrawal of food, water, medication, medical services, shelter, cooling, heating or other services necessary to maintain minimum physical or mental health and that the person desires that the services be withdrawn. A written expression is valid only if the person is of sound mind and if the consent is witnessed by at least two individuals who do not benefit by the withdrawal of services.
  • Consent to withdraw food, water, medication, medical services, shelter, cooling, heating or other services necessary to maintain minimum physical or mental health as permitted by an order of a court of competent jurisdiction.
  • A declaration made pursuant to title 36, chapter 32.
  • Consent by another person under a durable power of attorney relating to health care services to withdraw food, water, medication, medical services, shelter, cooling, heating or other services necessary to maintain minimum physical or mental health.

Neglect” means the deprivation of food, water, medication, medical services, shelter, supervision, cooling, heating or other services necessary to maintain a vulnerable adult’s minimum physical or mental health.

Who is liable for other conditions caused by bedsores?

Since bed sores are often preventable, related infections could come down to caregiver negligence.

If osteomyelitis stemmed from a severe bed sore infection, the patient may have grounds for a personal injury claim against his or her nursing home, hospital, or caregiver.

Someone else may be liable for osteomyelitis-related medical expenses, pain and suffering, lost wages, loss of limb, and permanent disabilities.

If you’re unsure if you can bring a case for related conditions, discuss you or a loved one’s bedsore cases with an attorney today to learn more.

Why can a facility be liable for a patient developing a bed sore?

There are several reasons why a facility and/or medical professional could be held liable for a resident’s bed sores.

First, nursing homes, long term care facilities and rehabilitation centers are liable for bed sore injuries because they are preventable injuries (the duty to the resident).

This means the facility has the ability to take action to avoid the injury but has failed to do so (the facility’s breach of the duty to the resident).

The reasons why action was not taken to avoid the bed sores can vary, and sometimes the reasons can be intertwined.

Failure to Reposition

Bed sores often develop because a resident has not been repositioned or moved for many hours.

It is the nursing home or long term care facility’s responsibility to make sure that residents are repositioned on a regular basis so that bed sores do not develop.

The facility must also ensure that staff are regularly changing bed sheets and making sure they are clean, and the resident is not lying on damp sheets or clothing for prolonged periods of time.

Improper Initial Assessment

When a resident is admitted the facility is required to complete a thorough assessment of the resident to determine what condition or conditions the resident currently has.

The facility is responsible for determining the resident’s condition or conditions, and preparing a plan of care so that the resident.

Sometimes residents may be admitted with a bed sore. It is the responsibility of the facility to document the bed sore, determine the stage of the sore, and prepare a plan of care to effectively treat the sore.

If a facility knows, through thorough assessment upon a resident being admitted, that he or she is more prone to developing bed sores, then the facility should take even more precautions to make sure that the resident is repositioned more often, bed sheets and clothes are examined, and the resident’s nutrition is closely monitored.

Insufficient Staffing

Many times a nursing home or long term care facility does not have enough staff to ensure that all residents are properly repositioned on a regular basis.

If a nursing home or long term care facility is more motivated about profits than the care of its residents, then one way to keep costs down is to hire less staff.

The staff at the facility may be overwhelmed with the needs of the residents, and the residents may not receive the proper care they have been promised by the facility.

Another way a facility can keep down costs is not properly training its staff.

If the staff members do not know how to properly identify a bed sore, or know how to properly treat a bedsore when one becomes present, the resident may not receive the care he or she needs to recover and heal from the sore.

What to do if you believe poor care has led to pressure ulcers:

If you or someone you love has developed a bedsore that you believe is the result of the malpractice or negligence of a nursing home, you do have options.

You can find more information on these types of cases by reading our Bedsore Settlements article.

If you believe you have a case or have any further questions about your legal rights, contact Thompson Law, LLC for a consultation today.


  • Mayo Clinic, “Bedsores (pressure ulcers)”
  • Nursing Home Abuse Center
  • Johns Hopkins Medicine
  • Newman v. Select Specialty Hospital-Arizona, Inc., 239 Ariz. 558 (2016)
  • The Federal Nursing Home Reform Act

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