What Are Bedsores and Why Do They Occur in Nursing Homes?

Pressure ulcers — commonly called bedsores or decubitus ulcers — are injuries to skin and underlying tissue caused by prolonged pressure on skin over bony prominences such as the tailbone, heels, hips, and shoulder blades. They develop when a person remains in one position for too long, cutting off blood supply to the skin.

For the vast majority of nursing home residents, bedsores are preventable. The standard of care requires nursing homes to assess every resident's pressure ulcer risk on admission, develop an individualised prevention plan, and implement that plan consistently — repositioning immobile residents every 2 hours, maintaining nutrition and hydration, keeping skin clean and dry, and using pressure-relieving mattresses and cushions where indicated.

When a nursing home resident develops a serious pressure ulcer — or an existing ulcer deteriorates — it is almost always a sign that the standard of care was not met. In Texas, bedsores are one of the most common triggers for nursing home negligence lawsuits.

🚨 Stage 3 and 4 bedsores can be fatal

Advanced pressure ulcers can lead to osteomyelitis (bone infection), sepsis, and death. If your loved one has a Stage 3 or 4 ulcer, seek emergency medical evaluation and report to DFPS at 1-800-458-9858 immediately.

The Four Stages of Pressure Ulcers

CMS uses a standardised staging system to classify pressure ulcer severity. The stage determines the seriousness of the neglect and the extent of legal liability:

Stage 1 — Skin intact, persistent redness

Non-blanchable redness of intact skin. May appear darker in people with darker skin tones. The area may feel warm, firm, soft, or painful. Stage 1 ulcers are a warning sign — they indicate that damaging pressure has been occurring and must be immediately addressed to prevent progression.

Stage 2 — Partial thickness skin loss

Shallow open wound with a red or pink wound bed, or an intact or open blister. No slough (dead tissue) present. Stage 2 ulcers are painful and indicate that neglect has already caused real tissue damage. Development of a Stage 2 ulcer in a previously ulcer-free resident is a serious red flag.

Stage 3 — Full thickness skin loss

Full thickness skin loss involving damage or necrosis of subcutaneous tissue. May present as a deep crater. Slough may be present but does not obscure the depth of tissue loss. Stage 3 ulcers are serious injuries that require intensive wound care and often hospitalisation. Their presence in a nursing home resident is strong evidence of neglect.

Stage 4 — Full thickness tissue loss

Full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present. Stage 4 ulcers are life-threatening. Osteomyelitis (bone infection) is common and difficult to treat. Sepsis — systemic infection that can cause organ failure and death — is a frequent complication. Stage 4 bedsores in a nursing home resident almost invariably indicate severe, prolonged neglect.

⚠ "Unstageable" and "Deep Tissue Injury"

CMS also recognises two additional categories: Unstageable ulcers where the wound bed is covered by slough or eschar and true depth cannot be determined, and Suspected Deep Tissue Injury (SDTI) — purple or maroon localised areas of discoloured intact skin or blood-filled blister. Both are serious and indicate significant underlying tissue damage.

Where Bedsores Most Commonly Develop

  • Sacrum and coccyx (tailbone) — most common site in residents who spend long periods sitting or lying on their back
  • Heels — second most common; particularly in residents with diabetes or poor circulation
  • Hips (greater trochanters) — common in residents who spend time on their sides
  • Shoulder blades and spine — in residents who are predominantly supine
  • Back of the head — in residents who are bedbound and not repositioned
  • Under medical equipment — casts, oxygen masks, compression stockings, and catheters can all cause pressure injuries if not properly managed

Signs Your Loved One May Have a Developing Bedsore

  • An area of skin that looks red, purple, or darker than surrounding skin and does not blanch (turn white) when pressed
  • A blister, open wound, or crater over a bony prominence
  • Skin that feels warm, hard, or boggy compared to surrounding tissue
  • Your loved one complaining of pain or soreness in a specific area, particularly when repositioned
  • Staining on bedding or clothing suggesting wound drainage
  • An odour around a wound site suggesting infection
  • Confusion or fever — which may indicate systemic infection from an infected ulcer
1 in 10
nursing home residents develops a pressure ulcer — most are preventable
$40K+
average cost of treating a Stage 4 pressure ulcer — a preventable injury

What a Nursing Home Must Do to Prevent Bedsores

Federal regulations (42 CFR §483.25) require nursing homes to ensure that a resident who enters the facility without pressure ulcers does not develop them unless the individual's clinical condition demonstrates they were unavoidable. The facility must:

  • Assess every resident's pressure ulcer risk on admission and regularly thereafter using a validated tool such as the Braden Scale
  • Develop and implement an individualised prevention care plan for all at-risk residents
  • Reposition immobile residents at least every 2 hours while in bed, and every hour while in a wheelchair
  • Maintain adequate nutrition and hydration — malnutrition dramatically increases ulcer risk
  • Use pressure-relieving support surfaces (specialised mattresses and cushions) for high-risk residents
  • Keep skin clean, dry, and moisturised — incontinence management is critical
  • Monitor existing ulcers and document wound status at every dressing change

If the nursing home cannot demonstrate that it followed each of these steps, a pressure ulcer is legally "avoidable" — and the facility is liable for the resulting harm.

Serious bedsores in a Texas nursing home? You may have a claim.

Stage 3 and 4 pressure ulcers — and deaths caused by infected bedsores — are among the strongest nursing home negligence cases in Texas. A free attorney consultation costs you nothing and can determine whether you have a claim worth pursuing.

When a resident develops a serious pressure ulcer due to nursing home neglect, the following legal remedies are available in Texas:

  • Negligence claim against the facility for failure to meet the standard of care — recovers medical expenses, pain and suffering, and emotional distress damages
  • Gross negligence claim where the neglect was particularly egregious — may support punitive damages
  • Wrongful death claim where an infected ulcer caused or contributed to death — recovers damages for surviving family members including loss of companionship and mental anguish
  • Regulatory complaints to DFPS and HHSC — can result in CMS citations, fines, and payment denial against the facility

Texas nursing home negligence claims must be filed within 2 years of the date of injury or discovery. Do not delay seeking legal advice.

Frequently Asked Questions

In rare cases, yes — residents with severe vascular disease, malnutrition, or terminal illness may develop pressure ulcers despite optimal care. However, the law requires the facility to demonstrate that it implemented all appropriate preventive measures and that the ulcer was truly unavoidable given the resident's clinical condition. In practice, Stage 3 or 4 ulcers in a resident without these extreme risk factors are almost always avoidable and therefore evidence of neglect.
Request the complete medical record including: admission assessment, Braden Scale scores, care plans, nursing notes, wound care documentation (including photographs), turning and repositioning logs, nutrition and hydration records, incident reports, and staffing logs. You have a legal right to these records. An attorney can obtain them through formal legal discovery if the facility is slow to produce them.
Yes — and if the current facility is causing ongoing harm, you should. Consult an attorney before transferring if possible, as they can advise on preserving evidence and ensuring the medical records transfer completely. Moving a resident does not affect your right to pursue a legal claim for harm that has already occurred.