Also known as pressure ulcers, bed sores are a serious, fast-occurring, and most importantly preventable condition occurring in nursing home residents. Widely considered a “never” event by the Centers for Medicare & Medicaid Services (CMS), bed sores can be a major red flag that you or a loved one are being neglected by their care providers. Fortunately, most cases of bed sores can be treated before permanent damage has occurred. There are four major stages of bed sores outlined below.


Stages of Bed Sores

Stage 1:

The sores will not yet be open wounds. It’s common for the skin to be red, inflamed, and painful to the touch. The redness will not blanch when you press on it with your finger, as skin normally would.

Stage 2:

The skin will break open, wear away, or will form an ulcer causing the area to become tender and painful. The sore will spread into the deeper layers of the skin. Appearance varies from the what seems like a scrape or abrasion, blister, to a shallow wound in the skin. At this stage, it is possible for certain layers of the skin to be damaged beyond repair.

Stage 3:

The sore worsens and spreads into more tissue beneath the skin, forming a small open-wound. Fat may be visible in the sore but you should not be able to see muscle, tendons, or bones in this stage. Pain may no longer be occurring in stage 3 as the nerves have been damaged.

Stage 4:

The bed sore injury is extremely deep, spreading into muscle and bone causing irreversible/extensive damage. As with stage 3, pain may no longer be occurring as the nerves have been damaged. If the bed sore has not been addressed/resolved before stage 4 occurs, the patient could have damage to deeper tissue, tendons and even their joints.

Bed Sore Trouble Areas

For patients in a wheelchair, pressure sores commonly present themselves in the main contact areas with their wheelchair. This is usually on their buttocks or tailbone, along their shoulder blades, and the backs of their legs and arms. For those who are bedridden, bed sores will often occur along the shoulder blades, lower back or tailbone, hips, heels, ankles and along the sides and back of the head. The common contributor to these sores is main contact points either with their skin rubbing together or the patient’s main position in a chair or a bed.

Common Causes

As previously pointed out, the main contributing factors to pressure sores are pressure, friction, and sheer.

Continued pressure on any part of the body will inevitably reduce the blood flow to tissues. While blood flow is essential to delivering oxygen and other nutrients to the tissues, without said nutrients, the skin and nearby tissues will become damaged and may even eventually die.

For patients with limited mobility, these kinds of pressure tend to occur in/around areas that aren’t naturally well-padded with muscle or fat and are over a bone. This includes the spine, shoulder blades, tailbone, hips, heels, and elbows.

Friction occurs when the skin rubs against itself, bedding, or clothing. Friction can cause the fragile skin to become even more susceptible to injury, especially in cases where the skin is moist.

Sheer can occur when two surfaces move in opposite directions. Unlike friction, which is typically repeated micro-movements, sheer would be long drawn out contact/pressure with motion involved. Consider you’re raising the back support on an adjustable bed, if not properly positioned the patient could slide down the bed causing sheer between the bedding material and the buttocks and shoulder blades of the patient.

Risk Factors

People who have difficulty moving or changing positions while seated or in bed are especially at risk of developing bed sores. Risk factors include immobility, lack of sensory perception, poor nutrition and hydration, and medical conditions affecting blood flow.

Immobility could have a number of causes that result in one’s motionlessness either while sitting or laying down. This could include poor health, obesity, spinal cord injuries, and more.

Spinal cord injuries and neurological disorders are among the conditions that can result in a reduction or complete loss of sensation. The inability to feel discomfort or pain can result in less awareness regarding warning signs from the body letting you know to change positions.

Additionally, your diet and the nutrients you intake all contribute to a healthy body, including your skin. When your diet is poor your skin becomes increasingly less healthy and eventually, the tissues can actually break down.

Another contributing factor could be diabetes or vascular disease. Both affect blood flow throughout the body and can increase the risk of tissue damage.


The complications of bed sores vary from simply discomfort to, in some cases, becoming life-threatening. They include cellulitis, bone and joint infections, cancer, and sepsis.

Cellulitis, an infection in the skin and connected soft tissues, can cause warmth, swelling, and redness in the affected area. Those with nerve damage often will not feel the pain in the area affected by cellulitis.

If left untreated for an extended period of time, bed sores can burrow into joints and bones. Joint infections can damage both cartilage and tissue. Bone infections can limit the function of joints and limbs.

Squamous cell carcinoma is the second most common form of skin cancer and can be caused by long-term, nonhealing wounds.

In rare instances, bed sores can lead to sepsis, a life-threatening complication of an infection.

When to seek help

If you’re in stage 1 of a bed sore you can attempt to alter any contributing factors to alleviate pressure on the area. If you do not see improvement within 24-48 hours you should seek medical attention. If you are in stage 2 you should seek immediate medical care.

If you or a loved one are under the care of someone else and you notice continued bed sores without proper prevention procedures being implemented, then it may be a case of nursing home neglect.

Call 301-389-5081 now to set up your free nursing home abuse or nursing home negligence legal evaluation of your claim with the lawyers of Potter Burnett Law in Bowie, Maryland.