Pressure ulcers—commonly referred to as bedsores—are among the most serious and revealing indicators of neglect in nursing homes and assisted living facilities. These painful injuries do not appear suddenly or without warning. In most cases, pressure ulcers develop gradually when residents are left in the same position for extended periods without proper monitoring, repositioning, or basic care. When a resident develops a bedsore, it often signals a broader failure by the facility to meet its fundamental obligations to protect vulnerable residents.
For families in Winston-Salem and throughout North Carolina, understanding what pressure ulcers are, why they develop, and what they reveal about a facility’s care practices is critical. Bedsores can lead to severe infections, prolonged hospitalization, permanent injury, and even death. Just as importantly, they frequently provide strong evidence that a nursing home or assisted living facility failed to follow required standards of care.
Pressure Ulcer Statistics: How Common Are Bedsores in Nursing Homes?
Pressure ulcers are a significant problem in North Carolina nursing homes. According to North Carolina nursing home quality data analyzed by ElderGuide, nearly 10 percent of nursing home residents in North Carolina have pressure ulcers. This statistic is particularly concerning given that bedsores are widely recognized as preventable injuries.
National research further highlights the scope of the issue. Research combining multiple studies found that about 11.6 % of nursing home residents in long-term care had pressure injuries, and approximately 8.5 % developed these injuries while residing in the facility — highlighting how prevalent pressure ulcers remain in long-term care settings across the U.S.
What Are Pressure Ulcers (Bedsores)?
Pressure ulcers are injuries to the skin and underlying tissue caused by prolonged pressure, friction, or shear. They most often develop when a resident has limited mobility and is not repositioned frequently enough to relieve pressure on vulnerable areas of the body. When pressure restricts blood flow, tissues are deprived of oxygen and nutrients, causing the skin to break down.
Common locations for pressure ulcers include the heels, ankles, hips, tailbone, lower back, elbows, shoulder blades, and the back of the head. Elderly residents are particularly susceptible because of reduced circulation, fragile skin, chronic illness, incontinence, and cognitive impairment that may prevent them from recognizing or reporting discomfort.
Stages of Pressure Ulcers
Medical professionals classify pressure ulcers into stages based on severity. Understanding these stages is important because advanced ulcers almost never develop without earlier warning signs.
Stage 1 pressure ulcers involve reddened skin that does not blanch when pressed. The area may feel warm, firm, or painful. Stage 1 ulcers are often overlooked or dismissed as minor irritation, but they are a clear warning sign that immediate intervention is required.
Stage 2 pressure ulcers involve partial-thickness skin loss. The skin may blister, peel, or form a shallow open wound. These ulcers are painful and visible and require active wound care.
Stage 3 pressure ulcers involve full-thickness skin loss extending into fatty tissue. The wound may appear deep, and the risk of infection increases significantly. These wounds are dangerous and require aggressive treatment.
Stage 4 pressure ulcers are the most severe. They involve extensive tissue damage and may expose muscle, tendon, or bone. These wounds are extremely dangerous and can be life-threatening.
Stage 3 and Stage 4 pressure ulcers often indicate prolonged neglect.
Why Pressure Ulcers Are Considered Largely Preventable
Federal Centers for Medicare & Medicaid Services (CMS) guidelines recognize most pressure ulcers as preventable when nursing homes follow proper care protocols. Facilities are required to assess residents for pressure-ulcer risk, develop individualized care plans, and implement preventative measures.
Core prevention measures include repositioning immobile residents on a regular schedule, using pressure-relieving mattresses and cushions, keeping skin clean and dry, monitoring skin integrity daily, and ensuring adequate nutrition and hydration. When these steps are consistently followed, pressure ulcers are uncommon.
How Nursing Homes Should Prevent Bedsores
Preventing pressure ulcers requires diligence and adequate staffing. Facilities should conduct comprehensive risk assessments upon admission and after any change in a resident’s condition. Residents identified as high risk must be repositioned at appropriate intervals, often every two hours.
Facilities should use pressure-reducing mattresses, heel protectors, and chair cushions. Staff must assist residents with hygiene and promptly address moisture from incontinence, which increases skin breakdown. Nutrition and hydration must be monitored closely, as malnourished residents heal more slowly and are more susceptible to ulcers.
Just as importantly, staff must be trained to recognize early signs of skin breakdown and report them promptly so that intervention occurs before a wound progresses.
Treatment of Minor Bedsores (Stage 1 and 2)
When pressure ulcers are identified early, prompt treatment can prevent serious harm. Stage 1 ulcers typically require relieving pressure from the affected area, increasing repositioning frequency, improving skin care, and addressing contributing factors such as moisture or poor nutrition.
Stage 2 ulcers may require wound dressings, topical treatments, and closer medical monitoring. The goal at these stages is to promote healing and prevent infection. Failure to treat early-stage ulcers appropriately allows them to progress into far more dangerous wounds.
Treatment of Severe Bedsores (Stage 3 and 4)
Stage 3 and Stage 4 pressure ulcers require aggressive medical treatment. Care often includes specialized wound care, debridement of dead tissue, prescription antibiotics, and advanced dressings. In severe cases, surgery may be required.
Residents with advanced pressure ulcers frequently require hospitalization. Complications such as sepsis, bone infection, and systemic illness are common. These injuries often cause prolonged suffering and may ultimately prove fatal.
Legal and Regulatory Duties of Nursing Homes in North Carolina
Nursing homes in North Carolina are legally required to protect residents from avoidable harm. Facilities must assess pressure-ulcer risk, follow care plans, maintain adequate staffing, and provide appropriate medical treatment. Failure to meet these obligations may constitute negligence.
What Families Should Do If a Loved One Develops a Bedsore
Families should document the wound, request immediate medical evaluation, obtain care plans and wound-care records, and consult an experienced nursing home neglect attorney. Early action helps protect the resident and preserve evidence.
Pressure Ulcers Are a Serious Warning Sign
A bedsore is rarely an isolated issue. It is often a visible sign of systemic neglect. When nursing homes cut corners, residents suffer the consequences.
Assisted Living Facilities and the Duty to Transfer Residents With Serious Bedsores
Assisted living facilities in North Carolina are fundamentally different from nursing homes and other skilled nursing facilities. They are designed to provide supervision, assistance with activities of daily living, and limited health-related services—not advanced medical or wound care. Because of these limitations, assisted living facilities have a heightened duty to recognize when a resident’s medical needs exceed the level of care the facility is licensed and equipped to provide.
Stage 3 and Stage 4 pressure ulcers almost always require skilled nursing care, specialized wound treatment, and close medical supervision. When an assisted living resident develops a serious bedsore, the facility generally should not attempt to manage the condition in-house. Instead, the facility should promptly arrange transfer to a higher level of care, such as a skilled nursing facility or hospital.
In North Carolina, assisted living facilities are regulated under adult care home standards, which require facilities to ensure that residents receive care appropriate to their needs. When a resident’s condition deteriorates beyond what the facility can safely manage, the facility has a duty to initiate a transfer or discharge to a setting capable of providing appropriate medical treatment. Failing to do so places the resident at significant risk of infection, sepsis, and further tissue breakdown.
Facilities sometimes delay transfers for non-medical reasons, such as concerns about losing occupancy or reimbursement. Other times, staff may minimize the seriousness of a bedsore or fail to recognize its progression. These failures can have devastating consequences. Stage 3 and Stage 4 pressure ulcers often worsen rapidly without skilled wound care, increasing the risk of systemic infection and permanent injury.
Proper transfer procedures should include timely medical evaluation, communication with the resident’s family or responsible party, coordination with healthcare providers, and safe transport to the receiving facility. Delays, poor documentation, or inadequate handoff of medical information can further compound harm.
When an assisted living facility fails to transfer a resident with a serious pressure ulcer to a higher level of care, that failure may constitute negligence. In many cases, the presence of an advanced bedsore in an assisted living setting is itself evidence that the resident was not receiving appropriate care and supervision.
Families should be especially alert to pressure ulcers in assisted living facilities. These facilities are not equipped to provide the same level of medical oversight as nursing homes, and advanced bedsores should be treated as medical emergencies requiring escalation of care.
Conclusion
Whether they occur in a nursing home or assisted living facility, pressure ulcers are rarely unavoidable. They are often a visible sign that a facility failed to recognize risk, failed to intervene early, or failed to transfer a resident when higher-level care was required. When facilities ignore these responsibilities, residents suffer the consequences.
If your loved one developed a pressure ulcer/bedsore in a North Carolina nursing home or assisted living facility, the Law Office of Kevin J. Williams can help. We represent families throughout Winston-Salem and surrounding counties who need answers, accountability, and justice.
Contact the Law Office of Kevin J. Williams today at (336)793-8459 for a free consultation.
