Health & Wellness

Advocating for Your Loved One in a Nursing Home

The decision to place an elderly loved one in a nursing home is often one of the most difficult decisions a family can make.  The nursing facility is often the last home that the elderly resident will have, so providing a healthy and safe environment is vital to ensuring optimal quality of life in an individual’s twilight years.  Sadly, the inadequate staffing and care provided in many nursing homes throughout the country has been the cause of deadly and completely preventable medical conditions.  One of the most common of these conditions in the elderly nursing home resident is the bedsore.  Left untreated, bedsores cause protracted pain and suffering, disfigurement and often lead to premature death.

So just what is a bed sore? Simply put, a bed sore is an injury caused by constant pressure to the skin and muscle. Due to the underlying cause of a bedsore, it is often used synonymously with the term “pressure sore” or “pressure ulcer.” When a person cannot change positions, pressure cuts off the blood supply to the skin and underlying tissue. This results in skin breakdown and the development of sores.

Not surprisingly, elderly residents living in nursing homes are particularly prone to developing bedsores, based in large part on the immobility associated with being bedbound for long periods of time.  They are most commonly found in the lower back, buttocks and heels of the feet, due to the pressure associated with lying on their back without repositioning.  One recent study found that a more than 20% of all long term care residents have developed bed sores during their stay in a facility. Each year, over 500,000 new cases of bed sores occur in the United States, with nearly 13% of bed sore cases resulting in death.

Sadly, elderly residents affected by bed sores often experience extreme pain and suffering associated with disfiguring wounds on their bodies. Premature death usually occurs as the result of infection associated with severe skin breakdown. Stories abound where nursing home administrators tell a family that the sores are to be expected in the elderly population and “it just happens” in the nursing home setting. This is simply not true and is often an attempt by nursing home administrators to shield themselves from potential litigation. The truth is that negligent care is all too common within nursing homes throughout much of the country, due, in significant part, to inadequate staffing levels in many facilities.

There are some basic and potentially life-saving steps that you can do on behalf of your elderly loved one to reduce the odds that he/she will develop this debilitating, unnecessary and life threatening injury. Prevention and early intervention are the keys to protecting the elderly from the needless pain, suffering and death commonly associated with bedsores.  The following is a brief, non-exhaustive list that you can utilize:

-Plan early and do your research. While the process of placing a family member into long term care is stressful and often done on short notice, finding the right facility is vital to the protection of the elderly resident. When choosing a facility, research basic statistics such as nurse to patient ratios and whether a comprehensive healthcare approach will be in place for your loved one. This should include having a certified wound-ostomy nurse on staff, in addition to physical therapists, social workers and nutritionists. One useful research tool is the Nursing Home Compare Web Site sponsored by Medicare, where facilities across the country are reviewed for quality of care. Additionally, most states have informative Department of Health websites, where consumers can find ratings and cost comparisons for nursing homes in their respective area.  Additionally, take some time out to visit the facility you are considering for your family member and pay attention to how clean the environment is and the amount of staff on the floor of each unit.

-Monitor skin integrity. Upon admission into a nursing home, ask the nursing staff to conduct a baseline skin integrity assessment and repeat these requests at least once a month thereafter. By doing this, it helps to ensure that the staff will be vigilant in spotting and minimizing the progression of early bedsore development.  Do not expect that nursing home administration will contact you in the event that bedsore(s) develop on your loved one.  Being proactive about skin integrity and overall health is absolutely vital.  It is all too common in our law firm to have the family of a nursing home resident be told by a funeral director that their loved one had multiple advanced stage sores on their body.   While this may be shocking, one must not forget that a nursing home often has no incentive to inform the family of these wounds, as they subject themselves to liability by doing so.

-Turn, Turn, Turn.  Immobility is one of the most important factors in the development and progression of bedsores. One of the keys to preventing bedsore development is to utilize a two-hour turn schedule in a patient’s plan of care, so that pressure is not kept on one part of the body for too long.  While the standard “two-hour” turn schedule is taught and re-taught to every Registered Nurse and Licensed Practical Nurse in their schooling and workplace orientation programs, it is rarely put into practice in the daily care routine.  The reality of inadequate staffing in the nursing homes is that there is a lack of attention to each individual resident, whether it applies to turning in accordance with protocol, or toileting.  These deviations from acceptable nursing practice result in a greater incidence of bed sore development, in addition to other preventable medical issues among the residents.

– Document. When I lecture on nursing home negligence, I always suggest to families that they purchase a journal and document every call or visit made by you or a family member to the facility, including which staff members were spoken with and the substance of each conversation. In the event that an elderly loved one is neglected, it creates an important tool for litigation purposes and State and Local Department of Health investigations.  Furthermore, in the event that a sore develops, photographing the wound is vital for investigative and legal proceedings in the future.

-Know your ombudsman. An ombudsman is a citizen in the community who volunteers their time to be an advocate on behalf of nursing home residents. They play a pivotal role in ensuring that residents and family member’s complaints are appropriately handled by the facility. When admitting a loved one to the nursing home, ask that the staff provide you with the contact information for the ombudsman assigned to that facility. You may also do a quick Google search to find a listing of ombudsmen in your area.

-Get help from a geriatric care manager. A geriatric care manager, usually a nurse or social worker, is an expert in planning and coordinating care of older adults.  The geriatric care manager becomes the eyes and ears of the family and relieves some of the huge burden placed on loved ones.  Go to the National Association of Professional Geriatric Care Mangers at to find a geriatric care manager in your loved one’s community.

Utilizing some very basic tools, we can go far in protecting one of the most vulnerable patient populations in our health care system. In most cases, the elderly nursing home resident doesn’t have the means or ability to advocate on their own behalf and thus relies on friends and loved ones to be their voice. We owe it to them to be vigilant for signs of abuse and to act accordingly in the event that they are mistreated.

Glenn Race is a trial attorney specializing in Nursing Home Neglect litigation.  He may be reached at [email protected] or, by phone,  at 888.875.1059

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Rhiyah Rogers
8 years ago

My mom is in a nursing home and has a stage 3 bed sore they didn’t turn her at all and still haven’t been turning her even though she has the bedsore. I tried to call an ambulance and the nurses intervened and manipulating my mom to stay there. After the ambulance left i was extremely worried they still wouldn’t take care of her properly. That night she said they left her in a soiled breifs for an hour or more. They still make her get in her wheelchair even though she is in extreme pain. Also she is diabetic and has M.S This can’t be right I know they are neglecting or something.

9 years ago

Excellent article. Bottom line is that the family of those residents in any nursing care facility have to check on them regularly to ensure they are receiving proper care. I’ve seen far too many residents who only see a relative show up 2 or 3 times a year. That’s a disgrace!

Rev. Samuel M. Smith
9 years ago

Since 1 November 2006, my wife and I, both licensed CNA’s, have operated what is known as an Adult Foster Care Home (legally RACCP). Our first client was short-term and was only with us a couple of months, but the second, an 84-year old woman who was totally helpless came to us. When her son admitted her, he did not expect her to live more than a couple of weeks or a couple of months at most. She did have some “bedsores” when she came, but within a few days were healed over. In the end, she was with us 28 months, the last 8 we served as a hospice care, and since hospice care is only supposed to be 6 months, she had to be reevaluated.

Now, here in Hawaii, RACCP homes are limited to two or sometimes 3 “clients” as they are called at this level of care. These clients stay in our family home 24/7 unless signed out by an approved relative or friend, who certifies responsibility for the Client while in their care. We are under the Department of Human Services and have different rules and guidelines than regular care homes where the elderly and infirm are legally called “Residents.” They are under the Department of Health and are inspected less, but have some rules more and some less strict than ours. The specifications they must meet are stricter but they are allowed many beds and residents and have to hire full-time staff to operate.

At our level, only my wife and I are normally the caregivers and one or the other of us must be with the clients at all times unless a previously approved family member, either ours or theirs, can relieve us for about an hour so we can run necessary errands.

Contrary to what Old Warhorse said, though doubtless true where he is, here, “Private Pay” clients pay at least double what we receive from Medicare/Medicaid clients, and some pay even more. When you depend on the goverment funded clients, you may be fortunate if you do not actually lose your home to the mortgage holder, as this state has “farmed out” the paperwork for filing billing to Ohana Care and if every “i” is not dotted at the right spot or every “t” crossed just right, it may be necessary to rebill, making mortgage payments late with costly consequences. In addition, the pay per hour is less than minimum wage when you consider the 24/7 hours service availability required!

Our current two clients have been with us for close to three (3) years — the 102-year old almost 3-1/2 years and the other about three months short of three years.

The OLD Warhorse
9 years ago

The reason “nursing homes” are so expensive is twofold.
First, is all the paperwork required for reimbursment by Medicare.
Second is the cost of malpractice insurance to fend off ambulance chasers like the author.
His advice to make sure you demand various services on a monthly basis so you can go back and sue are just what any operator of a care facility wants to hear.
I went through this whole process with my mother several years ago.
I was shocked that when her Medicare coverage ran out, I was able to move her into a private room for about half what Medicare had been paying for a space in a four person room.

I will say there is no reason for “bed sores”. There is a pneumatic matress cover which constantly rotates air through various chambers thus constantly changing “pressure points”. This greatly reduces the occurance and severity of bed sores. Had one of these for my mother for the last five years of her life, and it worked beautifully.

Ric O Shay
9 years ago

Old Warhorse. That piece of news about the a pneumatic mattress cover is invaluable information for everyone to take note. Thanks for sharing it.
As for Medicare. There are so many ways taxpayer dollars are wasted because of lackadaisical to no oversight in the Medicare system. The Government has permitted this abuse of policy and procedure, complaining about one thing or another for years. The government seems to be satisfied as long as they complain – that is their answer to the ongoing problems. If the government will not do anything to correct wrongs, who else can? (A subject for another time.)

Ric O Shay
9 years ago

Most of us are so busy in thought and actions of value and non-value, that this subject does not occur to us at all – until that “something happens.” One does not need to be in a Nursing Home for attention to this subject. I became award of it when my spouse of almost 60 years was suddenly diagnosed with cancer and Hospice entered the picture for care at home. In this scenario, I came in contact with the subject of bedsores and the cream used to help prevent or treat the condition. I saw first hand how bedsores can come about if left unattended. It does not take long for bedsores to develop. This article ought to be helpful information for everyone – before it is needed – and, of course, especially when needed to help the patient avoid unnecessary pain. Thank you for the publicizing the subject.

pat s
9 years ago

The amount of money charged to the family/individual seems to me to be extremely expensive. Why is it that these facilities are “understaffed?” Fortunately, my family has not faced this decision, but the article is certainly helpful for the time that we will need to consider nursing home care.

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