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Bedsores are among the most painful and most preventable injuries that develop in elderly patients receiving long-term care. They are also one of the clearest warning signs that a nursing home or caregiver is not meeting basic standards. At The Elder Justice Firm, we work with families who have watched their loved ones develop serious pressure ulcers in facilities that should have prevented them. This guide explains the medical facts behind bedsore prevention, what facilities are legally required to do, and what legal options exist when prevention fails.
Bedsores, also called pressure ulcers or decubitus ulcers, are injuries to the skin and underlying tissue caused by prolonged, unrelieved pressure. That pressure restricts blood flow, depriving cells of oxygen and nutrients, and the tissue begins to die. According to the CDC National Center for Health Statistics, approximately 11 percent of nursing home residents have pressure ulcers at any given time. Research cited by Duke University School of Nursing finds that one in ten nursing home residents will develop a pressure injury during their stay.
The injury progresses in stages. Stage 1 presents as persistent skin discoloration with no open wound. Stage 2 involves partial skin loss, often appearing as a shallow wound or blister. Stage 3 involves full thickness skin loss exposing the fat layer beneath. Stage 4 involves deep wounds exposing muscle, tendon, or bone, creating a life-threatening risk of bone infection and sepsis. The medical community classifies Stage 3 and Stage 4 ulcers as "never events," meaning that with proper care they should not occur.
Elderly individuals are at elevated risk for pressure ulcers because aging reduces skin elasticity, slows healing, and is often accompanied by other conditions that compound vulnerability. The primary risk factors are:
Bedsore prevention is not medically complicated. It requires consistent execution of a small number of well-established protocols. When nursing homes are adequately staffed and follow their own care plans, the vast majority of pressure ulcers are preventable.
The single most important preventive measure is consistent repositioning. Residents in bed must be turned at minimum every two hours. Residents in wheelchairs or chairs must shift weight or be repositioned approximately every 15 minutes. These intervals represent the clinical standard. Under California Health and Safety Code Section 1276.5, skilled nursing facilities are required to provide a minimum of 3.5 direct care service hours per resident per day. When a facility's staffing falls below this threshold or staff are too stretched to execute repositioning schedules, bedsores become a predictable consequence.
Every nursing home resident should have skin inspected daily, with particular attention to bony prominences: heels, ankles, tailbone, sacrum, hips, shoulder blades, elbows, and the back of the head. Stage 1 changes are fully reversible with prompt intervention. The purpose of daily assessment is to catch those early changes before they progress.
Specialized mattresses, overlays, and cushions distribute pressure across a larger surface area and reduce concentration over any single point. Heel protectors prevent the constant pressure that causes heel ulcers in bedridden residents. These are inexpensive, evidence-based interventions that nursing homes are expected to use for any resident identified as at risk.
Proper nutrition and hydration are essential to skin integrity and wound healing. Protein, vitamin C, and zinc are particularly important for tissue maintenance and repair. When a nursing home fails to monitor food and fluid intake or to assist residents who need help eating or drinking, it is contributing to the conditions that make bedsores more likely and slower to heal once they develop.
Urine and fecal matter left in contact with skin accelerates tissue breakdown. Residents who are incontinent require prompt cleaning, careful drying, and the application of moisture barrier creams. When a nursing home fails to respond promptly to incontinence, it creates the chemical conditions for skin breakdown on top of the pressure-related conditions already present.
California law imposes specific, enforceable duties on nursing homes to prevent pressure ulcers. Under Welfare and Institutions Code Section 15610.57, neglect includes failing to provide hygiene, medical care, and protection from health and safety hazards. Allowing a preventable pressure ulcer to develop and progress is neglect under this statutory definition.
California's Elder Abuse and Dependent Adult Civil Protection Act, Welfare and Institutions Code Section 15600 provides that when a nursing home's failure to prevent or treat bedsores constitutes reckless neglect, the family may pursue enhanced damages and attorney's fees in addition to compensation for the resident's injuries. This law was designed to deter the kind of systemic failure that produces preventable pressure ulcers in vulnerable residents.
If you discover a pressure ulcer on a loved one during a nursing home visit, take the following steps:
Stage 1 changes can appear within two to six hours of unrelieved pressure on vulnerable tissue, and a wound can progress from Stage 1 to Stage 2 within days when early signs are not addressed. The speed of progression depends on the resident's overall health, nutritional status, and whether any intervention occurs at the Stage 1 phase. This is precisely why daily skin inspection matters: there is a narrow window between a reversible surface change and a serious, potentially life-threatening wound.
In rare circumstances, such as the final days of life when the body's circulation fails systemically, some skin breakdown may be unavoidable. However, Stage 3 and Stage 4 ulcers in a resident who was not actively dying are not considered unavoidable in clinical medicine. When these wounds develop in a nursing home, the standard clinical presumption is that a failure of care occurred, and the facility bears the burden of explaining what prevention measures it implemented.
Yes. Wound healing does not eliminate the legal claim for the harm caused while the wound was present, including pain and suffering, medical expenses, and any complications such as infection that required separate treatment. If the wound healed after the resident was transferred to a different facility that provided proper care, that transfer often underscores the original facility's failures rather than diminishing the claim.
If your loved one developed a bedsore in a California nursing home or care facility, the law may entitle your family to compensation. At The Elder Justice Firm, we review medical records, wound documentation, staffing logs, and facility inspection histories to determine whether a preventable injury occurred and who is responsible. We handle all cases on contingency, meaning no fees unless we recover for you. Contact us today for a free, confidential case evaluation.
We have won multi-million-dollar cases against public and private facilities on behalf of our clients. As a result, many institutions and their insurance companies opt to settle with us, based on our attorneys’ reputations.
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