California Nursing Home Abuse Lawyers Blog

Blumenthal, Whitehouse, Franken, Casey Introduce Elder Protection and Abuse Prevention Act

(Washington, DC) - Senator Richard Blumenthal (D-CT), Senator Al Franken (D-MN), Senator Sheldon Whitehouse (D-RI), and Senator Robert Casey (D-PA) introduced the Elder Protection and Abuse Prevention Act, a bill to implement a comprehensive network of elder abuse prevention and response measures says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

"A spreading epidemic of seniors who are abused or exploited by family or caregivers must be stopped," said Blumenthal. "Rigorous screening and reporting to detect and deter abuse, physical or financial, is necessary to help remedy seniors who may be too fearful or embarrassed to report it themselves. This measure would require tough national standards for screening and reporting so wrongdoers can be stopped and prosecuted. There is no excuse for one in ten seniors continuing to suffer the physical injury, emotional anguish and anxiety, and financial hardship, costing upwards of $3 billion every year."

"Our nation's seniors deserve the peace of mind of knowing that they are protected from physical and emotional abuse and financial exploitation," said Whitehouse. "I am proud to be an original cosponsor of this bill, which would strengthen and improve State programs to better prevent and address elder abuse."

"Across the country, far too many seniors are being abused or exploited by the very people who should be looking after their wellbeing," said Sen. Franken. "This bill will address the tragedy of elder abuse - which is far too prevalent in Minnesota and across the country - by providing resources to protect seniors from abuse and help those who have already been abused."

"We must bring this largely silent epidemic of elder abuse to an end", said Senator Casey. "We have an obligation to protect our parents and neighbors who have helped build our Nation. This bill is an important step in the right direction in stopping the abuse and neglect of our older citizens."

While child abuse and domestic violence screenings are well-integrated into the nation's health and community services network, elder abuse screening requirements are noticeably absent in federally-supported senior services. The Elder Protection and Abuse Prevention Act seeks to fill that void by encouraging the development of a strong network of elder abuse screening and support programs to identify instances of elder abuse and stop them before they happen. In some states, strong mandatory reporting laws and penalties exist for crimes against seniors, but they are ineffective without screening and reporting standards in every part of our community.

Specifically, the bill would:

Toughen federal standards for abuse - toughens the federal definitions for elder abuse, neglect and exploitation, streamlining the definitions for elder abuse between the Elder Justice Act and the Older Americans Act (OAA). The Act also defines Adult Protective Services (APS) in the Older Americans Act, the only victim services resource for adults with the authority to act on reports of abuse. The bill defines financial exploitation for the first time in federal statue, and adds victims or alleged victims of abuse and exploitation to a list of conditions eligible for priority for social services under the Older Americans Act.

Improved Coordination of all Elder Justice Activities - requires that the appropriate training and prevention and provision of elder justice throughout the OAA Programs are routinely updated as necessary and sees to the full integration of elder justice activities with all social services programs under the Act.

Authorization of the National Adult Protective Services Resource Center - codifies the National Adult Protective Resources Center in the Administration on Aging, and expand both its guidance and responsibilities to states.

Requires the development of best elder abuse screening practices - directs the National Adult Protective Resources Center to support states in the development of best practices to incorporate elder abuse screening into health and wellness services and would require the research center to study and disseminate this information to states regularly.

State prevention, assessment, and response to elder abuse - incorporates elder abuse prevention training, screening, and reporting protocol into all senior service access points that receive federal dollars under this bill as part of their state and area plans on aging

Improvement of training for elder justice activities -incorporates the research and replication of successful models of elder abuse, neglect, and exploitation prevention and training into the Older Individuals' Protection from Violence Projects and strengthens Elder Justice sensitivity training requirements.

In 2009, there were 6 million instances of elder abuse reported nationwide, and only 23.5% of cases are reported due to a lack of screening, awareness, and prevention efforts. It is estimated that seniors lose a minimum of $2.9 billion each year to financial abuse and exploitation and victims experience a mortality rate of three times higher than those who are not victims of elder abuse.

Continue reading "Senators Introduce Elder Protection and Abuse Prevention Act to Curb and Prevent Elder Abuse in the United States" »

Charlene Harrington, a professor emerita at the University of California at San Francisco, has studied the nursing home industry for 30 years. Last year, she examined the nation's 10 largest for-profit chains and found up to five layers of ownership.

"You can't tell who owns'' many nursing homes, Harrington says. "It's like tracking a problem mortgage when you don't know who owns the bank.''

Even the federal government can't figure it out. Medicare and Medicaid pay most of the nation's nursing home bills and require homes to disclose their ownership structures. But when the General Accounting Office looked at six big chains in 2010, the information those chains had provided Washington gave no indication of which affiliated companies controlled what.

People who put their mother in a nursing home have no idea that decisions on staff and supplies are not being made by the administrator or a local owner says California Nursing Home Abuse and Neglect Lawyer Steven Peck. Medical decisions are governed many times solely by monetary concerns by corporate entities and their individual ownership.

It's all about the amount of money the Nursing Home Operators can make versus the care the are supposed to give as is mandated by Federal Law and State Laws which regulate these facilities.

Continue reading "Nursing Home Abuse and Neglect Responsibility is a Sophisticated Network Of Behind the Scene Business Dealings" »

According to official figures more than 75,000 people died in hospitals in 2010 after having experienced neglect and poor care from hospital staff.

Most if not all were affected by bedsores and infected wounds, others died after becoming dehydrated and malnourished says Nursing Home Abuse and Neglect Lawyer Steven Peck. The death toll from bedsores and wound infections has risen substantially in the last 10 years.

The figures are shocking because bedsores are fully preventable in the majority of cases. When a patient spends longer periods in bed, they need to regularly turn and shift their body position to avoid excessive pressure on tissues. However, when patients are not able to move on their own it is the hospital staff's responsibility to check for tissue damage and to turn patients.

Even though not all fatalities were directly caused by infected wounds and bedsores, the fact that they affected such a huge number of patients suggests very poor level of care says Peck.

Bedsores, Pressure Sores and Decubitus Ulcers are frequently listed on death certificates many other elders also die of blood poisoning, Sepsis, primarily caused by wound infections. Malnutrition and Dehydration are other major signs of nursing home abuse and neglect.

Continue reading "Bed Sores, Malnutrition and Dehydration Are Common Signs of Nursing Home Abuse and Neglect" »

A former employee of the Central Coast Nursing Center pleaded guilty last week to neglecting a dependent adult under circumstances likely to produce great bodily harm.

Brian Watt, who was 29 years old at the time of his arrest in September 2011, had worked as a certified nursing assistant at the center. He was already serving a two year prison term, however, when he was arrested, related to a charge in Ventura of a sexual relationship with an underage female.

He had to register as a sex offender for life related to that offense, Senior Deputy District Attorney Mary Barron said.

Watt - who is still serving out his prison term - will be sentenced next month to three years of probation, Barron said. He had originally been charged with a lewd act on a dependent adult, felony sexual battery on an institutionalized victim, and misdemeanor abuse of a dependent adult abuse.

Watt will not be able to work as a caretaker for the elderly while he is on probation, and his record will come up during required background checks should he apply to work at another facility, Barron said. "It was in the best interest of our case and our victim to settle," she said. "It was a fair resolution."

Watt was one of two men who worked at the nursing center arrested by authorities last year. The other, Hugo Rendon, is scheduled to be in on February 7, 2012.

Continue reading "Nursing Home Abuse and Neglect Will Be Criminally Prosecuted" »

What if the sore gets infected?
Pressure sores, Bed sores and Decubitus Ulcers that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away.

Signs of an infected pressure sore include the following:
•Thick yellow or green pus
•A bad smell from the sore
•Redness or warmth around the sore
•Swelling around the sore
•Tenderness around the sore

Signs that the infection may have spread include the following:
•Fever
•Chills
•Mental confusion or difficulty concentrating
•Rapid heartbeat
•Weakness
How are infected pressure sores treated?
The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenously (through a needle put in a vein) or orally (by mouth).

How can I tell if the sore is getting better?
As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing.
How can pressure sores be prevented?The most important step to prevent pressure sores is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously.

It's also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap and warm (not hot) water. Apply moisturizers so your skin doesn't get too dry. If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur.

If you smoke, you should quit. People who smoke are more likely to develop pressure sores.

Exercise can help improve blood flow, strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is hard for you. He or she can suggest exercises that can work for you, or refer you to physical therapist that can help.

Continue reading "What Do You Do if a Bed Sores, Pressure Sores, Decubitus Ulcers Become Infected says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Sepsis and septic shock can result from an infection anywhere in the body, including pneumonia says Nursing Home Abuse and Neglect Lawyer Steven Peck. It is known that in the United States, health care-associated infections (HCAI) affect 1.7 million hospitalizations every year. And, the two most common conditions are sepsis and pneumonia. In February 2010, a study published in the Archives of Internal Medicine, confirmed the high costs resulting from caring for patients: an more than $8.4 billion per year. In addition to this, the study found that such infections cost an average of an extra 11 days in the hospital and $33,000 dollars, per person.

Sometimes called blood poisoning, sepsis is the body's often deadly response to infection or injury. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival.

Worldwide, one-third of patients who develop sepsis die. Almost 20% of patients who develop sepsis after surgery die. Many who do survive are left with organ dysfunction and/or amputations.

The most common source of infection, among adults, is the lung or lungs.

Continue reading "Nursing Homes and Long Term Care Facility Infections May Lead to Sepsis and Septic Shock Says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

A hospital is an important place that takes care of the sick. It caters people who are in need of proper attention and medical treatment. Since it houses those who are bedridden, paralyzed, and injured as well, it is just very essential for nurses to know how to take care of them properly. Because if not, they will develop some severe conditions that are pretty much difficult to deal with. One of these things that may happen to them is the development of bed sores in hospital. Since these mentioned people are constantly lying or sitting down, the pressure and friction in wheelchairs and mattresses can shed up the skin. Since it does not only affect the epidermis, it can also develop down to the bone. When bed sores occur, it just means that the nurses and the whole management of the hospital do not give the needed requirements of the patient such as constant turning to relieve pressure.

Continue reading "Why Bed Sores, Pressure Sores, and Decubitus Ulcers Occur In Nursing Homes and Hospitals" »

Two Orange County nursing homes, Newport Nursing and Rehabilitation Center in Newport Beach and Emeritus at Yorba Linda, both received Class "AA" citations, the most severe penalty under State law, from the State of California after investigations concluded that inadequate care at the nursing homes lead to a death at each facility, announced Dr. Ron Chapman, director of the California Department of Public Health (CDPH) and state public health officer.

Newport Nursing and Rehabilitation Center was fined $100,000 after a CDPH investigation found that the facility failed to provide adequate safety measures and supervision, leading to the patient's death. Emeritus at Yorba Linda received a $90,000 fine after a CDPH investigation found that the facility failed to serve a diet as prescribed resulting in a patient choking and subsequent death.

All nursing facilities in California are required to be in compliance with applicable state and federal laws and regulations governing health care facilities to ensure quality of care.

California has statutory authority to impose fines against nursing facilities it licenses as part of enforcement remedies to poor care. State citations that require a civil monetary penalty are categorized as Class B, A or AA. The associated fines range from $100 to $2,000 for Class B, $2,000 to $20,000 for Class A and $25,000 to $100,000 for Class AA. The citation class and amount of the fine depend upon the significance and severity of the substantiated violation, as prescribed and defined in California law.

By providing nursing facilities it licenses with consequences for substantiated violations, CDPH strives to protect the health and safety of vulnerable individuals. The citation process is part of CDPH's ongoing enforcement efforts in improving the quality of care provided to residents of the state's approximately 1,400 skilled nursing facilities

Continue reading "California Nursing Homes Receive The Most Severe Penalty Under State Law" »

Controversy is usually considered undesirable -- in the same category as conflict, discord, and disagreement. However, when it takes the form of respectful dialogue rather than debate, controversy can transform opinion and even give rise to unexpected progress. One hopes, for the benefit of all concerned, that the current controversy surrounding pressure ulcers might bring about a similarly positive outcome.
In 2010 the Centers for Medicare & Medicaid Services (CMS) halted additional payments to hospitals for selected conditions that were acquired in the hospital (in other words, not present when the patient was admitted). One of these conditions was the pressure ulcer, bed sore and the decubitus ulcer which CMS asserted "could reasonably have been prevented through the application of evidence-based guidelines." This regulation was known as the Inpatient Prospective Payment System Fiscal Year 2009 Final Rule (IPPS FY 2009 Final Rule).[1] In IPPS FY 2009 Final Rule, CMS hedges a bit with language. The rule does not state unequivocally that pressure ulcers are always or entirely preventable -- only that they are reasonably preventable. Still, no recourse exists for hospitals to receive any additional reimbursement for the treatment of hospital-acquired pressure ulcers even if clinicians deem them unavoidable.

A reduction in reimbursement is not the only consequence of the CMS ruling. The assertion by CMS that pressure ulcers, bed sores and decubitus ulcers can be prevented raises the legal stakes for nurses because the ruling essentially implies that if a pressure ulcer, bed sore and decubitus ulcer occurs during hospitalization, it must be the result of inadequate nursing care. Patients, families, attorneys, the courts, juries, and the public will now believe that pressure ulcers, bed sores and decubitus can be always be prevented with adequate vigilance and care, leaving nurses and hospitals open to lawsuits every time a pressure ulcer, bed sore and decubitus ulcer appears to have its onset during hospitalization.

A controversy wouldn't be a controversy without 2 points of view. In contrast to CMS's stance, some believe that pressure ulcers will occur, in certain patients, even if staff members follow the best guidelines or use the latest high-tech skin protection devices.
CMS has already maintained, in writing, that pressure ulcers, bed sores and decubitus ulcers are not all preventable, at least in long-term care settings This is true. In their guidance to state and federal surveyors, CMS states that long-term care facilities must ensure that "a resident who enters the facility without pressure sores, bed sores and decubitus ulcers does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable. Unavoidability means "the resident developed a pressure ulcer, bed sore and decubitus ulcer even though the facility had evaluated the resident's clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice; monitored and evaluated the impact of interventions; and revised the approaches as appropriate.

"Why should the setting matter? We are taking care of the same patients, with the same conditions and comorbidities. It makes no sense to say that a pressure ulcer is avoidable in one venue and unavoidable in a different venue. In hospitals, patients are more acutely ill. At a minimum, I would call it inconsistent public policy."

So, which side of the fence do the experts -- the wound care clinicians -- fall on? Can all pressure ulcers be prevented with the right kind of care? Or is it possible for pressure ulcers to develop despite the best efforts to prevent them?

There is consensus among most wound care clinicians that there is such a thing as an unavoidable pressure ulcer. The debate is about frequency. Some would say they are rare. Others contend that nearly all pressure ulcers are unavoidable because of the underlying comorbidities. These are the 2 extremes, and the truth is probably somewhere in the middle. But if there is such a thing as an unavoidable pressure ulcer, how do we define it? What are the variables that would make a pressure ulcer unavoidable?"

With the most diligent, consistent care, you can reduce the number of facility-acquired pressure ulcers. But no pressure ulcers? "You probably won't get to zero incidence and sustain that, a strong collaborative approach can reduce a facility's incidence of pressure ulcers. At the same time, the continued occurrence of pressure ulcers in certain patients despite appropriate care suggests that there is a floor effect in the prevention of pressure ulcers.

Although opinions may vary on the frequency and circumstances surrounding the unavoidable pressure ulcer, the wound care community does not agree with CMS that all pressure ulcers can be avoided. The WOCN Society are the country's nursing experts in the assessment, prevention, and care of pressure ulcers, and have taken a leadership role in the pressure ulcer controversy. On behalf of nurses who take care of patients at risk for pressure ulcers, the WOCN Society responded to the CMS ruling with the position paper "Avoidable and Unavoidable Pressure Ulcers. This position paper takes the view that pressure ulcers are not entirely avoidable and provides the evidence base to support this stance.

Continue reading "Are Bed Sores, Pressure Sores, and Decubitus Ulcers Unavoidable or Avoidable asks Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Having a simple blood test could prevent the dangerous complications associated with a medical condition called sepsis.

"Sepsis is really the body's response to severe infection," says California Nursing Home Abuse and Neglect Attorney Steven Peck. "There's inflammatory activity in the cells trying to fight the infection, but in some ways, it's thought that the body turns upon itself."

Also called "blood poisoning," sepsis kills 215,000 Americans every year, according to the Sepsis Alliance. Those lucky enough to survive can face organ failure and lost limbs.

"Sometimes it can move very quickly, sometimes minutes to hours, and so catching it early, your window of easy treatment can be very narrow," says Elder Abuse Lawyer Peck.

Commonly, sepsis is diagnosed only after symptoms start to show, but thanks to a new blood test, sepsis can be detected earlier Peck says.

The test measures a protein which can be found in the blood called procalcitonin. It measures the levels of procalcitonin, normally not present in a healthy individual. The higher the levels of procalcitonin, the greater the risk of patients going to progress to severe sepsis or septic shock.

Using the procalcitonin test, doctors can easily locate the protein in the blood, catching sepsis before it's too late.

Continue reading "Sepsis Can Cause Dangerous Complications says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Bed Sores, Pressure Sores and Decubitus Ulcers were again the most common medical errors found in the year 2010 closely followed by foreign objects left inside patients after surgeries says Nursing Home Abuse and Neglect Lawyer Steven Peck.
The Department of Health released its 2010 Medical Error Report on It cited numerous stage three or stage four bed sores after hospital admissions--the most common problem in four of the last five years--and secondly foreign objects left behind in residents after surgeries.

Other common mistakes were falls resulting in deaths or disabilities and surgeries on the wrong body parts.

Medication errors resulting in deaths or disabilities have also been a major problem.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Were Again the Most Common Medical Errors Found says Nursing Home Abuse and Neglect Layer Steven Peck" »

Nursing Homes may be at unique risk for outbreaks of gastrointestinal disease. Multiple chronic diseases and functional impairments, as well as common air, food, water, and medical care, heighten the potential for an outbreak, as do prolonged lengths of stay, limited diagnostic facilities, and poorly developed infection-control programs.[

Among epidemic illnesses, outbreaks of gastrointestinal disease may be particularly severe. A variety of characteristics of the nursing home and its residents predispose to serious gastrointestinal infection. One review of such outbreaks identified a variety of factors placing this population at risk. Age-related (or medication-induced) achlorhydria and high rates of antibiotic usage, which alter the normal protective gastrointestinal flora, increase rates of infection and colonization. Additionally, dementia, incontinence, and psychosis, present in high rates in long-term care facilities, as well as crowded communal living conditions, facilitate behavioral patterns that allow person-to-person transmission of gastrointestinal pathogens. These risk factors create the potential for the occurrence of severe outbreaks, including wrongful death.

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Effective prevention and treatment measures depend on a comprehensive care plan that includes scheduled turning and body repositioning in order to stop the incidence of Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Attorney Steven Peck. There is evidence that the frequency and intervals between turnings may be more critical than pressure in the production of pressure ulcers. Tthe practice of turning patients every 2 hours, and this procedure remains the mainstay of prevention strategies. Various other factors clearly contribute to the development of pressure ulcers. However, the best advice still is to establish a regimen in which pressure is completely relieved on all areas of the body at regular intervals.

Providers working with persons at risk need to be able to recognize skin changes that might indicate an impending breakdown. This is particularly true in elderly patients or in patients who are immunocompromised because the signs of impending or fulminating infection are frequently absent in these patients. Systemic signs of infection that mark the need to culture wounds include drainage, leukocytosis, fever, hypotension, increased heart rate, and changes in mental status. Prevention of progression to more serious damage requires immediate, complete elimination of pressure to the involved area.

If the proposition that pressure in excess of normal is the chief cause of pressure ulcers is accepted, then the primary prevention efforts have to be directed toward reducing or eliminating pressure over susceptible areas. The intensity and duration of external pressure and shearing forces necessary for pressure ulcers, bed sores and decubitus ulcers to occur depend on an individual's susceptibility, which could be summarized as their tissue tolerance. Nursing strategies include prevention of prolonged pressure, elimination of shearing forces and friction, and removal of skin secretions and excretions.

Statistically, 21.2% of patients who underwent surgery for more than 4 hours developed 70 pressure ulcers in the first 2 days following surgery. Twenty-one pressure ulcers, bed sores and decubitus ulcers deteriorated in the days following surgery. More than half (52.9%) of the lesions developed on the heels, and 15.7% developed in the sacral area.

Additional interventions that may be indicated for patients most at risk for pressure ulcers, bed sores and decubitus ulcers include avoiding hot water; using a mild cleansing agent that does not irritate or dry the skin; using moisturizers; using topical agents such as moisture barriers; keeping the sheets dry and wrinkle free; providing adequate intake of protein and calories; and maintaining current levels of activity, mobility, and range of motion. Massaging body prominences should also be avoided since this practice has been associated with increased tissue breakdown and risk for the formation of pressure ulcers.] Positioning devices such as pillows or foam wedges should be used to prevent direct contact between bony prominences (eg, knees, ankles). Donut-type devices should not be used because they are known to cause venous congestion and edema.

Continue reading "Comprehensive Care Plans Must Be Instituted to Halt the Incidence of Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Attorney Steven Peck" »

•The United States Census Bureau projected in 2000 that California's elderly population will have doubled by 2025 to 6.4 million - a larger growth rate than any other state.
•The California State Department of Finance claims that the number of California residents age 85 and older - those who are most likely to need nursing homes --- will nearly double by the year 2030, when the bulk of baby boomers will come of age.
•In 2005, the Office of Statewide Health Planning and Development reported that one-fifth of California's nursing facilities did not meet state-mandated requirements for staffing levels.
•In 2006, Centers for Medicare and Medicaid Services reported that twice as many of California's 115,000 plus residents are placed in physical restraints as are nationally.
•From 2001 to 2005, the California Department of Health Care Services, found that two-thirds of all reported deficiencies caused or could have caused significant harm to one of more residents in nursing homes. More than half of all complaints in nursing homes are related to poor quality of care. Eighteen percent of substantiated complaints were related to mistreatment or abuse.
Together, these staggering statistics and projections illustrate the urgent need to address and remedy the poor quality of care in many of California's skilled nursing facilities

Continue reading "Elder Abuse Statistics Are Staggering says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

A Pressure Sore, Bed Sore also known as a Decubitus Ulcer is an area of the skin or underlying tissue that is dead or dying as a result of the loss of blood flow to the area says Nursing Home Abuse and Neglect lawyer Steven Peck. The pressure occurs when a person rests on a bony area for a prolonged period of time. The extended pressure leads to a pressure sore.

Anyone can get a pressure sore, bed sores or decubitus ulcer. They occur in as many as 10% of all hospitalized patients, but it is estimated that up to 80% of individuals with spinal cord injury (SCI) will have at least one pressure sore during their lifetime.

There are four stages of a pressure sore, bed sores and decubitus ulcers..

Stage 1 - Damage is limited to the top two layers of skin, the epidermal and dermal layers. The skin is not broken, but there is redness that does not turn white when touched. A person with dark skin will also see a change in skin color, which may become darker, dry, flaky, or ashy. The area may be warmer than other areas, and there may be a change in the skin's texture.
Stage 2 - Damage extends beyond the top two layers of the skin to the adipose tissue. The skin is slightly broken. The sore appears to be an abrasion, blister or small crater.
Stage 3 - Damage extends through all the superficial layers of the skin, adipose tissue, down to and including the muscle. The ulcer appears as a deep crater and damage to surrounding tissue may be present.
Stage 4 - Damage includes destruction of all soft tissue structures and involves bone or joint structures. Undermining of ajoining tissue and sinus tracts may be associated with these sores.

The Evaluation
Anytime you have a pressure sore, it is essential that you keep weight off of the area and contact you doctor immediately. Your doctor will evaluate your condition to determine your treatment options.

You also need to be evaluated for proper equipment. You may need bedding with a specialized mattress or a change in your wheelchair cushion.

Stage 1 and 2 pressure sores are usually treated without surgery. Stage 1 treatment is almost always bed rest because it is essential to stay off the pressure sore to allow healing. Other treatments might include wound care, improving nutrition, pressure reliefs and exercises. Treatment for muscle spasms may be necessary to allow the wound to heal.

Surgery might be used for stage 3 and 4 pressure sores located on the sacrum (tailbone), ischium (beneath the buttocks), and trochanter (hips). Surgery may also be needed to treat sores that have not responded to non-surgical treatments, correct a previous surgical failure, remove infection from the hip joint, and prevent exposure of bone, plates or screws.

Patients who are poor candidates for operations in general should not undergo surgery. For example, patients with a history of drug and alcohol abuse are not considered good candidates for surgery. The same is true for patients without adequate social support or appropriate equipment. Because smokers have a greater risk for skin flap failure and other complications, smokers are usually not candidates unless they stop smoking 8 weeks prior to surgery.

Antibiotic use for pressure sore infections can affect treatment and may change the plan for surgery. Infection is suggested by redness at the wound edge, foul odor, or discharge. An additional evaluation is required for medical problems that could complicate the surgery itself or reduce the body's ability to heal. These problems include such things as heart disease, blocked arteries, lung problems and diabetes.

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