Bedsore Symptoms: What to Look for During a Nursing Home Visit

You visit your loved one and something does not look right. A patch of skin is red. Or the area feels warm. Or your family member winces when you touch a spot on their heel. Pressure injury risk assessment must occur within eight hours of admission under national guidelines [PMC8354930]. But if the nursing home missed the warning signs, it may fall to you to notice them first. Knowing what bedsore symptoms look like can make the difference between early treatment and a wound that threatens your loved one’s life.

If you have noticed redness, swelling, or broken skin on your loved one during a nursing home visit, these could be signs of a bed sore that should not have happened.

Find Out If It Was Preventable

The Four Early Warning Signs

Four symptoms routinely appear before a bedsore becomes visible to the eye. Each one represents a distinct signal that tissue damage is happening [NCBI StatPearls].

Pain

Localized pain over a bony area is often the first symptom. It may appear before any change is visible on the skin. Pain is an official component of Stage 1 assessment – not a secondary concern, but a primary diagnostic signal [NBK553107].

For residents with dementia or cognitive impairment who cannot report pain, watch for flinching, guarding, or agitation when a specific area is touched.

Warmth

When tissue is being damaged, the body sends extra blood flow to the area. This makes the skin over a forming injury measurably warmer than the skin around it. If you place your hand on your loved one’s heel and it feels notably warm, that is a warning sign.

Non-Blanchable Redness

This is the hallmark sign of a Stage 1 pressure injury. When you press the red area with your finger for a few seconds and the redness does not fade, the capillaries in that area are no longer working normally. Blanchable redness (redness that fades when pressed) signals intact blood flow. Non-blanchable redness signals injury that has already begun [NPIAP / NCBI].

Non-blanchable redness lasting more than one hour after pressure is removed confirms Stage 1 tissue damage.

Firmness

The skin over a bony area may feel harder, swollen, or tighter than the skin around it. This is called induration. It can appear before any visible discoloration. If a spot on your loved one’s heel or lower back feels unusually firm, do not dismiss it.

Bedsore Symptoms on Darker Skin

On darker skin tones, non-blanchable erythema does not appear as red. Instead, it may show as deep brown, ashy gray, or violet discoloration. These changes are easy to miss under typical institutional lighting or during a brief visual check [NPIAP / JAN 2025].

Research has found that educational bias on skin tone contributes to pressure injuries being diagnosed at later, more advanced stages in Black and Brown residents [Gunowa et al., JAN 2025]. Wounds that could have been caught at Stage 1 are missed until the skin breaks open at Stage 2 or beyond.

For family members: if your loved one has darker skin, pay close attention to areas over bony points. Use touch, not just sight. Check for warmth, firmness, swelling, and whether your loved one reports pain in a specific spot. If the color of the skin over a bony area looks different from the same area on the other side of the body, that is a warning sign.

What Bedsore Symptoms Look Like at Each Stage

As a bedsore progresses, the symptoms change. Here is what to look for at each stage:

• Stage 1: Persistent redness on intact skin that does not fade when pressed. The area may feel warm, firm, or swollen. Skin is not broken.
• Stage 2: The skin is broken. A shallow pink or red wound or a blister (intact or ruptured) appears. Clear fluid may drain from the area.
• Stage 3: A deep, crater-like wound. Fat tissue may be visible. Yellow, tan, or black dead tissue may be present. Drainage and odor may increase.
• Stage 4: The deepest wound. Bone, muscle, or tendon may be visible. Heavy drainage, foul odor, and surrounding redness are common.
• Deep Tissue Injury: Persistent deep red, maroon, or purple discoloration on intact or broken skin. The surface may look minor, but damage at the bone-muscle level is far worse than it appears [NPIAP / NBK553107].

For a complete overview of all stages, see our Bedsore Stages Guide.

Signs of Infection

If a bedsore becomes infected, new symptoms appear:

• Black or darkened tissue (necrotic tissue) in or around the wound
• Heavy drainage or fluid that soaks through bandages quickly
• Drainage that is thick, cloudy, or has a yellow or green color
• A foul smell from the wound
• Warmth, redness, or swelling spreading beyond the wound edges
• Fever, chills, or confusion
• Increased pain at the wound site

Infection in a pressure injury is a medical emergency. Untreated wound infections can spread to the bloodstream and cause sepsis. If your loved one shows any of these signs, do not wait for the next scheduled visit from a wound care nurse. Report these symptoms to the nursing staff immediately and document that you did so.

Bedsores vs. Other Skin Conditions

Not every skin change is a bedsore. One important distinction families should know:

Pressure injuries vs. incontinence-associated dermatitis (IAD). Bedsores are “bottom-up” injuries. They start deep in the tissue over bony areas where pressure builds up. IAD is “surface-down.” It starts at the skin surface from prolonged contact with urine, stool, or moisture [PMC3900143].

IAD typically appears in areas exposed to moisture – the buttocks, inner thighs, and groin. It looks like general redness, irritation, or raw skin over a broad area. Bedsores appear over specific bony points and have a defined wound border.

Black necrotic tissue and heavy drainage are consistent with a pressure injury, not IAD [PMC3900143].

Both conditions indicate care problems. IAD means the resident is not being kept clean and dry. A bedsore means the resident is not being repositioned.

If you are unsure whether what you see is a bedsore or another skin condition, ask the nursing home staff to document and stage the wound using NPIAP definitions. You have the right to request this.

What the Nursing Home Is Required to Do

Federal law requires nursing homes to assess every resident’s pressure injury risk and to act on that assessment [42 CFR 483.25(b)]. Specifically, the facility must:

• Complete a risk assessment using the Braden Scale within eight hours of admission [PMC8354930]
• Reassess regularly and after any change in condition
• Create an individualized care plan for at-risk residents
• Conduct skin assessments at every shift and document findings
• Respond immediately when symptoms appear

A drop in Braden score within 21 days of admission is strongly associated with pressure injury development [PMC8354930]. If the score drops and the facility does not update the care plan, that is a failure. For more on what causes bedsores in nursing homes, see our bedsore causes guide.