Bedsores in Nursing Homes: What Families Need to Know

You visit your parent in the nursing home and notice a dark red patch on their heel. Or a raw, open wound on their lower back. You ask the staff and get vague answers. A meta-analysis of over 355,000 older adults found that 11.6 percent develop pressure injuries [PMC12599044]. That means roughly one in nine nursing home residents may be affected. If you are reading this, you may already be one of those families.

If your loved one developed bedsores in a nursing home, you may have the right to find out whether it was preventable. A free case evaluation can help you understand what happened and what comes next.

Find Out If It Was Preventable

What Are Bedsores?

A bedsore – also called a bed sore, pressure sore, pressure ulcer, pressure injury, or decubitus ulcer – is a wound caused by constant pressure on the skin. It begins when blood flow to a patch of skin gets cut off. Tissue that loses blood flow starts to break down from the inside out [NCBI StatPearls]. By the time redness shows on the surface, damage has already begun underneath.

Bedsores form most often over bony areas. The heel is the most common site, making up 34.1 percent of all pressure injuries. The sacrum (lower back) accounts for 27.2 percent. The foot accounts for 18.4 percent [PMC12599044].

In 2016, the National Pressure Injury Advisory Panel (NPIAP) changed its language from “pressure ulcer” to “pressure injury.” This was not just a name change. It recognizes that tissue damage can start before any break appears on the skin surface [PMC5098472].

Nursing homes are required to assess each resident’s risk using tools like the Braden Scale. This scale scores six factors: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A score of 18 or less means the resident is at risk [PMC9690319]. At-risk residents need a prevention plan. When that plan fails or does not exist, bed sores develop.

You may hear doctors use different terms. Bedsores, bed sores, pressure sores, pressure ulcers, and pressure injuries all refer to the same condition. The clinical term “decubitus ulcer” is also still used in some medical records. Regardless of the name, the injury is the same – and so is the nursing home’s duty to prevent it.

Warning Signs Families Should Watch For

• Redness on the skin that does not fade when you press it with a finger
• Skin that feels warmer than the area around it
• A patch of skin that feels harder or softer than normal
• Swelling over a bony area like the heel, hip, or lower back
• A shallow open wound or blister on the skin
• An area of skin that looks purple, dark brown, or ashy gray, especially on darker skin tones
• Your loved one complains of pain or tenderness at a specific spot
• A foul smell coming from a wound or bandaged area
• Broken skin with drainage or fluid leaking from it

If you notice any of these signs during a nursing home visit, ask the staff directly: “Has my family member been assessed for pressure injuries?” For a complete guide to identifying these signs, see our bedsore symptoms page.

When Is a Nursing Home Responsible?

Nursing homes have a legal duty to keep residents safe from preventable harm. When it comes to bed sores, the standard is clear. The facility must make sure that a resident who enters without bedsores does not develop them – unless the resident’s medical condition makes them truly unavoidable [42 CFR 483.25(b)].

That word – “unavoidable” – matters. The nursing home must prove that it did everything right. It must show it assessed the resident’s risk, created a care plan, and followed that plan. If the facility cannot show those steps, the bedsore is considered preventable.

This includes basic steps like turning and repositioning residents. The standard of care calls for repositioning at least every two hours [PMC7265629]. It also includes proper nutrition, skin checks, clean and dry bedding, and the right mattress.

Immobility is the strongest single predictor of bedsores. Research shows it carries an odds ratio of 4.54 – meaning immobile residents are more than four times as likely to develop a pressure injury [PMC12599044]. Malnutrition raises the risk three-fold [PMC12599044]. These are conditions the nursing home is supposed to manage.

When a nursing home fails to manage these risk factors, it is not just a clinical failure. It may be a violation of federal law. Families have the right to request the resident’s care plan and verify that these steps were taken.

One question to ask the facility: “Can you show me my loved one’s repositioning schedule and skin assessment records?” For more on what causes bed sores and how nursing homes fail to prevent them, see our guide on bedsore causes.

What Happens If Bedsores Go Untreated

Bedsores do not stay the same. They get worse. A pressure injury that starts as redness on intact skin (Stage 1) can progress to an open wound exposing fat, muscle, or bone (Stage 3 or Stage 4).

The health consequences are severe. Patients with Stage 3 and Stage 4 wounds have a 2.4 times higher mortality risk compared to other patients [PMC7949299]. Any pressure injury – at any stage – is linked to two to 3.6 times higher overall mortality over a 21-month follow-up period [PMC7949299].

Untreated bedsores can lead to:

• Infection that spreads from the wound into the bloodstream
• Sepsis, a life-threatening response to infection
• Osteomyelitis, a bone infection that can develop when Stage 4 wounds expose bone
• Chronic pain that reduces quality of life
• Extended hospitalization and repeated surgeries

The data makes the urgency clear. These injuries demand immediate, proper treatment. For information about what proper wound care includes, see our bedsore treatment guide.