Stage 3 Bedsores: Full-Thickness Skin Loss in Nursing Homes

You visit your loved one and see a wound that is no longer just on the surface. It is deep. You can see yellowish tissue inside. The nurse says it is “getting attention.” But the wound has been there for weeks and it is not getting smaller. Stage 3 and Stage 4 injuries together carry a 3.6-fold increased mortality rate within 21 months [PMC7949299]. A wound this deep should never have been allowed to progress this far.

A stage 3 bedsore means the wound has broken through the full thickness of skin. If this happened to your loved one in a nursing home, you deserve answers.

Find Out If It Was Preventable

What Is a Stage 3 Bedsore?

A stage 3 pressure injury means full-thickness loss of skin. The wound has gone through every layer of skin and into the fat tissue underneath. You may see fat visible in the wound bed, along with granulation tissue (bumpy, reddish healing tissue) and rolled wound edges called epibole [NPIAP / PMC5098472].

At this stage, the wound has not yet reached the fascia, muscle, tendon, or bone. If those deeper structures are visible or can be felt, the wound is Stage 4. That distinction matters for treatment and prognosis.

Slough (yellow or tan dead tissue) and eschar (black or brown dried dead tissue) may be present in the wound. These must be cleaned away before the true depth can be measured.

Two features often make stage 3 wounds worse than they look:

• Tunneling: Narrow passages extend from the wound opening deeper under the skin. These create pockets where fluid builds up and bacteria multiply. Tunneling is a pathway to abscess and deeper infection [NPIAP].
• Undermining: The wound is wider at its base than at the surface. This happens when shearing forces destroy tissue sideways beneath the skin edge [NPIAP].

Important: Some body sites – the bridge of the nose, ears, back of the skull, and ankle bones – cannot develop a true Stage 3 injury. These areas have too little fat tissue for the wound to fill [NPIAP].

Warning Signs of a Stage 3 Bedsore

• A deep wound where fat tissue is visible in the wound bed
• Yellow, tan, or black tissue inside the wound
• The wound appears crater-like with rolled or curled edges
• Drainage or fluid leaking through bandages
• Skin around the wound is red, warm, or swollen
• A foul odor from the wound area
• Your loved one has increased pain, fever, or confusion
• The wound has been present for weeks and is not shrinking

When Is a Nursing Home Responsible?

Federal law requires nursing homes to prevent bedsores unless the resident’s condition makes them medically unavoidable [42 CFR 483.25(b)]. A stage 3 wound does not appear suddenly. It progresses from Stage 1 and Stage 2 over days or weeks. At each earlier stage, proper care could have stopped the progression.

A nursing home that allows a bedsore to reach Stage 3 had multiple chances to act. It should have assessed the resident’s risk, created a prevention plan, repositioned the resident regularly, managed nutrition, and treated the wound when it was smaller and easier to heal.

Stage 3 and Stage 4 injuries together account for only about 4 percent of all pressure injuries [PMC7716611]. That means 90 percent of bedsores are caught and managed at earlier stages. When a wound reaches Stage 3, it often reflects a breakdown in the care system.

The facility must be able to produce records showing what it did at every step. If it cannot, the injury may be considered evidence of inadequate care.

Ask the nursing home: “When was this wound first documented, and what has the care plan included since then?”

CMS treats Stage 3 wounds as serious regulatory events. Deficiency citations at this level can fall into the “actual harm” category or higher. Families should understand that a Stage 3 wound is not just a medical problem – it is a signal that the care system broke down at multiple points.

The medical record should show a clear trail of actions from the first sign of redness through every stage of progression. Look for Braden Scale scores, repositioning logs with staff signatures, wound measurements taken at regular intervals, and documentation of any changes to the care plan. If the record has gaps – missing skin assessments, unsigned repositioning logs, or weeks without wound measurements – those gaps may show where the care system failed. Each missing entry represents a point where the nursing home had a chance to act and did not.

What Happens If a Stage 3 Bedsore Goes Untreated

Stage 3 bedsores carry serious health risks that are well documented.

Mortality. Elderly patients with Stage 3 and 4 injuries face a pooled hazard ratio of 2.41 – meaning roughly 2.4 times the risk of death compared to patients without pressure injuries [PMC7949299]. Mortality rates reach as high as 60 percent at one year after hospital discharge in older adults with pressure ulcers [PMC7949299].

Slow healing. Stage 3 pressure injuries achieve only about 50 percent healing rates at six months [NBK553107]. Compare that to Stage 2, where about 72 percent heal in the same time. Once a wound reaches Stage 3, recovery becomes far less certain.

Infection and osteomyelitis. Infection can develop underneath the wound without obvious warmth or redness on the surface. If the wound deepens to expose bone, osteomyelitis (bone infection) may develop. Treating osteomyelitis requires antibiotic therapy for six to eight weeks at minimum [PMC11355209].

Progression to Stage 4. Without proper treatment, a stage 3 wound can progress to Stage 4, where bone, muscle, or tendon is exposed. This dramatically worsens the prognosis.

Nutritional demands. Healing a stage 3 wound requires increased protein and calorie intake: 1.5 grams of protein per kilogram of body weight per day, 30 calories per kilogram per day, and Vitamin C at 1,000 to 2,000 milligrams per day [PMC6906754]. If the nursing home is not providing this level of nutrition, healing stalls.

Prevalence context. Overall, about 11.6 percent of nursing home residents develop pressure injuries of any stage. The nursing home-acquired prevalence is 8.5 percent [PubMed 37801939]. Stage 3 and Stage 4 injuries together make up only about 4 percent of all cases [PMC7716611]. That means the vast majority of pressure injuries are caught before they reach this severity – which makes a stage 3 wound in a nursing home an even stronger signal that something went wrong with the care system.

For more on how bedsores develop and progress, see our guide on bedsore causes. For information about proper wound care at this stage, see our bedsore treatment guide.