Sepsis in Nursing Homes: What Families Need to Know

Your loved one went into the nursing home with a manageable condition. Then they developed an infection. Then the infection got worse. Then they were rushed to the hospital with sepsis. You are trying to understand how something this serious could have happened under the facility’s care. Nursing home residents are 7 times more likely to develop severe sepsis than the general population. Their in-hospital mortality rate is 37 percent – more than double the rate for other patients. Most of the infections that lead to sepsis are preventable. Most of the deaths are too.

If your loved one developed sepsis in a nursing home – from a urinary tract infection, bedsore, or other preventable infection – the facility may have failed federal infection control standards. A nursing home neglect attorney can evaluate whether you have a case, at no cost.

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What Sepsis Is and How It Starts

Sepsis is the body’s extreme response to an infection. Instead of fighting the infection in one area, the immune system overreacts and attacks the body’s own organs and tissues. Blood pressure drops. Organs begin to fail. Without fast treatment, sepsis kills.

In nursing homes, sepsis almost always starts with a common infection that was not prevented or not caught in time. The most common starting points are urinary tract infections — often linked to poorly managed catheters — and pneumonia, including aspiration pneumonia from swallowing problems. Skin infections from untreated bedsores and wound infections after surgery are also common sources.

The CDC found that 72 percent of sepsis patients had a recent healthcare factor, such as a hospital stay, nursing home residence, or invasive procedure. Eighteen percent of adult sepsis hospital admissions came from nursing homes and skilled nursing facilities. These are not random events. They are infections that developed in a care setting where prevention and early treatment should have been standard.

Sepsis progresses through stages. It begins as an infection with systemic symptoms like fever and rapid heartbeat. If untreated, it advances to severe sepsis, where organs begin to malfunction. The final stage is septic shock, where blood pressure drops dangerously low despite treatment. Each stage is harder to survive than the last. The window for effective treatment narrows with every hour.

Warning Signs of Sepsis

Sepsis moves fast. Families and staff need to recognize the signs early:

• Fever (temperature above 101.3 degrees F) or abnormally low temperature (below 96.8 degrees F)
• Rapid heartbeat (above 90 beats per minute)
• Rapid breathing (above 20 breaths per minute)
• Confusion, disorientation, or sudden mental changes – this may be the only early sign in older adults
• Shaking, chills, or feeling very cold
• Extreme pain or general discomfort that seems out of proportion
• Clammy, sweaty, or pale skin
• A known infection that is not getting better with treatment
• Low urine output
• Nausea, vomiting, or diarrhea

In elderly nursing home residents, the classic signs can be misleading. Older adults may not develop a high fever even with a severe infection. Their heart rate may be altered by medications. The most reliable early warning sign is often a sudden change in mental status – new confusion, increased agitation, or unusual drowsiness.

If you visit your loved one and they seem suddenly different — more confused or lethargic than usual — ask the nursing staff whether they have been checked for infection.

When the Nursing Home Is Responsible

Nursing homes are required by federal law to maintain an active infection prevention and control program. The National Academies found that 82 percent of nursing homes had infection control deficiencies between 2013 and 2017. Two-thirds were cited multiple times. These are not isolated failures. They are systemic problems.

The facility’s duty covers three areas: preventing infections from starting, catching infections early, and acting quickly when infections are detected.

Prevention means proper hand hygiene, safe catheter management, regular wound care, clean facilities, and vaccination programs. The CDC has a Sepsis Prevention Assessment Tool designed for nursing homes that identifies five key prevention domains. These are known, well-documented practices. When the nursing home does not follow them, infections happen.

Early detection means monitoring residents for signs of infection. Staff must check vital signs, watch for changes in mental status, track wound healing, and respond to complaints of pain or discomfort. When a resident with a bedsore develops redness, warmth, or drainage at the wound site, that is a warning. When a catheterized resident develops cloudy urine and fever, that is a warning. The nursing home must act on these signs immediately.

Quick response means starting treatment and transferring the resident to a hospital when needed. Sepsis is a medical emergency. Every hour of delay in treatment increases the risk of death. A nursing home that waits, watches, or fails to call emergency services when a resident shows signs of sepsis is putting that resident’s life at risk.

Dehydration can mask or worsen sepsis symptoms. A dehydrated resident may already have low blood pressure and confusion, making it harder to recognize when sepsis is developing. Proper hydration is part of infection prevention.

Medication errors can also contribute to sepsis. A missed antibiotic dose lets an infection grow. The wrong medication fails to treat the actual pathogen. These failures in medication management can turn a treatable infection into a life-threatening crisis.

Ask the facility: “What is your infection prevention protocol? When was the last time my loved one’s infection risk was assessed? What training do your staff receive on recognizing early signs of sepsis?”

What Happens When Sepsis Is Not Caught Early

The mortality numbers tell the story. Nursing home residents who develop severe sepsis face a 37 percent in-hospital mortality rate. That is more than double the 15 percent rate for non-nursing home patients.

The CDC reported 201,092 sepsis-related deaths in the United States in 2019. Three-fourths of those deaths were among adults 65 and older. The death rate for adults 65 and older was 277.4 per 100,000. For adults 85 and older, it reached 750 per 100,000.

These numbers got worse during the pandemic. A 2025 study in BMC Infectious Diseases found a 30.22 percent surge in sepsis mortality between 2019 and 2021. For adults 75 and older, the sepsis mortality rate ranged from 439 to 522 per 100,000. COVID-19 contributed to roughly one-sixth of sepsis deaths between 2020 and 2022.

Even when sepsis does not kill, it damages. Survivors often face lasting organ damage, cognitive decline, chronic pain, and increased vulnerability to future infections. A resident who survives sepsis may never return to their previous level of function.

AHRQ reported that 22 percent of Medicare beneficiaries in skilled nursing facilities experienced an adverse event. More than half of all adverse events in nursing homes are preventable. Sepsis from an uncontrolled infection is a textbook case of a preventable adverse event.

The chain from preventable infection to sepsis to death is well documented. A wrongful death claim may exist when the facility could have broken that chain at any point and failed to.