Understanding Pressure Injuries in Nursing Homes

Pressure injuries are among the most common injuries involved in California elder abuse and nursing home neglect lawsuits.

According to The Centers for Medicare & Medicaid Services (CMS), a pressure injury is "a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of intense and/or prolonged pressure or pressure in combination with shear. The injury can present as intact skin or an open ulcer and may be painful."

Without adequate circulation, tissue begins to break down, leading to wounds that can become severe, painful, and potentially life-threatening.

How Do Pressure Injuries Typically Arise?

A common scenario involves a nursing home resident who develops a pressure injury because caregivers failed to provide basic preventive care, such as regularly repositioning the resident, maintaining good skin hygiene, or promptly addressing moisture and nutritional needs. Since most pressure injuries are preventable with appropriate care, their presence may indicate neglect.

For families with loved ones in nursing homes or assisted living facilities, understanding the warning signs of pressure injuries can help identify problems before they become life-threatening. Likewise, attorneys handling elder abuse cases should have a thorough understanding of how these injuries develop, how they are documented, and what they may reveal about the quality of care a resident received.

What Kind of Evidence is Presented in Elder Abuse Litigation?

Photographs often become some of the most compelling evidence in pressure injury litigation. Images may be taken by family members who notice a wound during a visit or by hospitals and other healthcare providers after the resident is transferred for treatment.

These photographs serve several important purposes. They can document how the injury developed or worsened over time, provide objective evidence of its severity, and help medical experts evaluate whether appropriate care was provided. They can also have a significant impact on a jury by illustrating the extent of a resident's suffering far more effectively than written medical records alone.

For these reasons, preserving photographs of a pressure injury should be a priority whenever neglect is suspected. A dedicated elder abuse attorney can help you use photographic evidence to support legal action.

Stages of Pressure Injuries

Pressure injuries are classified according to the depth of tissue damage. They typically progress in the following stages:

1) Non-Blanchable Redness

The skin remains intact but develops persistent redness that does not fade when pressure is applied. The affected area may feel warmer or cooler than surrounding skin and may be painful, firm, or unusually soft.

Although there is no open wound, Stage 1 represents the earliest visible sign of pressure-related tissue damage.

2) Partial-Thickness Skin Loss

The outer layers of the skin are damaged, creating a shallow open sore with a pink or red wound bed. It may also appear as an intact or ruptured blister.

The injury extends through the epidermis but does not involve deeper tissues.

3) Full-Thickness Skin Loss

The wound extends through the skin into the underlying fatty tissue. Bone, tendon, and muscle are not yet exposed, although dead tissue (slough), undermining, or tunneling may be present.

At this stage, the injury requires significant medical treatment and carries an increased risk of complications.

4) Full-Thickness Skin and Tissue Loss

Stage 4 pressure injuries are the most severe. The wound extends through the skin and fat, exposing muscle, tendon, ligament, cartilage, or bone.

These injuries carry a substantial risk of serious infection, including osteomyelitis and sepsis, and often require extensive wound care or surgery.

Deep Tissue Pressure Injury

A deep tissue pressure injury may initially appear as persistent dark red, maroon, or purple discoloration beneath intact or broken skin. It may also present as a blood-filled blister.

These injuries result from prolonged pressure and shear forces damaging tissue beneath the skin's surface, particularly at the interface between bone and muscle. Although the skin may appear relatively intact, the underlying damage can progress rapidly.

Unstageable Pressure Injury

An unstageable pressure injury involves full-thickness tissue loss, but the true depth of the wound cannot be determined because it is covered by dead tissue. Once this material is removed, the wound is typically classified as either Stage 3 or Stage 4.

If you believe your loved one’s pressure injury has been the result of elder abuse in a California nursing home, a nursing home abuse lawyer can help you navigate the legal system and determine whether you have a case.