What Are Bedsores? A Guide for Families of Nursing Home Residents
If you've recently visited a loved one in a nursing home and noticed painful, discolored patches on their skin — or worse, open wounds — you're probably feeling a mix of shock, guilt, and anger. You may be wondering: What are bedsores, and how did this happen?
You're not alone. Every year, thousands of families across New York discover that someone they love has developed bedsores while in the care of a nursing home or hospital. These injuries are painful, potentially life-threatening, and — in the vast majority of cases — entirely preventable.
This guide will help you understand what bedsores are, how they develop, what the different stages look like, and when these wounds may be a sign that your loved one is being neglected.
What Are Bedsores? The Medical Definition
Bedsores — also called pressure ulcers, pressure injuries, or decubitus ulcers — are areas of damaged skin and tissue caused by sustained pressure that reduces blood flow to the affected area. According to the National Pressure Injury Advisory Panel (NPIAP), a pressure injury is defined as "localized damage to the skin and underlying soft tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear."
In simpler terms: when a person remains in the same position for too long — lying in bed or sitting in a wheelchair — the weight of their own body compresses the skin and tissue against the bone beneath it. This cuts off blood flow. Without adequate blood supply, the skin cells begin to die, and a wound forms.
Bedsores most commonly develop on areas of the body where bone sits close to the skin surface, including:
These injuries can range from mild redness on the skin's surface to deep, devastating wounds that penetrate through muscle down to the bone — creating a serious risk of life-threatening infection.
What Causes Bedsores?
Understanding the causes of bedsores is essential, especially for families trying to determine whether a nursing home provided adequate care. The primary factors include:
Prolonged Pressure
This is the leading cause. When a patient lies or sits in one position without being repositioned, the sustained pressure compresses blood vessels and starves tissue of oxygen and nutrients. As a general medical standard, immobile patients should be repositioned at least every two hours.
Friction and Shear
Friction occurs when the skin rubs against bedding or clothing. Shear happens when the skin moves in one direction while the underlying bone moves in another — such as when a patient slides down in a hospital bed. Both forces damage fragile skin and accelerate wound formation.
Moisture
Prolonged exposure to moisture — from perspiration, urine, or fecal matter — softens and breaks down the skin, making it far more vulnerable to pressure injuries. Proper incontinence care is a critical part of bedsore prevention.
Poor Nutrition
Patients who are malnourished or dehydrated heal more slowly and have weaker skin integrity. Nursing homes are required to monitor and maintain each resident's nutritional status. Failure to do so is a form of neglect.
Reduced Sensation or Mobility
Patients with conditions like paralysis, dementia, diabetes, or those recovering from surgery may not feel the discomfort that would normally prompt a person to shift their weight. These residents depend entirely on staff to reposition them regularly.
The Four Stages of Bedsores
Medical professionals classify bedsores into four stages based on severity. Understanding the stages of bedsores can help families assess how serious a loved one's condition is — and how long the wound may have been developing without proper care.
Stage 1: Non-Blanchable Redness
The skin is intact but shows a persistent area of redness that does not turn white when pressed. The area may feel warm, firm, or slightly swollen compared to surrounding tissue. In patients with darker skin tones, the discoloration may appear differently — as a purple or dark patch.
What it means: Stage 1 is the earliest warning sign. With proper intervention — repositioning, pressure-relieving surfaces, and monitoring — these injuries are fully reversible. If a nursing home fails to identify and address Stage 1 bedsores, it raises serious questions about the quality of care.
Stage 2: Partial-Thickness Skin Loss
The wound has broken through the top layer of skin (epidermis) and may extend into the underlying layer (dermis). It typically appears as a shallow, open wound with a pinkish-red wound bed, or as an intact or ruptured blister.
What it means: A Stage 2 bedsore indicates that the problem has been developing for some time without adequate intervention. These wounds are painful and require active wound care to heal.
Stage 3: Full-Thickness Skin Loss
The damage extends through the full thickness of the skin, exposing subcutaneous fat. Bone, tendon, and muscle are not yet visible, but the wound may be deep with undermining or tunneling beneath the skin surface.
What it means: Stage 3 bedsores are serious injuries that take months to heal, even with optimal treatment. The risk of infection is significant. Developing a Stage 3 bedsore in a care facility is a strong indicator of sustained neglect.
Stage 4: Full-Thickness Tissue Loss
The most severe classification. The wound extends through the skin and subcutaneous tissue, exposing bone, muscle, or tendon. These devastating injuries carry a high risk of osteomyelitis (bone infection), sepsis (a life-threatening bloodstream infection), and other fatal complications.
What it means: Stage 4 bedsores represent a catastrophic failure of care. Research published in the International Wound Journal shows that patients with pressure ulcers have double the risk of mortality compared to those without, within a three-year period. According to the Agency for Healthcare Research and Quality (AHRQ), more than 60,000 people die every year from bedsore-related complications in the United States.
To learn more about the most severe cases, read our guide on Stage 4 bedsore life expectancy.
Bedsores in Nursing Homes: How Common Are They?
The statistics are alarming. The Centers for Disease Control and Prevention (CDC) reports that approximately 1 in 10 nursing home residents will develop a pressure injury during their stay. In a state as large as New York — with hundreds of thousands of nursing home residents — that translates to thousands of preventable injuries every year.
New York City is particularly affected. A 2019 investigation by the City University of New York (CUNY) found that nine out of the ten nursing homes with the highest bedsore incidence rates in New York State were located in New York City. This is not a minor problem — it's an epidemic of preventable harm.
The residents most at risk include:
When Bedsores Indicate Nursing Home Negligence
Here is what many families don't realize: federal law requires nursing homes to prevent bedsores. Under 42 CFR §483.25(b) — known as the F686 regulation — the Centers for Medicare & Medicaid Services (CMS) mandates that:
"A resident who does not have pressure ulcers is not to develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable."
In other words, when a nursing home resident develops bedsores, the burden is on the facility to prove the injury was clinically unavoidable — not on the family to prove neglect occurred. This is an important legal distinction.
The accepted standards of care for bedsore prevention include:
When a facility fails to follow these basic protocols, and a resident develops a bedsore as a result, that constitutes negligence. If you're wondering whether your family's situation rises to the level of a legal claim, our article on whether you can sue for bedsores can help answer that question.
Signs That a Bedsore May Be the Result of Neglect
While not every bedsore is the result of substandard care, certain circumstances strongly suggest negligence:
Your Legal Rights as a Family Member
If your loved one has developed bedsores in a New York nursing home or hospital, you may have grounds for a legal claim. New York law allows families to pursue compensation for:
Bedsore lawsuit settlements in New York have ranged from hundreds of thousands to millions of dollars, depending on the severity of the injury and the degree of negligence involved. For more information about potential compensation, visit our guide on bedsore lawsuit settlements.
You can also learn about suing a nursing home for bedsores or suing a hospital for bedsores, depending on where your loved one's injury occurred.
What You Should Do Right Now
If you suspect that a loved one is suffering from bedsores due to negligent care, here are the steps we recommend:
Talk to a New York Bedsore Lawyer — Free Case Evaluation
At Sinel & Olesen, PLLC, we represent families throughout New York City whose loved ones have been harmed by nursing home and hospital negligence. We understand how painful it is to see someone you love suffering from a preventable injury — and we're here to help.
Our experienced bedsore lawyers will review your case at no cost and with no obligation. If we take your case, you pay nothing unless we win.
Call us today at 212-465-1000 or contact us online for a free, confidential case evaluation.
We're located at 330 7th Avenue, 10th Floor, New York, NY 10001.
The information on this page is for educational purposes and does not constitute legal advice. Every case is different. Contact our office to discuss your specific situation.
