What's Your Question About Nursing Homes?
By Kathy Gannoe - September 2008
Question:
What is that sore on my father’s tailbone? It looks very tender and he has a similar sore on his heel.
Answer:
Those sores are probably pressure ulcers. Other terms you may hear are: bed sores, decubitus ulcers, skin breakdown, or pressure sores. Pressure ulcers are a serious condition and need to be treated aggressively by the nursing staff.
Question:
How did he get them?
Answer:
These ulcers develop when pressure on a portion of a person’s body gets in the way of the blood circulating correctly. A person who is incontinent (can’t get up and go to the toilet), who needs help moving their arms and legs, or who can’t change positions when sitting or lying down is at risk for pressure ulcers. Some diseases seem more prone to pressure sores than others. If your father is incontinent or cannot shift his body it is likely that a pressure ulcer developed when he was allowed to sit for long periods of time. In general, people need to be shifted from one position to another every two hours. If a person remains any longer than that on one spot, it can lead to pressure ulcers. The angle a person is sitting at can also contribute to pressure ulcers. At about a 30-degree angle, “shearing” occurs and it can mean even more trouble with skin condition. Shearing causes the layers of the skin to shift back and forth, adding stress to the pressure area.
Question:
Shouldn’t the nurses have noticed that he was getting them?
Answer:
Yes. There are risk factors which staff (and families) should watch for. These factors are: incontinence, immobility, weight loss, poor appetite, and dehydration. If you see signs of these, you can be pretty sure that there is a high risk for pressure ulcers. Discolored, torn, or swollen skin over bony areas of the body are also red flags. Check your father’s chart and see if the ulcers have been diagnosed and what treatment plan was prescribed.
Question:
Are these inevitable? My father isn’t going to suddenly be continent or able to move; he’s had a stroke and isn’t recovering.
Answer:
No, they are not inevitable, but it takes work to prevent them. Vigilance is the key to keeping on top of skin conditions. Any warning signs should be noted and the problem dealt with. Residents need to be kept clean and dry, to be repositioned often, to be encouraged to drink water, to be encouraged to eat high calorie, high protein meals and snacks. Sometimes when a resident is very near the end of life and no longer eats or drinks these ulcers cannot be prevented or healed but this is not common.
Question:
Is there a cure?
Answer:
Yes and no. The ulcers can be treated. There are special dressings and other special treatments which can be used to help them heal. However, I have been told that once a pressure ulcer occurs, that place is forever especially vulnerable to breaking down again. Pressure ulcers may be “staged” by nurses. This is a way of describing just how serious the breakdown of the skin is. Stages range from 1 (red skin) to 4 (you can see muscle and/or bone). Identifying risk factors, addressing them and then treating any skin break down at the earliest possible stage are very important. It is far easier to heal an early stage than a later one.
Question:
I need to know if they hurt him; he isn’t able to tell me himself.
Answer:
I can’t really answer this but you might observe his facial expressions when he is moved. If he is in pain, this can be addressed by medication. There are medications which can reduce any odor associated with the sores as well.
This column is presented as a public service of the Nursing Home Ombudsman Agency of the Bluegrass. If you have a question, send it to:
Kathy Gannoe
Nursing Home Ombudsman Agency
1530 Nicholasville Rd.
Lexington, KY, 40503