Pressure Sores and Nursing Home Injuries in Indiana

A bedsore, an unexplained fall or sudden weight loss is often the first visible sign that something has gone wrong with a loved one’s care. Powless Law helps Indiana families find out what happened and hold facilities accountable when neglect is to blame.

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On this page

• What is a pressure sore?
• The stages of a pressure sore
• Are pressure sores a sign of neglect?
• Other nursing home injuries we handle
• Warning signs for families
• Nursing home injury claims under Indiana law
• Frequently asked questions

If your parent or spouse has been injured in an Indiana nursing home, you probably have two questions: how serious is it, and should it have happened at all? This page answers both. It explains what pressure sores are, how doctors stage them, when they and other common injuries signal neglect, and what Indiana law allows families to do about it.

Pressure sores are the injury families ask us about most, and they are highly indicative of negligent care. Federal nursing home regulations expect facilities to prevent them, and a facility that follows its own care plan rarely sees one develop. The same is true of many falls, transfer injuries, dehydration and infections: when a facility fails to assess risk, follow its own care plan, or act on an early warning, the result is often an injury that did not need to happen.

What Is a Pressure Sore?

A pressure sore, also called a pressure injury, pressure ulcer, bedsore or decubitus ulcer, is damage to the skin and underlying tissue caused by sustained pressure, often combined with friction or shear. The pressure cuts off blood flow to the area, and without blood the tissue begins to break down. The National Pressure Injury Advisory Panel (NPIAP) adopted the term “pressure injury” in 2016, and most medical records now use it.

Sores form where bone sits close to the skin. For residents confined to bed, the most common sites are the tailbone and lower back (sacrum and coccyx), the heels, and the hips. Residents who sit for long periods in wheelchairs often develop sores on the sit bones (ischial tuberosities). Sores can also form under medical devices such as oxygen tubing, braces, casts and catheters.

The term “bedsore” is somewhat misleading. Some of the most severe pressure injuries develop in residents who spend the day in a chair, not a bed. Heel wounds are a particular concern; our article on heel eschar and “floating” the feet explains why a simple positioning step prevents so many of them.

The Stages of a Pressure Sore

Clinicians classify pressure injuries by depth. Understanding the stage helps families understand both the medical risk and the care that should have been provided before the sore reached that point.

• Stage 1 – Skin is intact but red (or, on darker skin, discolored) and does not blanch when pressed. The area may feel warmer, cooler, firmer or softer than surrounding skin. This is the stage at which a sore is easiest to reverse.
• Stage 2 – Partial-thickness skin loss. The sore looks like a shallow open wound, blister or abrasion with a pink or red wound bed.
• Stage 3 – Full-thickness skin loss. Fat tissue is visible. The wound may have undermining or tunneling beneath the skin edges.
• Stage 4 – Full-thickness skin and tissue loss with exposed muscle, tendon, ligament or bone. Infection of the bone (osteomyelitis) is common at this stage.
• Unstageable – The wound base is covered by dead tissue (slough or eschar), so its true depth cannot be seen.
• Deep tissue pressure injury – Intact or non-intact skin with persistent deep red, maroon or purple discoloration, indicating damage to tissue beneath the surface.

A Stage 3 or Stage 4 sore does not appear overnight. In most cases it progresses through earlier stages over days or weeks, and each of those days was an opportunity for staff to notice and intervene. A deep sore that becomes infected can also lead to sepsis; our sepsis timeline article walks through how that progression happens and the points at which it should be caught.

Are Pressure Sores a Sign of Nursing Home Neglect?

Yes. Pressure sores are highly indicative of negligent care. They develop when a resident is left in one position too long, when skin is not kept clean and dry, when nutrition and hydration are not maintained, or when an early sore is noticed and not treated. Each of those is a task the facility is responsible for.

Federal regulations at 42 CFR 483.25(b)(1) require a nursing home to ensure that a resident who enters without pressure ulcers does not develop them, and that a resident who has a pressure ulcer receives the care needed to promote healing, prevent infection and prevent new ulcers. State surveyors cite violations of this standard under deficiency tag F-686.

In practice, meeting that standard means a facility should:

• Assess each resident’s skin-breakdown risk on admission and regularly thereafter, usually with a tool such as the Braden Scale
• Reposition at-risk residents on a documented schedule, often every two hours in bed
• Use pressure-relieving mattresses and cushions for high-risk residents
• Keep skin clean and dry, and manage incontinence promptly
• Ensure adequate nutrition and hydration, since malnourished residents break down faster
• Inspect skin daily and document any changes
• Notify the physician and family promptly when a sore is found

When a sore develops, the chart almost always tells the story: missed repositioning, gaps in skin checks, weight loss that no one addressed, or a Stage 1 sore that was documented and then ignored. Facilities frequently blame the resident’s age or health instead of their own care, which is why obtaining and reviewing the complete medical record is the first thing we do. For a broader look at what counts as neglect, see Indiana Nursing Home Neglect Explained: A Guide for Families.

Other Nursing Home Injuries We Handle

Pressure sores rarely occur in isolation. The same understaffing and missed assessments that allow a sore to develop tend to produce other injuries, and a family that finds one often finds more once the records are reviewed. These are the injuries we see most often in Indiana facilities.

Falls and Transfer Injuries

Falls are among the most common serious injuries in nursing homes, and many are preventable with a proper fall-risk assessment, bed and chair alarms, adequate supervision and timely help with toileting. Injuries during mechanical transfers are a related problem: a resident dropped from a lift during a one-person transfer that required two is a classic sign of a staffing failure. Our article on Hoyer lift injuries explains who may be responsible when a transfer goes wrong.

Malnutrition, Dehydration and Choking

Residents who cannot feed themselves depend entirely on staff for food and fluids. Unexplained weight loss, dry mouth, confusion, urinary tract infections and constipation are frequent signs that intake is not being monitored. Residents with swallowing difficulty (dysphagia) face a second risk: a physician’s order for a pureed or mechanical-soft diet is only protective if the kitchen and the aides follow it. See Choking Hazards: Neglect of “Mechanical Soft” Diet Orders.

Infections and Sepsis

Infected wounds, untreated urinary tract infections, aspiration pneumonia and poor catheter care can all progress to sepsis, which is life-threatening in frail residents. In most cases there are hours or days of warning signs, such as fever, confusion and rapid breathing, during which a prompt call to the physician would have changed the outcome. Our Sepsis Timeline article describes that window in detail.

Dislodged Tubes and Medical Device Injuries

Residents with tracheostomy tubes, feeding tubes or catheters need specific monitoring. A dislodged tube that goes unnoticed can cause serious harm within minutes. Read Accidental Decannulation: When a Dislodged Tube Is Negligence.

Physical and Emotional Abuse

Not every nursing home injury is the product of neglect; some are inflicted. Unexplained bruising, fractures, fear of particular staff members, withdrawal and sudden behavioral change all warrant investigation. Our guides to recognizing physical signs of neglect or abuse and the impact of isolation and emotional neglect describe what to look for, and our Nursing Home Abuse practice page covers each type of abuse in more depth.

Records, Photos and Reporting

Families often run into resistance when they try to document an injury or obtain records. You generally have the right to photograph your loved one’s injuries with their or their legal representative’s consent (Can a Nursing Home Stop You From Taking Injury Photos?), and a facility that delays or withholds records may be violating state and federal rules (What to Do When an Indiana Nursing Home Hides Records). For reporting, see our Indiana nursing home complaint timeline, our guide to filing a nursing home complaint in Indiana, and how to check an Indiana nursing home’s inspection record.

Warning Signs Families Should Watch For

Many residents who are injured in nursing homes cannot report their own pain. They may have dementia, a stroke or a condition that limits speech or movement. That makes family visits an important safeguard. Signs that warrant a closer look include red or discolored patches over bony areas, a resident who is always found in the same position, unexplained bruises or bandages, noticeable weight loss, an unexplained odor, or staff who are reluctant to let you see your loved one’s skin.

You have the right to ask to see the care plan and to ask what the facility’s repositioning, fall-prevention and skin-check schedules are for your family member. Dated photographs of any injury, taken with consent, can be valuable later. For a fuller checklist, see Recognizing the Early Signs of Nursing Home Neglect: A Family’s Guide and Nursing Home Patient Rights: Understanding Your Protections.

Nursing Home Injury Claims Under Indiana Law

Indiana nursing homes that are licensed health care providers generally fall under the Indiana Medical Malpractice Act. That has several practical consequences for families:

• Deadline. Claims must generally be filed within two years of the negligent act or omission (Indiana Code 34-18-7-1), with limited exceptions. Because pressure sores and malnutrition develop over time, identifying the right start date can itself require careful review of the records. Do not wait to get advice.
• Medical review panel. Most claims must first be submitted to a panel of health care providers before a lawsuit can proceed in court.
• Damages cap. Indiana caps the total recovery in medical malpractice cases. Your attorney can explain how the cap applies to your situation.
• Wrongful death. When a resident dies from complications of a nursing home injury, the family may have a claim under Indiana’s wrongful death statutes, which have their own requirements.

A nursing home injury case typically involves obtaining the complete facility chart, state survey records and hospital records; having the care reviewed by a qualified nurse or physician; and documenting the resident’s pain, treatment costs and loss of function. We handle each of those steps and advance the costs of investigation. There is no attorney fee unless we recover compensation for your family. Residents and families also have rights independent of any lawsuit; see The Legal Rights of Nursing Home Residents and Their Families.

Why Families Across Indiana Call Powless Law

Powless Law is an Indianapolis firm that represents families in nursing home neglect, medical malpractice and wrongful death cases. We take a limited number of cases so that each family works directly with an attorney, not a case manager. We serve families throughout Indiana, including Indianapolis, Fort Wayne, Evansville, South Bend, Gary, Lafayette and Bloomington.

Frequently Asked Questions About Nursing Home Pressure Sores and Injuries

Are bedsores a sign of nursing home neglect?

Yes. Pressure sores are highly indicative of negligent care. They are prevented by routine tasks the facility is responsible for: risk assessment, repositioning, skin checks, hygiene, nutrition and hydration. Federal regulations hold facilities to that standard, and a sore that develops or worsens in a facility is a strong signal that the standard was not met. The medical records will show which steps were missed, which is why an attorney review is the first step.

What stage bedsore is considered serious?

Stage 3 and Stage 4 sores involve full-thickness tissue loss and carry a significant risk of infection, osteomyelitis and sepsis. Unstageable sores are treated as at least Stage 3 until the wound bed can be seen. That said, a Stage 2 sore that was never treated can also indicate a breakdown in care.

Is a fall in a nursing home grounds for a claim?

It can be. A single fall is not automatically negligence, but a fall that follows a documented high fall risk with no care-plan interventions, a fall during an understaffed transfer, or repeated falls with no change in the plan may be. The facility’s fall-risk assessments and incident reports usually answer the question.

Can a nursing home injury cause death?

Yes. Infected pressure sores, falls with hip or head injuries, aspiration from improper feeding and untreated infections can all lead to sepsis or other fatal complications in frail residents. When that happens, the family may have a wrongful death claim in addition to a claim for the resident’s own pain and medical expenses.

How long do I have to file a nursing home injury claim in Indiana?

In most cases, two years from the negligent act or omission under the Indiana Medical Malpractice Act, though exceptions exist. Because pressure sores and malnutrition develop over time, the deadline can be difficult to calculate without the records. Contact an attorney as soon as you learn of the injury.

What compensation can a family recover?

Depending on the case, compensation may cover medical and wound-care expenses, pain and suffering, loss of enjoyment of life, and, in death cases, funeral expenses and the family’s losses. Indiana caps total recovery in medical malpractice cases, and your attorney can explain how the cap applies to your situation.

What should I do if I find a bedsore or other injury on my loved one?

Ask the facility for the care plan and assessment records, ask when the injury was first documented and when the physician and family were notified, and take dated photographs with consent. Make sure the resident is seen by a physician. Then contact an attorney before the facility’s records are altered or lost.

Does Powless Law charge for a consultation?

No. Consultations are free and there is no obligation. If we take your case, we work on a contingency fee, meaning there is no attorney fee unless we recover compensation.

Talk to an Indiana Nursing Home Injury Attorney

If your loved one has developed a bedsore or been injured in a nursing home, assisted living facility or hospital, we can help you understand whether it should have been prevented and what your options are. Consultations are free and confidential, and there is no obligation.

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This page is for general information and is not legal or medical advice. Every case is different, and past results do not guarantee a similar outcome. Contacting Powless Law does not create an attorney-client relationship until a written agreement is signed.

If you have questions or suspect possible  neglect, contact us for a free consultation.  Just call us at 887.769.5377, submit a request for a free consultation by clicking here.  Our firm handles pressure sore cases across Indiana.