Bedsore Treatment Costs in Nursing Homes [Do You Pay?]

Bedsores–also known as pressure sores or pressure ulcers–usually happen to people who are bed-bound or must use a wheelchair to get around. Putting pressure on one area for a long time, especially where a bone is close to the skin, can cause a sore that can easily become infected.

Pressure sores are often painful and can cause additional complications such as bone infections, joint infections, cellulitis, sepsis, and squamous cell carcinoma. In severe cases, pressure ulcers can lead to death.

WHO IS AT RISK FOR BEDSORES?

According to the Agency for Healthcare Research and Quality, about 60,000 people die due to complications from pressure ulcers each year. People who are at risk of developing bedsores are those who stay in one position for hours at a time.

Whether that person is in a wheelchair or bed-bound, if they do not shift positions often enough to relieve the pressure on parts of their skin, a pressure ulcer could develop. People who are most susceptible to pressure sores are those with traumatic brain injuries, neurological disorders, spinal cord injuries, in a coma, or who cannot easily change positions without assistance. People who suffer from vascular disease and diabetes are also particularly susceptible to bedsores.

People who use a wheelchair can also develop pressure ulcers on their shoulder blades, buttocks, the back of their arms, tailbone, and spine. People who must lie in bed often develop bedsores on their shoulder blades, hips, head, lower back, heels, behind the knees, ankles, and tailbone.

THE TRUE COST OF BEDSORES

Pressure ulcers in the United States cost over $26 billion per year to treat. Bedsores and pressure ulcers are the top forms of patient harm in care facilities. Worst of all, bedsores are completely preventable.

However, the true cost of bedsores is not the money that patients and insurance companies must pay for treatment—it’s the cost of the pain and suffering, scarring, and death that can result. If a person develops early-stage pressure ulcers, their stay in the hospital can increase by 10 days. If they have a stage III or IV pressure sore, they might have to stay in the hospital even longer. The direct costs of treatment and the cost of the hospital stay are astronomical, but the physical and emotional damage is off the scale, especially for a condition that medical professionals and caretakers can prevent.

HOW TO PREVENT PRESSURE ULCERS

Bedsores are completely preventable. They are a cost that patients and insurance companies do not have to incur. Some things a caregiver can do to prevent pressure ulcers include:

• Shift the patient’s weight every 15 minutes by repositioning the patient.
• For a person who cannot get out of bed, use pillows or cushions to turn the person every 15 minutes, so the pressure alternates from one side to the other.
• For someone in a wheelchair, use pillows or foam cushions to help prevent pressure sores.
• If the patient can move and is bed-bound, caregivers should instruct them to shift or lift themselves up every 15 minutes. If they are in a wheelchair and have sufficient upper body strength, caregivers should instruct them to use their arms to lift themselves off the wheelchair seat as often as possible, even if they use pillows or cushions.
• Hospitals can provide special air mattresses that doctors can program to turn a patient. If a nurse cannot turn the patient every 15 minutes, they should use a programmable air mattress—the cost is much less than the cost of treating a bedsore.
• Keep the patient’s skin clean and dry.
• Make sure the sheets are dry and try to minimize wrinkles as much as possible. When turning a loved one, be sure to straighten the bedsheets.

ADDITIONAL INJURIES CAUSED BY PRESSURE ULCERS

Bedsores can lead to additional injuries and harm. If medical professionals or caretakers are grossly negligent, they might not notice a pressure sore for days or even weeks. The longer a bedsore goes untreated, the more likely the patient is to develop serious complications, including infections. If caregivers do not notice the infection immediately, it can lead to gangrene and sometimes require amputation.

STAGES OF PRESSURE ULCERS

Bedsores can range in severity, and they begin at Stage I, where it affects only the top layer of skin. The pressure ulcer can progress to Stage II when the sore goes deeper into the first layer of skin. A Stage III pressure ulcer damages all of the layers of skin and the subcutaneous tissue. A Stage IV pressure ulcer damages the muscles, tendons, cartilage, and/or bones under the sore.

Two of the symptoms of a Stage III pressure ulcer include rolled wound edges and granulation tissue. There also may be tunneling, which makes the bedsore larger than it looks on the surface. Stage IV pressure ulcers cause deep holes in the skin, which can go down to the bone.

Should a bedsore become severe enough to be classified as a Stage III or Stage IV pressure ulcer, you or your loved one will need hospital care. You should also ask your attorney to investigate gross negligence by the caretaker and/or medical facility.

The healthcare cost to treat Stage III and Stage IV pressure ulcers is exponentially more than bedsores that affect the underlying layers of skin. They take much longer to heal and are more susceptible to infection and gangrene.

TREATING BEDSORES

If you or a loved one develop a bedsore, you will need a team of medical professionals to treat and manage it and any complications that arise. The team should include a primary care physician, a wound care nurse, a pain management nurse or doctor, a physical therapist to help with mobility, an occupational therapist for proper seating/bedding surfaces, a neurosurgeon if you have sensory issues, a dietician to create a diet that improves hydration and nutrition, and a social worker who can provide resources to help with long-term recovery.

Treating pressure ulcers might include prescription or over-the-counter pain medication, antibiotics to treat infection, surgery, and negative pressure therapy. Depending on the severity of the pain, your doctor might recommend prescription or over-the-counter pain medications. Additionally, doctors might administer antibiotics via oral or topical medications.

You shouldn’t have to bear the economic burden of treatment and other costs associated with your pressure ulcer injury, and you should contact an experienced attorney for help.

MEDICARE AND BEDSORES

In most cases, Medicare Part A covers pressure ulcers if you develop them in a Medicaid services facility, such as a hospital, inpatient rehabilitation facility, a skilled nursing facility, or a long-term care hospital. Medicaid should cover most of the costs, including drugs, general nursing, services, and supplies.

Medicare does have some restrictions, however. Your doctor must sign an order that states you need medical care for pressure ulcers for two nights, and the hospital must formally admit you. Your hospital must accept Medicare, and the Utilization Review Committee for the hospital must approve your admittance.

Medicare Part B could cover some of the cost of bedsores if you seek treatment in a doctor’s office. Generally, you are responsible for 20 percent of the total cost of treatment.

If you use home health care, Medicare Part A or B could cover some of the costs of treating bedsores. You must be under the supervision and care of a doctor, and the doctor must certify that you need intermittent skilled care or are homebound. Medicare might also cover bedsores if you meet the insurance company’s criteria for physical and/or occupational therapy.

CAN I SUE A CARE FACILITY IF I DEVELOP BEDSORES?

In short, yes, you can generally sue a medical facility if you or a loved one developed pressure ulcers or bedsores while in their care. Bedsores are a form of neglect. To prevent pressure ulcers, medical staff must move a person every 15 minutes if the person cannot move on their own.

Since pressure sores develop because you have too much pressure on one part of your body for an extended time, they are entirely preventable. When you develop bedsores in a hospital or any type of care facility and you have mobility and/or sensory issues, it is up to your caregivers, doctors, and nurses to move you to relieve the constant pressure on parts of your body.

Unfortunately, some facilities do not train their staff properly in pressure ulcer prevention or pressure ulcer care–or staff may simply ignore the facility’s health policy. A lawyer can hold the hospital or care facility responsible for their employees negligence or wrongdoing and help you get the justice and compensation you deserve.

RECOVERING DAMAGES BECAUSE OF BEDSORE INJURIES

Because pressure ulcers signal neglect, you may recover compensation for the poor care you or your loved one received. If you lost a loved one because of pressure sores, your loved one’s estate may be able to recover damages on behalf of the decedent’s heirs through a wrongful death claim. You could potentially recover two types of damages: compensatory damages and punitive damages. Compensatory damages can be broken into two subtypes: economic damages and non-economic damages.

ECONOMIC DAMAGES

Economic damages, often referred to as special damages, have a clear monetary value. A court orders a defendant to pay economic damages in an attempt to make the victim whole again. Types of economic damages include:

MEDICAL EXPENSES

Medical expenses might include surgery, hospitalization, supplies, prescriptions, installing hand controls in your vehicle, and installing wheelchair ramps, grab bars, and widening doors in the victim’s home. If the victim needs physical and/or occupational therapy, this can also be included.

WAGES

Sometimes, someone who is still working suffers from bedsores because of an accident or illness that causes the person to become bedridden. In this case, the victim may be able to recover lost wages and loss of future earning capacity if the bedsores cause them to continue to be out of work or make it impossible to return to their past profession.

END-OF-LIFE COSTS

Should you lose a loved one because of pressure ulcers, their estate may be able to recover funeral, burial, and/or cremation expenses. Additionally, the estate may be able to recover probate filing fees and certain other end-of-life expenses.

NON-ECONOMIC DAMAGES

Non-economic damages, often referred to as general damages, do not have a clear monetary value. Although money cannot make up for physical and emotional suffering, the court orders a defendant to pay non-economic damages as a way of attempting to make the victim whole again.

General damages can include compensation for:

• Pain and suffering, including emotional distress. If you lost a loved one because of complications from a pressure ulcer, you may also be able to recover compensation for emotional distress.
• Loss of quality of life if the victim must make major life changes, such as taking medications or using ambulatory aids for the rest of their life.
• Loss of companionship if the victim can no longer enjoy time, activities, and events with their family as a result of complications from the bedsores.
• Loss of consortium if the victim can no longer have a physical relationship with their spouse because of complications from the bedsores.
• Loss of use of a body part or bodily function because of the location of a pressure sore.
• Inconvenience if the victim must hire someone to perform the chores they would normally do, such as lawn maintenance, grocery shopping, house cleaning, and home repair and maintenance.
• Excessive scarring and/or disfigurement. Even minor bedsores can cause scars.
• Amputation of a limb because a bedsore developed gangrene or other complications that doctors cannot repair.

PUNITIVE DAMAGES

In certain cases, a victim might also be able to recover punitive damages. Since the court only orders punitive damages to punish the defendant, not to make the victim whole again, they must prove the defendant was grossly negligent. An attorney can help determine whether you or your loved one has a case that warrants filing for punitive damages.

Contact a nursing home pressure sore & bedsore attorney if you or a loved one develop pressure ulcers while under the care of medical professionals or in a care facility.

Nathan Hughey

Nathan Hughey, an attorney and fourth-generation South Carolinian, founded Hughey Law Firm in 2007. Before that, he spent five years defending nursing homes and insurance companies. Leveraging his experience, he now advocates for those injured or wronged by such entities, securing over $220 million in verdicts and settlements.