Bed Sores in a Pennsylvania Nursing Home: What a Stage Three Actually Proves
Pressure ulcers are preventable, they take time to form, and the chart records the hours that did not happen.
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A pressure sore that reaches stage three or four is largely preventable and takes sustained pressure over time to form. That makes the wound itself evidence: it records hours during which the resident was not repositioned. The repositioning and wound care records are usually what decide the case.
The staging matters
| Stage | What it means |
|---|---|
| Stage 1 | Intact skin with non blanchable redness. A warning sign |
| Stage 2 | Partial thickness loss, a shallow open ulcer or blister |
| Stage 3 | Full thickness loss with fat visible. Weeks of unrelieved pressure |
| Stage 4 | Exposed bone, tendon or muscle. Often infection and sometimes osteomyelitis |
| Unstageable | Depth obscured by dead tissue. Frequently stage 3 or 4 underneath |
A resident does not arrive at stage 4 quickly. The wound is a timeline.
The records that decide it
- Repositioning records. Care plans typically require turning at set intervals. Whether it happened, and whether the entries look genuine or completed in identical handwriting at shift end, is central.
- Braden scale assessments, which score pressure ulcer risk. A high risk score with no corresponding intervention is the clearest evidence there is.
- Skin assessments on admission and thereafter. A sore that appeared after admission is the facility’s.
- Wound care notes, measurements and photographs.
- Nutrition and hydration records, since poor nutrition both causes and prevents healing.
- Staffing rosters for the relevant period.
“Unavoidable” is a real category and a common overstatement
Some pressure ulcers genuinely are unavoidable, in residents at end of life or with specific medical conditions, and the regulations recognize this. Facilities reach for that explanation frequently, including where the risk assessment showed high risk and nothing in the record shows the interventions that follow from it.
The test is not whether a sore developed. It is whether the facility assessed the risk, planned for it, delivered the plan and revised it when the wound appeared.
What to do now
- Photograph the wound, dated, and keep photographing weekly.
- Request the complete chart in writing, naming the repositioning records, Braden assessments, skin assessments and wound care notes.
- Ask for the care plan and any revisions.
- Report to the Pennsylvania Department of Health.
- Ask for a wound care specialist referral in writing.
The attorneys who handle these cases
Every one of these bar numbers is searchable on the Pennsylvania Disciplinary Board register. The person who takes your call is the person at your hearing.
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Kenneth R. Schuster
Founding Member
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Justin M. Bernstein
Associate
Read Justin’s background -
Christopher D. Gasda
Associate
Read Christopher’s background -
Anthony S. Pinnie
Of Counsel
Read Anthony’s background -
Joseph J. Jachetti
Associate
Read Joseph’s background -
Andrew Valentin
Associate
Read Andrew’s background
Questions people ask us about this
Are bed sores always negligence?
No. Some pressure ulcers are genuinely unavoidable in residents at end of life or with particular medical conditions, and the regulations recognize that. But a stage three or four wound takes sustained pressure over time, and the question is whether the facility assessed the risk, planned for it and actually delivered the plan.
What records prove a pressure sore case?
Repositioning records, Braden scale risk assessments, admission and ongoing skin assessments, wound care notes with measurements, nutrition and hydration records, and staffing rosters. A high Braden risk score with no corresponding intervention in the record is about as clear as this evidence gets.
The sore appeared after admission. Does that matter?
Considerably. Skin assessments performed on admission establish the baseline. A pressure ulcer that developed during the stay is the facility's responsibility to explain, and the explanation has to be supported by what the record shows they actually did.
The facility says it was unavoidable.
That is a recognized category and it is also the standard explanation. It is tested against the record: was the risk assessed, was a plan made, was the plan carried out, and was it revised when the wound appeared. Facilities frequently assert unavoidability where the chart shows no interventions at all.
What should I do first?
Photograph the wound with dates and keep doing so weekly, request the complete chart in writing naming the specific records, ask for the care plan and any revisions, and report it to the Pennsylvania Department of Health. Records get thinner the longer you wait to ask.
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