Bed Sore Prevention

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Bed and pressure sores are common in an assisted living facility (“ALF”). Pressure sores can become severe and can turn fatal. This article addresses the prevention of pressure sores in ALFs.

Pressure/Bed Sore

Pressure sores, commonly called bed sores, form when a resident is unable to freely move and is allowed to lay or sit for long periods of time. Sores develop because the blood flow to the affected area is impaired causing the skin to break down and die. Over time, a hole develops and progresses to the bone. Bacteria invades the hole and bone, and can invade the blood making the person very sick. In some cases, residents die because of infection.

A bed sore is not limited to the buttocks area. Sores are formed at any area, including the feet, where a particular part of the body is allowed to stay in a fixed position for a long time. 

Ulcers are graded on a scale ranging from Stage 1 to Stage 4. Stage 1 bedsores are usually mild and are often healed. Stage 2 sores are identified as a blister or shallow open sore. The sores are often red and may have pus or fluid present. Stage 3 sores are severe pressure sores and the wound has gone through the skin layers exposing fat. Stage 4 are the most severe and there is decaying tissue down to the muscles, ligaments, or even bone. In California, ALFs are allowed to house people with Stage 1 and 2 sores, and only if the resident receives medical care from a skilled professional.  The law prohibits an ALF from renting a room to person with severe pressure sores. 

A bed sore is often a sign that the ALF is not properly caring for the sore. 


Prevention starts with a proper assessment of the resident. Assessment is the primary way of developing an effective plan. Assessment begins when the senior is first admitted. The assessment is designed to gather information about the resident’s health condition.  One of the most important assessments is the person’s physical condition. A critical factor in the development of pressure sores is poor physical condition. A sedentary person who is in poor physical condition is more likely to develop pressure sores.

An initial assessment is followed by the development of a written care plan, which is supposed to be done when the resident is first admitted. A proper care plan is necessary to prevent sores. A resident, and his or her family, has the absolute right to participate in the development of a plan that meets the needs of the senior. An effective plan does the following:

  • Addresses the specific needs of the resident, including the ability to move
  • Includes specific goals to care for those needs
  • Assigns tasks to staff members to meet those goals
  • Is updated as the resident’s condition changes

Every care plan must be followed. Plans can only be followed if there are enough caregivers. Many residents are dependent on caregivers for all of their movement needs. When a facility is understaffed, a resident is neglected. He or she is not moved as often as needed to prevent sores.

Also, caregivers must be trained to implement the plan of care. Plans provide specific directions to all the caregivers so that continuity of care is provided. Caregivers must know how to carry out the plan, including how to care for bedridden residents who have sores. 


Regrettably, many ALFs are neglectful. They fail to assess the resident at admission or at regular intervals. They accept residents they shouldn’t accept, including those with severe pressure sores. Also, they are understaffed and/or their staff is untrained so that care plans are not followed. As a result, residents are allowed to remain inactive and pressure sores occur.


If your loved one has been injured or killed in a nursing home or ALF, you have rights. Schedule a free consultation. No pressure, only advice.