Preventing Heel Ulcers in the Non-Ambulatory Nursing Home Patient Population

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Non-ambulatory patients residing in nursing homes are at risk of developing pressure sores on their heel and ankle areas as a result of unrelieved pressure and friction.

Once these sores develop, it can be difficult to achieve healing and avoid potentially painful and fatal complications including sepsis (blood infection), osteomyelitis (bone infection), amputation, surgical wound debridement and even ultimately death.

It is therefore critical that nursing homes develop and implement wound prevention care plans and perform risk assessments at the time of admission.  In addition to daily monitoring and regular skin assessments, the nursing home staff must ensure that pressure and friction in the heel and ankle areas are reduced and relieved.  This may be accomplished as simply as through the use of pillows to offload the heels.  The nursing home staff must, however, be on the lookout for patient movement that may displace the pillow.  Other preventative measures include heel protectors, boots and pressure relieving mattresses.  Heel protectors may help to provide continuous pressure relief, and also act to minimize friction and shear on feet, ankles and heels. 

Families must be advocates for their loved ones and they should be on alert for these issues and regularly visit the nursing home resident and inspect their skin.  Families should also discuss preventative heel ulcer care with the nursing home staff.  As the saying goes, "the squeaky wheel gets the grease."

In our practice, we have seen the tragic results of the failure of nursing homes to implement effective and proper heel pressure ulcer prevention protocols.  In one situation, a vulnerable, mentally challenged individual was admitted to the nursing home with no skin breakdown for short-term rehabilitation services.  He had previously resided in a group home environment and was able to participate in an adult day program.  The plan was for him to return to his previous living arrangements and level of functioning upon his discharge from the nursing home.    During his stay at the nursing home, he did not receive visits from family members.  He was not provided with heel ulcer preventative care and, unfortunately, developed a heel wound that became infected and necrotic, and progressed to stage 4.  He went on to develop severe osteomyelitis of his heel.  In an effort to prevent the potentially fatal spread of osteomyelitis, doctors performed an above-the-knee amputation of his leg.  Sadly, this mentally challenged individual became bed-ridden, requiring permanent nursing home care and never returned to his previous level of functioning.

The good news is that heel pressure ulcers are entirely avoidable so long as proper care and preventative measures are instituted and implemented by the nursing home.  Under new Medicare guidelines, hospitals are no longer even reimbursed for additional care resulting from pressure ulcers as the government has determined that development of bed sores at a hospital is a so-called "never event."

Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

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This page contains a single entry by David Feldstein published on September 24, 2009 8:35 AM.

Investigation of Potential Nursing Home Neglect Lawsuits Involving Residents Who Continue to Reside at the Target Nursing Home Facility -- Challenging Situation With No Easy Answers was the previous entry in this blog.

Nursing Home Injuries Caused By Fellow Residents is the next entry in this blog.

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