Bed Sores in Nursing Homes: Causes, Stages, Warning Signs & Your Legal Rights in New York

Key Takeaways

• About 11% of U.S. nursing home residents have a bed sore, and roughly 60,000 Americans die each year as a direct result of pressure ulcers (CDC; AHRQ).
• Bed sores can begin within 3 to 4 hours of unrelieved pressure and progress through four stages, with Stage 4 exposing muscle or bone.
• Federal law (42 CFR 483.25) and New York regulation (10 NYCRR 415.12) require nursing homes to prevent bed sores unless clinically unavoidable.
• New York Public Health Law § 2801-d lets residents and estates sue, with possible punitive damages and attorneys’ fees.
• Most New York nursing home neglect claims must be filed within three years; wrongful death claims within two years of death.
• Report suspected neglect to the NYSDOH Nursing Home Complaint Hotline: 1-888-201-4563.

What are Bed Sores?

A bed sore is damage to the skin and the tissue beneath it caused by pressure that is not relieved. The CDC’s National Center for Health Statistics notes that bed sores are also called pressure ulcers, pressure sores, or decubitus ulcers, and treats them as a key measure of nursing home care quality.
The clinical term today is pressure injury. In 2016 the National Pressure Injury Advisory Panel (NPIAP) revised its system to use “injury” instead of “ulcer,” because early-stage damage can exist while the skin is still intact. NPIAP defines a pressure injury as localized damage to skin and soft tissue, usually over a bony area or under a medical device, caused by intense or prolonged pressure, often combined with shear.

You will see all of these terms in medical records, state inspection reports, and court filings. They describe the same condition:

• Bed sore / pressure sore — the everyday terms families use.
• Pressure ulcer / decubitus ulcer — older clinical terms still common in charts and federal inspection reports.
• Pressure injury — the current NPIAP term, including deep tissue injuries under intact skin.
• Medical device–related pressure injury — damage caused by tubing, oxygen masks, braces, or catheters pressing on the skin.

How Common are Bed Sores in Nursing Homes?

Roughly one in ten nursing home residents has a bed sore at any given time. The most recent federal survey data put the figure at about 159,000 U.S. residents, or 11%.

The federal Office of Inspector General found that physician reviewers judged 59% of harm events in skilled nursing facilities, including pressure ulcers, to be clearly or likely preventable. The most common causes were substandard treatment, inadequate monitoring, and poor care planning.

These numbers may understate the problem. The CDC figure comes from the 2004 National Nursing Home Survey, the last national survey of its kind, and advocates have documented underreporting of pressure ulcers in nursing home quality data.

What causes bed sores?

Bed sores form when skin and soft tissue are squeezed between bone and a surface long enough to cut off blood flow. According to the Merck Manual, if that compression is not relieved, a pressure injury can develop in as little as 3 to 4 hours.

Three physical forces do the damage:

• Pressure — constant weight on one spot, such as lying on the back or sitting in a wheelchair without being shifted.
• Shear — skin stays put while the body slides, as when a resident slumps down in bed or is dragged instead of lifted.
• Friction — skin rubbing against sheets or clothing, which strips away the protective outer layer.

Who is Most at Risk?

Nursing home residents often carry several risk factors at once. The CDC/NCHS found higher rates among residents with recent weight loss, high immobility, and bowel or bladder incontinence. Other well-documented risk factors (StatPearls, NCBI; Merck Manual) include:

• Limited mobility from stroke, dementia, paralysis, hip fracture, or sedation
• Incontinence and prolonged moisture on the skin
• Malnutrition and dehydration
• Diabetes and poor circulation
• Reduced sensation, so the resident cannot feel discomfort and shift position
• Cognitive impairment that prevents a resident from asking for help

Where Bed Sores Form

They appear over bony areas that bear weight: the tailbone (sacrum and coccyx), hips, heels, ankles, shoulder blades, elbows, spine, and back of the head. In wheelchair users, the buttocks and the ischial bones (“sit bones”) are especially vulnerable.

Risk is Measurable

Nursing staff are trained to score each resident’s risk with standardized tools, most commonly the Braden Scale. It rates six factors: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. A lower score means higher risk. Because the risk can be measured, a facility that fails to assess it, or assesses it and does nothing, has a hard time claiming a sore was unforeseeable.

The Stages of Bed Sores

Sources: NPIAP Pressure Injury Stages (PDF); NPIAP Staging Poster (PDF); Edsberg et al., 2016 revision.

Two points matter for families reviewing records. First, sores are not “reverse staged”: a healing Stage 4 is charted as a healing Stage 4, not a Stage 2. Second, a wound that first appears in the chart as Stage 3, Stage 4, or unstageable suggests earlier stages were missed or never documented.

Warning Signs Families Should Watch For

The earliest signs are often visible during an ordinary visit, and residents with dementia may not be able to tell you something hurts. Watch for:

• A red, purple, or darkened patch on the tailbone, hips, or heels that stays discolored after pressure is removed
• Skin that feels warmer, cooler, firmer, or softer than the skin around it
• Blisters, open areas, or a dressing you were never told about
• Drainage, a foul odor, or stains on sheets and clothing
• Your loved one wincing or crying out when moved, or refusing to sit
• Finding them in the same position visit after visit, or sitting in a soiled brief
• Unexplained fever, confusion, or lethargy, which can signal infection
• Weight loss, uneaten meal trays, or water out of reach

On darker skin, early bed sores may not look red. NPIAP notes that color changes can appear differently in darkly pigmented skin, so changes in warmth, firmness, and pain deserve extra attention.

You have a right to ask. Federal rules require the facility to consult the resident’s representative about significant changes in condition, and you can ask to see the skin assessment and the care plan at any time.

Why Bed Sores can be Deadly

An advanced bed sore is an open wound that can carry bacteria into the bloodstream and bone. AHRQ estimates about 60,000 Americans die each year as a direct result of a pressure ulcer (AHRQ Toolkit).

The main complications are:

• Cellulitis — a spreading infection of the skin and soft tissue around the wound.
• Osteomyelitis — infection of the bone beneath the sore, most often the sacrum, hip, or heel. Visible or palpable bone at the base of a Stage 4 wound is a strong indicator (Kaka et al., Open Forum Infectious Diseases, 2019).
• Sepsis — the body’s life-threatening response to infection. The Sepsis Alliance lists local infection, cellulitis, and osteomyelitis from pressure ulcers as pathways to sepsis. One surgical series reported six-month mortality as high as 68% when severe pressure ulcers led to sepsis (World Journal of Surgery).
• Pain, surgery, and lost function — deep wounds may require repeated debridement, skin flap surgery, or amputation, and can take months to heal.

If a resident with a bed sore develops fever, chills, a racing heart, confusion, or new drowsiness, families should insist on immediate medical evaluation.

Are Bed Sores Preventable

Most are. Federal law treats a bed sore that develops in a nursing home as a failure of care unless the facility can prove it was clinically unavoidable.

The Federal Rule

Every nursing home that accepts Medicare or Medicaid must meet 42 CFR § 483.25(b)(1). It requires that a resident receives care, consistent with professional standards, to prevent pressure ulcers, and does not develop them unless their clinical condition shows they were unavoidable. A resident who already has a sore must receive treatment to promote healing, prevent infection, and prevent new sores.
State inspectors enforce this rule under F-Tag F686 in the CMS State Operations Manual, Appendix PP. Under that guidance, a sore counts as “unavoidable” only if the facility did all four of these things:

1. Evaluated the resident’s clinical condition and pressure ulcer risk factors
2. Defined and carried out interventions consistent with the resident’s needs and professional standards
3. Monitored and evaluated whether those interventions worked
4. Revised the approach when they did not

If any step is missing, the sore is considered avoidable. Advanced age and illness alone do not make a sore unavoidable (KevinMD, 2026).

What Proper Prevention Looks Like

The practices below reflect the AHRQ prevention toolkit, StatPearls, and American Family Physician guidance:

• A documented risk assessment (such as the Braden Scale) on admission and whenever the resident’s condition changes
• A written, individualized care plan based on that risk
• Regular repositioning of residents who cannot move themselves, commonly every two hours in bed
• Pressure-redistributing mattresses, cushions, and heel protectors
• Prompt incontinence care, gentle pH-balanced cleansers, and moisture barriers
• Nutrition and hydration assessment, with dietitian involvement for at-risk residents
• Routine head-to-toe skin checks, with any change reported to the nurse and physician
• Enough trained staff to actually carry out the plan on every shift

When a facility’s records show a high Braden risk score but no turning schedule, no specialty mattress, or weeks between skin checks, that gap is often the heart of a neglect case.

When is a Bed Sore Nursing Home Neglect Under New York Law?

In New York, a bed sore that develops or worsens in a nursing home can support a lawsuit when the facility failed to take reasonable steps to prevent or treat it. New York gives residents and their families several legal paths, and some are stronger than ordinary negligence claims.

New York’s Own Pressure Sore Rule is Stricter than the Federal One

State regulation 10 NYCRR § 415.12(c) requires that a resident who enters without pressure sores does not develop them unless their condition shows the sores were unavoidable despite every reasonable effort to prevent them. A resident who has sores must receive treatment to promote healing, prevent infection, and prevent new sores.

Public Health Law: A Resident’s Right to Sue

New York Public Health Law § 2801-d makes a nursing home liable for injuries caused by depriving a resident of any right or benefit created by contract, statute, or regulation, including the state and federal pressure sore rules above. Key features:

• Punitive damages are available when the deprivation was willful or in reckless disregard of the resident’s rights.
• Attorneys’ fees may be awarded to the resident by the court.
• Estates can sue — the resident’s legal representative or estate may bring the action. Hiller Comerford will work with you to get an estate set up if you need assistance in that regard.

The facility’s main defense is proving it exercised all care reasonably necessary to prevent and limit the deprivation and injury (2d Dept. decision citing § 2801-d). Because most facilities are understaffed and run like profit-centers rather than places of treatment, they often have difficulties meeting this burden.

Deadlines to File

Deadlines depend on the type of claim and when the neglect occurred. The table below reflects only the general rules. Often times there are exceptions which can extend the time to file. It is important to seek an individualized assessment from an attorney when determining if your case falls within the statute of limitations.

Wrongful death damages in New York remain limited to economic losses.
These deadlines are general guidance, not legal advice. The right deadline for your family depends on the facts, so speak with a lawyer as soon as you suspect neglect.

What to do if Your Loved One has a Bed Sore

Act quickly: get medical attention first, then preserve evidence and report. Bed sores can worsen in days, and records can change.

1. Get medical care now. Ask the charge nurse for an immediate wound assessment and physician notification. If there are signs of infection, request a hospital evaluation or call 911.
2. Document what you see. Photograph the wound (with permission), note the date and time, and keep a log of conversations, names, and what staff tell you.
3. Request the records. Under federal rules, a resident or authorized representative can inspect records within 24 hours (excluding weekends and holidays) and obtain copies with two working days’ notice (Elder Justice NY guide, citing 42 CFR 483.10(g)(2) and 10 NYCRR 415.3). Ask for skin and wound assessments, the care plan, Braden scores, turning and repositioning logs, nutrition notes, and physician orders.
4. Ask for a care plan meeting. Request a written plan that addresses repositioning, support surfaces, nutrition, and wound care.
5. Report it to the New York State Department of Health. File online through the Nursing Home Complaint Form or call the Nursing Home Complaint Hotline at 1-888-201-4563, available 24 hours a day (NYSDOH). DOH generally accepts complaints about occurrences within the past year (DOH-5022 form).
6. Contact the Long Term Care Ombudsman. The New York State Long Term Care Ombudsman Program provides free advocates for residents.
7. Check the facility’s inspection history. The NYSDOH Nursing Home Profiles site posts citations and plans of correction, including pressure sore deficiencies under 10 NYCRR 415.12(c).
8. Talk to a nursing home neglect lawyer before signing anything. Do not sign releases, arbitration agreements, or statements about the injury without legal advice.

If you believe your loved one is in immediate danger, call 911.

How Hiller Comerford helps families in Buffalo, Rochester, and Western New York

Hiller Comerford Injury & Disability Law represents nursing home residents and families across Western New York, including Buffalo, Rochester, and the surrounding communities of Erie, Niagara, Monroe, and Genesee counties.

In a bed sore case, our work typically includes:

• Obtaining and reviewing the complete nursing home and hospital chart, including wound, turning, and nutrition records
• Pulling state and federal inspection reports to identify patterns of pressure sore citations at the facility
• Working with independent wound care nurses and physicians to show when the sore began and how it was allowed to progress
• Evaluating claims under Public Health Law § 2801-d, negligence, and, when a death occurs, New York’s wrongful death statute
• Identifying every responsible party, including owners, operators, and management companies

With Hiller Comerford you also have our No Fee Guarantee. That means you will never owe us a fee unless we get a recovery in your case.

If your loved one developed a bed sore in a nursing home, contact us for a free, confidential case review. Time limits apply, and evidence is easier to preserve early.

Attorney Advertising. Prior results do not guarantee a similar outcome. This article is general information, not legal or medical advice.

Frequently Asked Questions About Nursing Home Bed Sores