Stage 4 Bedsore in a Nursing Home

Stage 4 bedsores (also called pressure ulcers or decubitus ulcers) occur when a person remains in one position for an extended period of time. Bedsores of this severity are preventable, and they’re often an indication of nursing home neglect. You may be owed compensation if you or a loved one developed a stage 4 bedsore while in an assisted living facility. See if we can help you take legal action and get justice.

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About Stage 4 Bedsores

A stage 4 bedsore is an area of damaged skin and tissue — often as wide as the palm of a hand — caused by prolonged pressure. It is the most serious type of bedsore.

Stage 4 bedsores can look like craters that have penetrated through multiple layers of dead tissue. In many cases, muscle, ligaments, or bone are exposed.

If left unaddressed, a stage 4 bedsore can lead to life-threatening complications, such as sepsis (blood infection) or cellulitis (skin infection).

Nursing home residents who are immobile, bedridden, or have severe medical issues that require round-the-clock care are at the greatest risk of developing a stage 4 bedsore.

If these residents are not positioned correctly, moved frequently, or given proper care, they may develop bedsores and other health problems.

In many cases, a stage 4 bedsore indicates nursing home abuse or neglect.

If you or a loved one developed a late-stage bedsore in a nursing home, may be able to help. Get a free case review now.

Pressure Ulcer Stages

If left untreated, bedsores go through different stages as they progress and worsen.

There are four pressure ulcer stages, with a stage 1 bedsore being the least serious type of this health condition, and a stage 4 bedsore being the most serious and dangerous.

The stages of bedsores are outlined below:

  • Stage 1 bedsore: A pressure sore can develop after just 2 hours of immobility. It appears as a red spot on the skin, is warm to the touch, and may be painful.
  • Stage 2 bedsore: At this stage, the skin breaks at the weakened area where the pressure persists, leaving a blister.
  • Stage 3 bedsore: The skin around the open sore begins to decay, releasing a foul odor. It may also begin showing signs of infection, like pus or drainage.
  • Stage 4 bedsore: The wound becomes wide, penetrating deep into the skin and potentially leading to severe health complications.

How common are bedsores? About 11% of nursing home residents or elderly long-term care patients experience pressure ulcers at any stage, with 2% of that population developing a stage 4 pressure ulcer.

When early-stage bedsores are treated quickly, they can prevent stage 3 and 4 bedsores from forming. For this reason, a stage 3 or 4 pressure ulcer is often a sign of nursing home abuse.

What Causes Bedsores?

Bedsores often begin with localized pressure on the skin and underlying tissues.

This can result from:

  • Constant pressure: Sitting or lying in the same position for long periods of time restricts blood flow to the area, causing a bedsore. This is especially common in specific parts of the body, like the tailbone, shoulder blades, and other bony areas.
  • Friction: If skin repeatedly rubs against bedding, clothing, or other surfaces, it can weaken its protective layers and increase the risk of injury.
  • Moisture: Excessive moisture from perspiration, urinary or fecal incontinence, or wound drainage can soften the skin, making it more susceptible to damage.
  • Shear: When the skin is pulled in one direction while underlying tissues are pulled in the opposite direction, the force can damage blood vessels and make the skin more vulnerable to bedsore formation.

Signs and Symptoms of a Stage 4 Bedsore

Signs of a stage 4 bedsore can be shocking, as this serious injury may result in deeper tissue and even bone being exposed.

Signs of a stage 4 pressure ulcer include:

  • A deep tissue injury that looks like a crater
  • Dead or blackened tissue, indicating tissue decay
  • Difficulty healing a wound, with no signs of improvement even after treatment
  • Exposed muscle or bone
  • Fever, chills, or confusion
  • Infection signaled by pus, discharge, or a foul odor
  • Lack of sensation due to nerve damage

If you’ve spotted signs of a stage 4 bedsore in someone you love, may be able to help you take legal action against those responsible for the injury. Chat with one of our case managers right now.

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Risk Factors for a Stage 4 Pressure Ulcer

When an early-stage bedsore is ignored by nursing home staff members, it can quickly turn into a stage 4 bedsore, causing already frail residents needless pain and suffering.

While nursing home neglect is one of the main causes of abuse in a care facility, there are additional, factors that may make it more likely for a patient to develop a stage 4 bedsore.

Risk factors for a stage 4 pressure ulcer include:

  • Infection: Infections can cause additional tissue damage, especially in untreated or poorly managed bedsores.
  • Limited mobility: Individuals with limited mobility (who cannot shift their weight or change positions) are more likely to develop bedsores since they cannot relieve pressure from the affected area on their own.
  • Neglect: Lack of proper care, including turning and repositioning, skincare, and use of specialized support surfaces, can contribute to the deterioration of a bedsore.
  • Poor nutrition: Inadequate nutrition or dehydration can impair the body’s ability to heal and repair damaged tissue.
  • Underlying health conditions: People with chronic illnesses, compromised immune systems, or vascular diseases are more susceptible to the rapid progression of pressure sores. For example, circulatory problems, such as poor blood flow or diabetes, reduce the body’s ability to deliver essential nutrients and oxygen to tissues, which weakens those areas.
  • Understaffing: When there aren’t enough health care professionals to regularly reposition and attend to the needs of residents, it can lead to insufficient attention and care for nursing home residents. This causes the risk of developing stage 4 bedsores to rise significantly.
Patients With Alzheimer’s Disease, Dementia, or Memory Issues

Conditions like Alzheimer’s disease and dementia can affect a patient’s ability to recognize discomfort or pain. They may also be unaware of or forget to change positions on their own, increasing their likelihood of developing pressure ulcers.

The bottom line is that nursing homes are responsible for ensuring that their residents receive proper care. When they fail to do so, they can and should be held responsible.

Nursing home abuse lawyers advocate for abuse victims and their families. In many cases, they are able to take legal action on behalf of affected families and make negligent nursing homes pay for the harm that they’ve caused.

Long-Term Effects of Stage 4 Bedsores

If left undiagnosed, untreated, or inadequately managed, a stage 4 pressure ulcer can lead to chronic, severe, and potentially life-threatening complications.


An untreated stage 4 pressure ulcer greatly increases a person’s risk of infection, which can rapidly spread to different areas of the body.

These infections include:

  • Cellulitis
  • Osteomyelitis (bone infection)
  • Soft tissue infections

Hardened Calcium Buildup

At times, the body may respond to severe tissue damage by depositing calcium in the affected area. This can lead to the formation of calcified tissue masses, further complicating wound management and reducing the chance of successful healing.

Organ Damage

A stage 4 bedsore can extend deep into the body, potentially affecting underlying organs or tissues. This damage can impair a person’s function and lead to long-term health issues, like organ failure.


Untreated infections that enter through a stage 4 pressure injury can lead to sepsis. Sepsis is the body’s aggressive response to a chronic infection.

This can dangerously lower a patient’s blood pressure and cause blood clotting, resulting in reduced blood supply throughout the body. As a result, oxygen and nutrients can’t be delivered to the tissues and organs, causing organs like the kidneys to shut down.


In the worst-case scenario, an untreated stage 4 ulcer can lead to death. The combination of severe infection, organ failure, and other complications can be fatal, especially for elderly patients.

Find out if you may be able to secure compensation for a stage 4 bedsore — contact at (888) 726-9160 now.

Treating a Stage 4 Ulcer

There are several different options for stage 4 bedsore treatment.

Treatment options include:

  • Infection control: Antibiotics may be prescribed if there is evidence of a bacterial infection. Regular wound cleaning and proper hygiene are essential to prevent further complications.
  • Pressure redistribution: To relieve pressure on the affected area, patients may require specialized pressure-reducing mattresses or cushions. Caregivers or nursing home staff must reposition patients frequently to prevent continued wound pressure.
  • Wound debridement: Removing dead or infected tissue creates a clean wound bed, which may improve the healing process.
  • Wound dressings: Specialized wound dressings, such as foams or ointments, help to maintain a moist environment, manage drainage, and protect the open wound from infection. These dressings facilitate the healing process and should be changed frequently.
  • Reconstructive surgery: In severe cases, this procedure can be used to clean, fill, and close the wound using a tissue transfer or healthy skin graft to promote healing.

These treatments are often painful, and they can be expensive.

In many cases, a family can file a nursing home abuse lawsuit against a negligent nursing home and pursue compensation to help pay for these treatments.

Get Legal Help for a Stage 4 Bedsore

Nursing home residents and their families expect that facility staff will provide basic care. Sadly, that’s not always the case.

Stage 4 bedsores are almost always preventable, which means that patients with these injuries have been forced to endure needless pain and suffering.

The nursing home abuse law firms that works with are fierce advocates of those who are most vulnerable. They have recovered more than $256 million for families affected by nursing home abuse and neglect.

Get a free case right now and see if they can help you with a stage 4 bedsore case.

Stage 4 Decubitus Ulcer FAQs

How serious is a stage 4 pressure sore?

A stage 4 pressure injury is the most serious type of bedsore. It can lead to life-threatening infections, organ damage, sepsis, and more.

About 60,000 patients die from bedsores every year, according to the Agency for Healthcare Research and Quality.

Can a stage 4 bedsore heal?

Yes, a stage 4 bedsore can heal with proper treatment like wound care, specialized dressings, nutrition support, and, in some cases, surgery.

However, if the damage is too extensive, the pressure sore may never heal completely.

How long does it take a stage 4 pressure ulcer to form?

The time it takes for a stage 4 pressure ulcer to form varies and depends on individual factors. However, it can develop quickly if risk factors like immobility or medical neglect are present.

Recognizing and treating pressure sores when they are in an early stage is key to preventing them from progressing to stage 4.

What is the life expectancy of a stage 4 bedsore patient?

Stage 4 bedsore life expectancy depends on a patient’s overall health, wound severity, wound complications (like infection), and other factors.

Many patients are able to live for months or even years with a stage 4 pressure ulcer.

Are stage 4 bedsores always a sign of neglect or abuse?

Stage 4 bedsores are often considered a nursing home abuse injury because they frequently result from neglect or inadequate care.

In most cases, a late-stage bedsore can be prevented if nursing home staff provides proper care.

How much are stage 4 bedsore lawsuit settlement amounts?

Stage 4 pressure ulcer settlements vary depending on the cost of medical treatment, the severity of the injury, and other factors.

It’s not unusual for a stage 4 bedsore settlement payout — or other nursing home abuse settlements — to hit $1 million or more when the patient endures significant pain and suffering or when the injury leads to wrongful death.

A nursing home lawyer can give you a better idea about the value of your case.

Can you sue a nursing home for a stage 4 bedsore?

Yes, you may be able to sue a nursing home if you or someone you love has developed a stage 4 bedsore. These advanced-stage pressure ulcers are often an indicator of nursing home neglect or elder abuse.

Nursing homes have a legal duty to provide a safe and healthy environment for residents. When they fail to do so, they may be forced to pay for the harm they’ve caused.

A nursing home abuse lawyer can determine if you’re eligible to file a claim.

Get a free case review and see if a top nursing home abuse attorney can help you.

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ReferencesView References
  1. Agency for Healthcare Research and Quality. “Preventing Pressure Ulcers in Hospitals.” Retrieved from: Accessed on October 25, 2023.
  2. Indian Journal of Plastic Surgery. “​​Pressure ulcers: Current understanding and newer modalities of treatment.” Retrieved from: Accessed on September 11, 2023.
  3. John Hopkins Medicine. “Bedsores.” Retrieved from: Accessed on September 11, 2023.
  4. Mayo Clinic. “Bedsores (pressure ulcers). Retrieved from: Accessed on September 11, 2023.
  5. Mayo Clinic. “Bedsores (pressure ulcers) Diagnosis.” Retrieved from: Accessed on September 11, 2023.
  6. National Library of Medicine: Medline Plus. “How to care for pressure sores.” Retrieved from: Accessed on September 11, 2023.
  7. National Kidney Foundation. “Acute Kidney Injury (AKI).” Retrieved from: Accessed on September 11, 2023.
  8. Centers for Disease Control and Prevention. “What is Sepsis?” Retrieved from: Accessed on September 11, 2023.
  9. Centers for Disease Control and Prevention. “ Pressure Ulcers Among Nursing Home Residents: United States, 2004.” Retrieved from:,most%2520severe%2520(stage%25204). Accessed on September 11, 2023.
  10. University of California San Francisco Department of Surgery. “Debridement.” Retrieved from: Accessed on February 21, 2024.

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