Ulcer Wounds in Nursing Homes

Ulcers are all too prevalent in nursing home residents and are a sign of nursing home abuse. The most common types of ulcer wounds that occur in nursing homes include pressure ulcers, or bedsores, diabetic ulcers (which are also a form of a pressure ulcer), and arterial, or ischemic, ulcers. Regardless of the type, ulcer wounds are a sign of neglect or an indication that the nursing home is understaffed and should be reported immediately. It is important to know the differences between types of ulcers, since knowing the type can help identify the cause of the ulcer and can lead to the appropriate course of treatment.

1. Pressure Ulcers – Pressure ulcers or bedsores result from prolonged exposure of the skin to pressure and/or shearing and friction. These localized injuries usually overlay a bony protrusion or occur in an area of the body that is not cushioned by fat. Pressure ulcers are categorized into 4 stages, or possibly even as “unstageable” if the wound is of indeterminate depth and severity.

2. Diabetic Ulcers or Neuropathic or Neurotrophic Ulcers – Diabetic ulcers commonly occur on the feet of diabetic individuals, in particular on the heel, and are full-thickness penetrations of the dermis. These types of ulcers occur as a result of prolonged exposure to pressure, and because the affected tissue is insensate, meaning it is unable to sense or detect pain. Since there is no feeling in the lower extremities, there is no pain associated with diabetic ulcers. The wound has a punched-out appearance, but overall diabetic ulcers can vary in how they look. This is because the extent of the wound depends on the blood flow to the affected area. The skin surrounding a diabetic ulcer often appears calloused.

3. Arterial Ulcers and Ischemic Ulcers – These ulcers form when there is the insufficient blood supply to the capillaries of an area of skin and the tissue dies because it is deprived of oxygen and nutrients. As a result, these types of ulcers have a punched-out appearance and will either have a slough in the wound bed, making the wound appear black, brown, gray, green, or yellow, or there will be a bright red, granulated-looking tissue in the wound bed. The edges or borders of arterial ulcers are smooth, but the whole area surrounding the wound may appear red and irritated. This type of ulceration is often the result of arterial occlusion and can cause claudication (pain caused by too little blood flow to an affected area) or gangrene (death of body tissue due to lack of blood).

One of the shared commonalities among all types of ulcers is that the best way to manage them is through preventative care. Once the ulcer has formed, regardless of its type, the ulcer will take a long time to heal, and pharmaceuticals offer little if any aid in treatment.

If your loved one has sustained an ulcer while residing in a nursing home facility, please contact The Rooth Law Firm today online or at 877-356-3007.

Photo Credit: pedrosimoes7 via Compfight cc


Holloway Jr., G., Arterial Ulcers: Assessment and Diagnosis, Ostomy. Wound Management, 1996 April, 42(3):46-8, 50-1