Navigating the Nursing Home Crisis: Staff Shortages vs Lack of Patient Advocacy in Pressure Injury Care

Pressure injuries in nursing homes remain a critical concern, often signaling deeper issues within care systems. A recent case I reviewed highlights this problem starkly: a patient was re-admitted with a documented stage 2 pressure injury on the coccyx. Over the next two months, there was no further documentation on wound progress, dressing changes, or interventions. Tragically, the patient developed osteomyelitis, sepsis, and ultimately died. This case raises a difficult question: is this outcome the result of staff shortages or a lack of empathy and patient advocacy from the nursing home staff?

Understanding the root causes behind such failures is essential to improving care quality and preventing avoidable suffering.

Pressure injury dressing on coccyx in nursing home bed

Pressure injury dressing on coccyx in nursing home bed

The Scope of Pressure Injuries in Nursing Homes

Pressure injuries, also known as bedsores or pressure ulcers, develop when prolonged pressure cuts off circulation to the skin and underlying tissues. Nursing home residents are particularly vulnerable due to limited mobility, chronic illnesses, and age-related skin changes.

• According to the Agency for Healthcare Research and Quality, pressure injuries affect approximately 2.5 million people annually in the U.S., with nursing home residents representing a significant portion.

• Studies show that up to 25% of nursing home residents develop pressure injuries during their stay.

• These wounds can progress rapidly without proper care, leading to infections like osteomyelitis and sepsis.

  
  

The case example reflects a common pattern: initial injury identification followed by inadequate follow-up care.

Staff Shortages and Their Impact on Care Quality

One of the most cited reasons for poor pressure injury management in nursing homes is chronic staff shortages. Many facilities operate with fewer nurses and aides than needed, which affects:

• Frequency of patient assessments: Limited staff means less time for thorough skin checks.

• Timely dressing changes: Wound care requires regular attention, which may be delayed.

• Documentation: Overburdened staff may neglect detailed record-keeping.

• Patient repositioning: Turning immobile patients every two hours is critical but labor-intensive.

  
  

Research from the National Institute on Aging links higher nurse-to-patient ratios with better pressure injury outcomes. When staffing falls short, care quality suffers.

In the reviewed case, the absence of wound progress notes or intervention records over two months suggests that staff may have lacked the time or resources to provide adequate care.

The Role of Empathy and Patient Advocacy

While staffing levels are crucial, they do not fully explain neglect in pressure injury care. Empathy and patient advocacy are equally important components.

• Empathy drives caregivers to notice subtle changes and prioritize patient comfort.

• Advocacy ensures that patients’ needs are communicated to the care team and family.

• Without these, wounds may be ignored or minimized, even when staff are present.

  
  

In some nursing homes, a culture focused on task completion rather than patient-centered care can erode empathy. Staff may become desensitized to suffering or feel powerless to effect change.

The case example raises the question: did the staff fail to advocate for the patient’s wound care needs, or were they simply overwhelmed? The lack of intervention documentation hints at a possible gap in advocacy.

Balancing Staffing and Culture for Better Outcomes

Improving pressure injury care requires addressing both staffing shortages and the culture of care.

Practical Steps Nursing Homes Can Take:

• Increase staffing levels: Hiring more nurses and aides allows for timely wound care and monitoring.

• Provide wound care training: Educate staff on pressure injury prevention and treatment protocols.

• Foster a culture of empathy: Encourage staff to see patients as individuals with dignity and needs.

• Implement patient advocacy programs: Assign advocates to monitor vulnerable residents and communicate concerns.

• Use technology: Electronic health records with alerts can prompt timely dressing changes and assessments.

• Engage families: Family members can help advocate for care and notice changes staff might miss.

  
  

These steps create an environment where pressure injuries are less likely to be neglected.

The Cost of Inaction

Ignoring pressure injury care has severe consequences:

• Patient suffering: Pain, infections, and reduced quality of life.

• Increased hospitalizations: Treating complications like sepsis requires costly hospital stays.

• Legal and reputational risks: Nursing homes may face lawsuits and loss of trust.

• Higher healthcare costs: Pressure injuries add billions annually to healthcare expenses.

  
  

The tragic outcome in the reviewed case underscores the human and financial toll of inadequate care.

What Families and Advocates Can Do

Families play a vital role in preventing pressure injury neglect:

• Ask questions: Inquire about wound care plans and progress during visits.

• Request documentation: Review care records for wound assessments and dressing changes.

• Report concerns: Notify nursing home management or regulatory bodies if care seems insufficient.

• Encourage mobility: Help residents reposition or engage in physical therapy when possible.

• Advocate for staffing: Support policies that improve nurse-to-patient ratios.

  
  

Active family involvement can prompt better care and accountability.

Pressure injuries in nursing homes reveal complex challenges. Staff shortages limit the time and resources needed for proper wound care, while a lack of empathy and patient advocacy can allow wounds to worsen unnoticed. The case of a patient developing fatal complications after a stage 2 pressure injury highlights the urgent need to address both issues.