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I just went and visited my mom and dad at the NH. I'm so upset about how things have been with my dad the last few weeks. First I realized how much weight he was losing. He was not eating because he could not feed himself. I got that taken care of and he is receiving pureed food and is being fed, I knew he had a bed sore. He has had them for years. They changed his mattress on Sunday to an air mattress. Today I saw the sore and it is about 4 inches in diameter. I freaked out. They told me that it just all of a sudden came up. That it was small and then just all of a sudden got big. My question is if this is possible. They said at end of life sometimes the skin will do that. I just don't know what to do. I can't be at the NH all the time, but it feels like I need to be for proper care.

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Usually the damage from pressure sores starts deep and is much more extensive than it may seem so I can see how once the skin breaks open it would become enormous quickly. The thing is they should have been watching for any sign of redness and never have allowed it to get that far, at least that is my humble opinion.
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srgdean, my father developed bed sores all of the sudden and he was on an air mattress. My caregiver alerted me to this. The one on his back was just developing and was simply red. The one on his heel was severe. The nurse told us to clean the wound with a saline solution and apply a patch that had honey in it. We also wrapped the heel in cushioned boots. Unfortunately my father passed away after developing other issues but the bed sores developed first. These sores can crop up suddenly so make sure that he not is sleeping in the same spot.
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The redness is a pressure point and when seen is a sign to do something right away. When my Dad entered rehab he had pressure points on his heels and it was noted on his admission work up. My Mom made a comment that when she put Dads diabetic socks on she broke thru a blister. She told the aide. They bandaged it. 4 days after my Dad was admitted, my RN daughter visited. Looked at the broken blisters and found there was black tissue. She immediately went to the DON that my Dad be put on an air mattress, which should have been done at the time he was admitted.

I would talk to the DON. If you don't get anywhere, call the Dr. who is taking care of Dad. If nowhere there, call APS. Dad needs wound care done by a nurse trained in wound care. They are hard to heal if where there isn't much tissue. But doesn't mean they do what they should.
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My mom fell, was hospitalized and then went to rehab in a facility. There she developed a stage 4 wound near the tailbone area that was only told to me when she was rushed to hospital with a bad UTI. I was shocked. I did not send her back to that failure of a facility. I have been told though that these develop very fast and the skin is the first thing to go in a decline. I ended up taking care of my mom at my home while she was on hospice. Because of the location of the wound and her fecal incontinence I had to make a barrier with gauze several times a day to keep the wound clean. I used colloidal silver spray in the wound, and found that eating protein helped shrink the wound. Peanut butter on toast for protein. You have to be careful with protein with the kidneys though. I did get the wound to shrink by half it's size, but in the weeks before she died nothing seemed to help and it went back to where it was. I would recommend some protein, and of course keeping the patient off of the effected area with air mattress and turning.
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Yes, sores can develop very quickly. Skin breaks down with age and provides an increasingly weak barrier to infection.
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Yes, they can pop up all of a sudden.

Try Colloidal Silver Gel - it was the only solution to curing my DH's pressure sore.
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Yes they can happen quickly. They can also heal quickly, but not always for everyone. There are so many factors that effect wounds: off-setting the pressure regularly, the weight of the patient, nutritional status, other medical conditions, integrity of the skin etc. I’ve seen some stubborn wounds that won’t go away even with a
skilled wound nurse seeing the patient every day, and a wound doctor seeing the patient weekly.
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srgdean - my dad sounded just like your dad.  He was in a NH too.    Losing weight, couldn't feed himself, put on pureed food.  He also had some sores that we knew about that all of a sudden got really bad.  Unfortunately, at the end of life, the skin starts to break down.  My dad passed away shortly after the bed sores started to get worse. It was heartbreaking to see this.  This was my recent experience.  I'm still not over it.  Prayers to you.
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LRMom2 Jan 2019
Prayers are coming to you. I have been there.
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The rapid development of a pressure ulcer is not really as rapid- rather too often not noticed in the early stages. The lack of nutrients, position changes and constant pressure contribute to pressure ulcer formation. The ulcers can often develop under the skin surface before they become apparent. The SNF should be on the look at for pressure ulcers as it is required and take action for prevention in patients who are demonstrating risk factors. Redness on the skin surface should not go unnoticed- and be tracked and measured before the skin breaks down. Early actions such as use of a alternating pressure mattress, frequent position changes, protein and vitamin supplements should be instituted.
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I agree with cwillie
Pressure sores can develop very quickly in geriatric skin. They develop from the bottom layer of skin up and show up first as a reddened area. They seem to get worse rapidly because the area under the red spot is already injured. The mostly likely first spots are where the skin is thin and located over a boney prominence. The staff should have been watching it more closely. Sometimes even the best of care does not prevent them The patient is just too fragile.If the pressure sore occurs first on the tailbone area, it is a sign that death is close
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That seems like a red flag to me that you had to address the eating issue with the staff before something was done. They assign a staff member to feed him one on one.
They just now changed his matress and hes had bed sores for years? They should be on top of that. Bed sores are a big deal. Where is their specialist for that? They usually have a bed sore nurse that takes care of that. It is a big deal.

My dad got a huge bed sore. Unfortunately right before he died, I saw 2 nursing staff go to turn him. They were not doing it correctly. They turn residents every 2 hrs. They never turned my dad completely on his side. Just his upper body somewhat. I bet that contributed to his sore. He never had the pressure taken off of his bottom. He was in the dying stages so I was too distraught to get into that then.

I would be real worried with his care that ypu have to address these issues before anything is done. If you can go to the care plan meetings that would help. Tell them what you have had to do. The sqeeky wheel does get the attention.
These are not small issues.
Id also want to talk to their bed sore specialist. What is being done?
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Years ago a dear friend of mine found bed sores on her Mom while in nursing home. She immediately brought her home to care for her. A nurse friend gave her a remedy to heal her sores! Mix mercurochrome and milk of magnesium,(to a nice pink color) dap on with cotton ball. She said the sores we're healed in less than a week!
Please pass this on to everyone you can.
Hopefully this will work for your loved one.
Post and let everyone know.
Thanks
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It’s too sad for me to read all the other responses but wanted to share my experience. My Mom developed huge pressure ulcers quite suddenly shortly before death. She was receiving wonderful care and it was no one’s fault. Seems there was a new one everyday. Her skin was just breaking down and she had no reserves. She couldn’t consume the protein she needed for healing, not even protein shakes. Wound care nurses lovingly dressed her wounds at least daily but this was part of her natural end stage decline. They became painful to her and I demanded that hospice start giving her morphine regularly. My neighbor, on the other hand, had a bedsore the size of a tennis ball and wonderful hospice nurses healed it. She’s doing well over 6 years later. Prayers for you and your parents.
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If your dad is at the end of his life, you might want to consider hospice services for him. Your account reminded me of my mom. She was in a nursing home and developed aspiration pneumonia. After a week in the hospital, she was able to return to the NH, however, I had to request that they help her eat as she was so weak. Doesn't that seem like something obvious? I also noticed they were failing miserably in keeping mom's hair washed. My observation was that she needed more care than a nursing home expects to provide each patient. That's when I called hospice. Yes. You can received hospice services in a nursing home. So, her care was supplemented by hospice. The CNA came in 5 days a week at lunchtime. That way, I knew mom would get assistance with eating and that there would be a conscientious CNA not associated with the nursing home inspecting and caring for mom's skin, nails, and hair......and the nursing home knew this too. Needless-to-say, mom's hair and nails in her bedridden state were much cleaner and her skin well cared for. Hospice also provided a weekly visit by their nurse as well, and mom's hospice nurse ordered her an air mattress preemptively. Hospice was a big step because it does mean letting go of one way of helping your loved one and accepting a different way and it isn't for everyone, but I learned that mom's care improved dramatically, that her CNA was very kind, and that the quality of mom's life was significantly better in her last months of her almost 90 year journey in this life.
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In our experience they come on very fast. First sign is a red area & the skin can be broken open as soon as later the same day. Preventing is mainly done by keeping him off the spot as much as possible. We have a "purple" cushion, some home-made foam cushions with the coccyx area cut out, a custom wheelchair with pressure sore preventive cushioning, an egg crate mattress and we even had an alternating pressure air mattress last year when he was on hospice but none of that prevented his getting sores. We haven't had one open up in quite a while now--just red marks periodically, but once there's a red spot you have to jump on it right away. Apparently everybody has their "pet" remedy for healing. The hospice nurses had patches which were treated with some healing stuff and we were supposed to leave them on for several days, but that was a joke--they started to come off within a day and it was very painful for him when we had to pull them off because of all the hair they were stuck to...and I don't recall that they had much effect on healing the sores. We've done well with Silvadene ointment and amorphous hydrogel after they've broken open, but the key is to get him off the spot the minute you see it. I'm told by our caregivers that it's just going to happen, you can't really prevent it completely just be vigilant and catch it right away when it starts.
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Lizhappens Jan 2019
What you say is very true. The red spot and you have to jump on it and stay on it. Somebody else mentioned that you have to care for it every toileting and it’s true well at least with a bowel movement. They are difficult to prevent but getting them off the spot is key. When one of my clients had one I would change the pillows underneath her bottom On a very regular basis. And the constant tending to it and the complete lying on her side and propping her up with pillows. Fortunately or unfortunately she had Parkinson’s so it’s very hard for her to move that probably helped us take care of her.
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If you don't have big bucks care is poor for Seniors. Bed sores need to be tended to and to me that is neglect - For sores they need to put a patient in a bath with solution to help heal. You get sores for not being moved and in bed all the time. $ inches is one big sore . If you can get home care it is a lot better than sending your loved one to a careless low income home. My Mom is 94 and I pray she never has to go to a home ; she lives on Medicare and very little pension; not enough for a nice decent home !
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Yes they can prove progress very quickly if not cared for properly. If you’re very unhappy with them see what you can do about calling Social Services on them. Obudsmen or office on aging agencies. Be there every day right now to make sure the bedsores being addressed properly or they may let it slide some more. I’m so sorry you have to go through this it’d make me want to scream too.
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srgdean: You answered your own question as you said "He has had (bed sores) for years." Yes, I understand that you asked how it could get to that size suddenly. Two things I see is that the NH was failing at seeing that your dad was receiving proper nutrition AND YOU WERE THE ONE TO DISCOVER THAT. This happened to my mother 2 decades before her death, when she was in an NH for a broken femur. Her sister found her meal tray, clearly marked with my mom's name in the hallway. My aunt spoke up to the staff and was given an answer so appalling ~ "the food server can't read English." So no doubt your parents' NH also had waited too long to tell you about the pressure sore when it could or may have healed sooner. You could seek out the Ombudsman. Also remember that an elder's skin thins as they age, which contribute to the pressure sore.
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Bed sores can happen very quickly and have to be treated immediately, and dressings changed DAILY and *properly*. Everytime they stool they have to be changed as well. If barely opened this is stage 2. It can take weeks to heal up again and tissues are extremely thin. if this is not treated it will progress to further stages rapidly and will necessitate a wound care doctor and debridement. Some bedsores are so severe the surgeon may perform a colostomy (divert the colon and collect stool in a bag) to keep feces away from the wound. four inches is rather large and serious if the area is opened as it can get infected with fecal material.
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Srgdean; Hello ! It all depends on the situation if a patient is .......bedridden then bed soars are almost inevitable no matter how much you turn them ,no matter how much cream or what type of cream,if duoderm is used ....it doesnt matter because of the failure to thrive ...there is the cases that the bed soar can tunnel from the inside out ! You see the reason its called pressure soar is that the bone puts pressure on the skin from the inside while the chair puts pressure on the outside of the skin while cutting of the circulation to that spot after the blood flow stops to the skin it begins to die think of it like when you put a rubberband around your finger see how fast the bloodflow stops or maybe a tight bandaide ....there are different stages of bed soars the best way to stop them is prevention...like crossing the legs , sitting in 1 position to long I beleive 2hours is too long I think like maybe 1 hour they at least need to releive the pressure to revive the blood flow, some patients prefer 1 position no matter how often we turned them they ended up back in the favorite position the constant turning is the only way and sometimes their skin can tear so easy if you barely rub it their skin tears its like tissue paper there is no fatty tissue or collegen left under their skin makeing it VERY FRAIL A patient that is mobile gets bed soars its usually much easier to heal because the person can move on their own to releive the pressure but the patient with Alzheimers or dementia needs to be reminded to switch up their positions sometimes they just sit right back in the same spot no matter how hard you try to reposition sometimes its difficult ..This is a very difficult problem ...my heart goes out to you and your parents And your family I agree that you should go to your parents care meetings bug them until they are afraid to piss you off the more you bother them the better care they will give .staff is usually tight and underpaid overworked and not enough staff, find out whos your moms and dads favorite CNA or caregiver and drown them in compliments bring a box of candy or donuts to the staff all of this makes your parents known as the residents with the best family all of the staff will know them ...maybe they will get more attention ...Sorry to go on and on Prayers to you!!
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Here's is a OTC recipe for bed sores.
Combine 3 equal parts of hydrocortisone cream (1% or more) A&D ointment (or generic) and liquid anti-acid (like Maylox or a generic).
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