Lessons for Risk Management and Resident Care
From Monica Chadwick, presented at the ASHRM Conference
Pressure ulcers—also called bedsores—are more than just a clinical challenge in skilled nursing and senior living facilities. They represent one of the top ten drivers of loss and litigation claims across the industry. Every year, facilities pay out significant sums related to pressure ulcer claims, and the presence of even one can compound the complexity of defending care provided.
This year at the ASHRM (American Society for Health Care Risk Management) Conference, we are proud to present a session alongside the renowned wound care expert Dr. Caroline Fife. Together, we will highlight the realities of pressure ulcer development, how facilities can strengthen prevention strategies, and how to effectively manage expectations with families and legal teams when wounds occur.
For skilled nursing facilities, understanding the nuances of wound care isn’t optional—it’s essential to resident safety, reputation, and financial stability.
Why Pressure Ulcers Matter
Pressure ulcers are often misunderstood as preventable in every case, but the truth is more complex. These injuries can evolve even under optimal care, leaving families distressed and facilities vulnerable to claims.
From a risk management perspective, pressure ulcers present two main challenges:
-
They look bad. Photos of advanced wounds are distressing even to experienced clinicians. For families unfamiliar with the realities of geriatric care, seeing an ulcer appear on a loved one can feel like an undeniable failure of care.
-
They are difficult to defend. Even when facilities followed care plans diligently, explaining to a jury or regulator why a wound appeared requires clinical knowledge that many outside healthcare don’t have. Without context, these cases are easily misinterpreted.
The truth is that pressure ulcers are circulatory and perfusion injuries. They often begin beneath the skin, much like an apple that rots from the inside out. The surface may look healthy, but damage to muscle and tissue below eventually reveals itself. By the time the injury is visible, the process is already underway, and it cannot be reversed overnight.
The Importance of Family Communication
One of the most important steps skilled nursing teams can take is setting realistic expectations with families. Families need to understand:
-
Even with proactive care, wounds can sometimes develop.
-
Once an ulcer begins, it typically worsens before it improves.
-
These injuries are often medically unpreventable and linked to circulation issues rather than neglect.
When facilities fail to communicate this clearly, the result is confusion, frustration, and in many cases, claims. Transparent communication builds trust, helping families feel like partners in care rather than outsiders questioning every outcome.
Prevention: A Team Approach
Although not every wound can be prevented, facilities can dramatically reduce risk through a coordinated, facility-wide approach:
-
Early Assessment: Every resident should be assessed upon admission for their risk of skin breakdown, with ongoing reassessments as conditions change.
-
Nutrition and Hydration: Nutritionists and dietary staff play a critical role. Adequate protein, vitamins, and fluid intake strengthen skin integrity and healing. Elderly residents often resist eating or drinking enough, so gentle encouragement from staff is vital.
-
Repositioning: Regular repositioning prevents prolonged pressure on vulnerable areas. Aides and nurses must integrate repositioning into daily routines, even during routine visits to a room.
-
Staff Awareness: From CNAs to RNs to dietary staff, everyone must be trained to recognize risks and act quickly. Wound prevention is not the responsibility of one department—it requires the whole facility.
This proactive culture not only protects residents but also demonstrates to families and regulators that the facility takes risk management seriously.
Why Wounds Are Hard to Defend
In litigation, pressure ulcers are uniquely challenging. Many jurors—and even some healthcare professionals—struggle to look at graphic wound photos without assuming negligence. They don’t understand the physiological realities:
-
Pressure ulcers are primarily perfusion injuries, not simply “bedsores” caused by neglect.
-
Muscle damage can occur beneath intact skin, making the injury invisible until it surfaces.
-
Once present, wounds follow a predictable course, often worsening before healing begins.
Our ASHRM session will explore these dynamics in depth, equipping risk managers and clinical leaders with the language and evidence needed to explain these realities in a legal setting.
Learning from the Experts: Why Attend Our Session
I am honored to co-present with Dr. Caroline Fife, one of the nation’s foremost wound care specialists. Dr. Fife has been an invaluable expert witness in litigation and a transformative educator in wound care.
I first encountered Dr. Fife nearly a decade ago, while working as a legal nurse consultant defending wound care cases. At the time, I thought I had a strong understanding of wound care. Hearing her speak changed everything. She provided clinical and physiological insights that reframed my perspective and gave me new tools to educate juries, defend care plans, and support facilities.
Every time I hear Dr. Fife present, I learn something new—and I guarantee attendees will as well. Her ability to translate complex medical processes into clear, compelling explanations is unmatched.
At last year’s ASHRM conference, our presentation was among the best-received sessions of the event. Attendees shared that it was the most valuable and eye-opening talk they had attended. This year, we’re back with an even stronger session and a prime time slot.
Key Takeaways for Skilled Nursing Facilities
By attending our session and integrating best practices into your facility, you will:
-
Gain a clearer understanding of the physiology of pressure ulcers.
-
Learn strategies for communicating with families to set realistic expectations and reduce conflict.
-
Understand why documentation and proactive care planning are essential to defend against claims.
-
Discover practical ways to engage your entire staff—from dietary to nursing—in wound prevention.
-
Leave with actionable insights that strengthen both resident outcomes and your facility’s risk profile.
The Bigger Picture: Beyond Compliance
Wound care isn’t just about avoiding claims. It’s about dignity, quality of life, and trust. Skilled nursing facilities that embrace proactive wound management demonstrate to families, regulators, and insurers that they are committed to excellence in care.
At CareAgents and across the senior living industry, we believe in supporting facilities not just through insurance policies, but through knowledge, training, and partnerships that reduce risk before it ever reaches a courtroom.
Join Us at ASHRM
If you are attending this year’s ASHRM Conference, make sure to join our session on wound care with Dr. Caroline Fife. Whether you are a risk manager, facility administrator, or clinical leader, you will leave with new insights to protect your residents, your staff, and your facility.
Because at the end of the day, pressure ulcers are more than a clinical issue—they are a window into how we manage risk, build trust with families, and defend the integrity of the care we provide.
