Question: My mother has been a patient at a nearby nursing home for nearly two years. We visit her several times each week, and thought she was getting proper care in her private room until she was suddenly hospitalized for what the hospital physicians described as Class V decubitus ulcers on her backside and Class III ulcers on both her heels.

We had thought Mom was doing well at 80 given the stroke that made her totally dependent a couple of years ago. But now, in addition to the bedsores, the doctors say she has contracted something called mersa, and is slipping quickly. The doctors tell us that she may die. We have not been able to get the nursing home physician on the phone, but the nursing home director tells us this can be anticipated with total care patients. In addition to being concerned, we are very angry. Mom has been spending an average more than $7,000.00 per month for her care. Is this the norm?

Answer. Your mother’s condition is neither the norm nor acceptable. Generally referred to as “pressure sores” or "bed sores", decubitus ulcers are classified in stages that run from a reddening of the skin that goes away within hours after pressure is removed from the area (Class I) to very a deep hole in the skin that can go through the bone and into one’s organs (Class V).

While commonly caused by pressure, the skin repeatedly rubbing against a bed sheet or brace can cause a bedsore. Because skin close to the bone is more likely to be susceptible to pressure because a patient’s weight is more concentrated there, these sores are more likely to appear on the hips, elbows, heels, spine, and tailbone. In fact, the skin and underlying tissue decays due to the lack of circulation.

Prevention of pressure sores is a basic principal taught to nurses and certified nursing assistants: Turn the patient ever two hours to allow tissue to endure pressure without being damage; use padding when necessary to prevent scrapes; and keep the patient clean, well-fed, and hydrated. Obviously, these principals were not followed in the facility where your mother was supposed to have been cared for, probably due to shortages of staff that, in turn, are due to budgetary problems. Or, your mother could have not been properly fed or could have refused food and water.

The second part of your question can be even more complicated. Staph bacteria infections have become more difficult to treat over the past half century because they are more resistant to antibiotics. These more resistant bacteria are called MRSA, an acronym for methicillin--resistant Staphylococcus aureus.

While staph bacteria can cause skin, bone, and bloodstream infections that are life-threatening, MRSA is more common in elderly folks in health care facilities who have open wounds, are tube-fed, or are catheterized.

Direct physical contact with a wound or touching objects use by an infected person is the way in which MRSA generally is spread. Use of good hygiene and avoiding contact with those who are infected is essential. Because MRSA are not killed by powerful antibiotics, they multiply, and may require higher doses and alternative treatments.

Taking the NextStep: We find it inconceivable that your mother was allowed to develop these problems with no one at the facility noticing either the wounds themselves or the odor. This is another reason we continually suggest the use of professional geriatric care managers to assess and follow residents in all facilities. Families need independent eyes to protect their loved ones, and we think care managers would have been able to nip this problem in the bud. Go to caremanager.org for more information. To view jpgs of ulcers check our helpful links above.