Questions to Ask Nursing Homes About Bedsore Prevention

Before Your Visit: Do Your Research

Before visiting any facility, take time to research its track record. This preparation helps you ask informed questions and identify potential concerns.

Check Inspection Reports

Medicare's Care Compare website provides inspection reports, quality ratings, and staffing information for every Medicare-certified nursing home. Look for:

• Overall star rating (1-5 stars)
• Health inspection rating and recent citations
• Staffing rating and hours of care per resident per day
• Quality measure rating
• Any history of abuse, neglect, or infection-related citations

Facilities with histories of pressure ulcer citations or staffing deficiencies may warrant extra scrutiny.

Contact the Long-Term Care Ombudsman

Your state's Long-Term Care Ombudsman program advocates for nursing home residents. They can provide information about complaint histories and help you understand what to look for during facility visits.

Questions About Staffing

Adequate staffing is the single most important factor in preventing bedsores. Understaffed facilities simply cannot provide the frequent attention residents need to stay safe.

Essential Staffing Questions

• What is your nurse-to-resident ratio? Lower ratios mean more individual attention. Ask about both day and night shifts.
• What is your certified nursing assistant (CNA) to resident ratio? CNAs provide most hands-on care, including repositioning. Ratios of 8-10 residents per CNA or less are generally better.
• How do staffing levels change on weekends and holidays?Many facilities reduce staff on weekends, when family visits are less frequent.
• What is your staff turnover rate? High turnover can indicate management problems and leads to inconsistent care.
• Do you use agency or temporary staff? While sometimes necessary, heavy reliance on temporary staff can reduce care quality.
• Is there always a registered nurse (RN) on site? RNs are essential for wound assessment and treatment decisions.

Questions About Prevention Protocols

Proper bedsore prevention requires systematic protocols, not just good intentions. Ask specific questions about how the facility prevents pressure injuries.

Risk Assessment

• How do you assess residents for pressure ulcer risk?Look for mention of validated tools like the Braden Scale or Norton Scale.
• When are risk assessments performed? They should be done at admission, after any significant change in condition, and regularly thereafter.
• What happens when a resident is identified as high-risk? The facility should have a clear care plan for at-risk residents.

Repositioning

• How often are immobile residents repositioned? The standard is every two hours during the day and nighttime repositioning schedules.
• How is repositioning documented? Ask to see sample documentation. Facilities should have a systematic tracking system.
• What positioning devices do you use? Look for mention of wedges, pillows, and specialty positioning equipment.

Support Surfaces

• What type of mattresses do you use? Pressure-relieving or pressure-redistributing mattresses reduce bedsore risk significantly.
• Do you have specialty beds for high-risk residents?Alternating pressure mattresses and low-air-loss beds may be needed for the highest-risk residents.
• What cushions do you use for residents who sit in wheelchairs? Wheelchair-bound residents need pressure-relieving cushions too.

Skin Care and Nutrition

• How often do you perform skin assessments? Regular skin checks catch problems early.
• How do you manage incontinence? Moisture from incontinence is a major bedsore risk factor.
• Is there a registered dietitian on staff? Proper nutrition is essential for skin health and healing.
• How do you ensure residents stay hydrated? Dehydration increases bedsore risk.

Questions About Monitoring and Response

Even with good prevention protocols, some residents may develop early pressure injuries. What matters then is how quickly and effectively the facility responds.

Key Monitoring Questions

• What is your policy when a resident develops a pressure injury? There should be immediate assessment, family notification, and treatment initiation.
• How do you notify families when skin issues arise? You should be informed promptly of any concerns.
• Is there wound care specialist access? Complex wounds may need specialized treatment.
• How do you track wound healing progress? Wounds should be regularly measured and photographed to monitor improvement.

Questions About Inspections and Compliance

Understanding how the facility performs on inspections can reveal a lot about care quality.

Inspection-Related Questions

• May I see your most recent state inspection report?Facilities are required to make these available.
• Have you had any citations related to pressure ulcers or skin care? Ask about citations and how they were addressed.
• What is your overall CMS star rating? This should match what you found in your online research.
• Have you had any substantiated abuse or neglect complaints? Ask about outcomes and corrective actions.

Questions About Family Communication

Good communication between the facility and family members is essential for ensuring quality care.

Communication Questions

• Who is my primary contact for questions about my loved one's care?
• How will you communicate changes in my loved one's condition?
• How can I access my loved one's medical records and care plan?
• Are care conferences held regularly? Can family attend?
• What is your visitation policy? Facilities that discourage frequent or unannounced visits may be trying to hide problems.

What to Observe During Your Visit

While asking questions, pay attention to what you see and hear. Your observations can be as valuable as the answers you receive.

Observe the Environment

• Is the facility clean and free of strong odors?
• Are residents dressed appropriately and appearing well-groomed?
• Do residents seem engaged, or are many left alone in hallways?
• How quickly do staff respond to call buttons?
• Are staff members friendly and patient with residents?
• Do you see adequate staff presence in resident areas?

Red Flags to Watch For

• Staff who seem rushed, frustrated, or dismissive
• Residents left sitting in wheelchairs for long periods
• Evidence of poor hygiene or soiled clothing
• Evasive or defensive answers to your questions
• Reluctance to show you inspection reports or policies
• Pressure to make a quick decision without adequate information

For more information about warning signs, see our guide on warning signs of nursing home neglect.

Printable Checklist

Use this checklist when evaluating nursing homes:

If Your Loved One Develops Bedsores

If your loved one is already in a nursing home and develops bedsores, this may indicate the facility is not following proper prevention protocols. Bedsores are largely preventable with appropriate care.

If this happens:

• Document the injury with photos and notes (see our documentation guide)
• Request to see the care plan and repositioning logs
• Ask for an explanation of how the bedsore developed
• Report concerns to the state health department and ombudsman (see our reporting guide)
• Consider consulting with an attorney about your legal options

To learn more about what constitutes proper prevention standards, see our article on how healthcare facilities should prevent bedsores.

Additional Resources

For more information and guidance, explore these related resources:

• Warning Signs of Nursing Home Neglect – Physical, behavioral, and environmental red flags
• Bedsore Prevention Standards – National guidelines facilities should follow
• Understanding Pressure Ulcer Stages – How bedsores are classified by severity
• Nursing Home Bedsore Lawyer – Legal options when neglect causes harm