A pressure injury has appeared in the long-term care home: what it means and what to demand

The moment you see it

You help your mother shift in her chair and you see a wound: on the sacrum, the heel, the hip. Redness that does not blanch under a finger, or skin already broken.

You ask, and you are told it happens, that it is her age, that her skin is thin.

Older skin is fragile. But a pressure injury is not inevitable: it is the result of sustained pressure in one place, and preventing it is expected care, not a favour.

What should have happened

• A skin and risk assessment on admission, using a recognised scale, repeated regularly and whenever her condition changes — after a hospital stay, weight loss, a period of immobility.
• Scheduled repositioning, documented, rather than decided by how busy the shift is.
• Pressure-redistribution surfaces: mattress or overlay, a proper cushion in the chair, heel protection.
• Nutrition and hydration, which determine whether skin holds and whether a wound heals. Unaddressed weight loss is a pressure injury risk factor.

When an injury appears anyway, the question is not who is to blame but: which of those four was not done, and since when? The chart can answer that.

The number you can look up

Canada reports long-term care quality indicators publicly, and one of them is the percentage of residents whose pressure ulcer worsened. In several provinces it is published home by home.

So the conversation does not have to rest on impressions:

"What is this home's rate for worsened pressure ulcers, and how does it compare with the provincial average?"

A home that knows its number and can explain its wound care program is working on it. A home that changes the subject has answered you.

The four records to request in writing

1. The skin and risk assessments: the one done on admission and the most recent.
2. The repositioning record for the last fifteen days.
3. The wound care plan: who assessed it, what stage, what dressing, how often, and who reassesses.
4. Weight and intake records for the last three months.

Send them in one email to the director of care and the attending physician, with a response date. As substitute decision-maker you are entitled to be involved in care planning — this is exactly what that means in practice.

What to ask for immediately

• A wound care specialist assessment — most regions have a wound care nurse or team that can be brought in. A wound that has not improved in three weeks needs another set of eyes.
• Dated photographs at each reassessment, in the chart. It is the best tracking tool and it concentrates attention.
• Pain treated. Pressure injuries hurt, including in someone who can no longer say so. Ask for an appropriate pain assessment.
• The equipment, in writing: which surface, since when, who ordered it.
• A care conference, with the plan written down and a review date.

Where to escalate

• The director of care and administrator, in writing, with the four requests and a date.
• The provincial reporting line for long-term care. A serious facility-acquired pressure injury is exactly the kind of concern that triggers inspection rather than negotiation. Report dated patterns — several wounds on one unit says something about night staffing.
• The provincial ombudsman, or a patient ombudsman where one exists, when the process itself has failed.
• An independent medical opinion from outside the home before any serious claim. Without it, everything stays a disagreement between versions.

Before you choose a home

If you are still looking, ask on the tour: "How many residents currently have a pressure injury, and who does the skin assessment on admission?" The reaction tells you more than the brochure.

The practical point

A pressure injury is not a consequence of age: it is pressure that lasted. Look up the home's reported rate, request the four records in writing, insist on a wound specialist and dated photographs, get the pain treated — and use the provincial reporting line if the documentation is not there.

If you conclude this home is not the right one, Curalune Care Help gives you the starting point: 3 to 5 suitable homes matched to the real situation within 24 working hours, with contact details, links and a ready-to-send message to all of them at once. CA$99, one-off. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here

Standards for skin assessment, repositioning and wound care, documentation requirements, published quality indicators, inspection processes and complaint routes are set province by province and are revised regularly; each home also has its own policies. Free help is available from the care coordinator for your region, provincial seniors advocacy services and legal clinics, and an independent medical opinion is worth obtaining before any formal claim. This article is general information and is not legal or medical advice. Curalune does not allocate beds and does not guarantee availability.