Stages of Bedsores Explained—and When You Should Take Action

Bedsores are often talked about as a single injury. But, in reality, they tend to develop gradually, starting with small changes in the skin that can be easy to miss during day‑to‑day care. Over time, those changes can deepen into wounds that affect comfort, health, and quality of life.

For families, noticing when a sore first appears, how it changes, and how quickly care responds can help clarify whether a situation calls for closer attention or additional support. This guide explains the commonly recognized stages of bedsores, what each stage may look like, and how changes over time can help signal when it’s appropriate to take action.

How Bedsores Develop, Step By Step

Bedsores, also known as pressure injuries, develop when sustained pressure limits blood flow to the skin and underlying tissue. In many cases, this process unfolds gradually:

Stage 1: Early Skin Changes That Are Easy to Miss

The initial stages of a bedsore are typically a visible response to sustained pressure. The skin remains intact, but subtle changes begin to appear. An area may appear red or discolored, feel warmer than the surrounding skin, or be tender to the touch. Texture can change as well, with skin that feels firmer or softer than usual.

Because there is no open wound at this stage, these symptoms are easy to overlook or attribute to something that will “pass.” This can be especially true for individuals with darker skin tones, where color changes may be less apparent and texture or temperature differences become more important clues.

These early stages are also when prevention is most effective. Close monitoring, regular repositioning, and attentive skin care can often reverse early changes and reduce the risk of progression if pressure is relieved consistently.

Stage 2: Open Skin and Clear Signs of Breakdown

The next stage of bedsores involves partial loss of skin, like a blister, shallow open sore, or abrasion. The affected area is more vulnerable to infection because the skin has broken, which often causes noticeable discomfort.

At this stage, the injury reflects ongoing neglect rather than a one-time issue. Continued breakdown of the skin often indicates that early warning signs were not addressed, whether properly or not at all. 

Care at this stage typically requires medical evaluation, wound care, and closer monitoring. Treatment plans should be clearly communicated, reviewed, and adjusted to prevent further damage.

Stage 3: Deep Tissue Injury and Escalating Risk

Stage 3 bedsores extend into deeper layers of tissue beneath the skin, where the wound may appear crater-like, and healing becomes more complex and slower.

At this stage, the risk of infection increases significantly, and complications can affect overall health. Stage 3 injuries often indicate that pressure relief and early intervention were insufficient or delayed.

Care often becomes more involved at this stage, with focused wound treatment and close medical supervision. Healing can take time and may place added strain on a resident’s overall health.

Stage 4: Severe Wounds With Lasting Consequences

Stage 4 bedsores are the most severe. They involve extensive damage to skin, tissue, and sometimes muscle or bone, and carry a high risk of infection, often requiring hospitalization.

The injury doesn’t become this severe overnight. Stage 4 bedsores tell a story, one of prolonged pressure and missed opportunities for intervention. 

The effects can linger well beyond the wound itself, influencing mobility, comfort, and a person’s overall quality of life.

What Proper Nursing Home Care Should Look Like

Preventing bedsores depends on consistent, everyday care practices that reduce pressure, protect skin, and respond to early changes.

• Proper nursing home care for residents at risk of bedsores generally includes:
• Regular repositioning, based on a resident’s mobility and tolerance, to relieve pressure on vulnerable areas
• Routine skin assessments that look for early changes in color, temperature, or texture
• Clear care plans that account for medical conditions affecting circulation, nutrition, or healing
• Timely response to early signs, including adjustments to positioning, support surfaces, or treatment
• Adequate staffing and supervision to ensure care routines are carried out consistently

When these basic practices are followed and documented, early-stage pressure injuries can often be addressed before they become severe. When missing or inconsistent, bedsores are more likely to progress and cause loved ones to suffer unnecessarily.

What to Do If a Bedsore Is Getting Worse

When a bedsore continues to worsen, it deserves attention. Ongoing skin breakdown, increasing pain, or slow healing can signal that nursing home care is not meeting your loved one's needs.

At this point, families often begin looking beyond day-to-day explanations and toward accountability. This is also when speaking with a law firm experienced in nursing home neglect becomes part of protecting a loved one.

Morgan & Morgan was built to stand up for people when powerful institutions fall short. With more than 1,000 trial-ready attorneys and offices across the country, our team has the resources to investigate what happened, preserve critical records, and advocate for residents who were not given the care they deserved. 

If you suspect a nursing home’s negligence caused your loved one to suffer, take the first step toward holding them accountable with our free, no-risk case evaluation.

Frequently Asked Questions

1. What are the stages of bedsores?

Bedsores are commonly grouped into four stages: Stage 1 involves redness or discoloration of intact skin; Stage 2 includes open or blistered skin; Stage 3 extends into deeper tissue; and Stage 4 causes extensive damage that may reach muscle or bone.

2. How quickly can bedsores develop or worsen?

Bedsores can begin developing within days when pressure is not relieved, and they may worsen over weeks without proper care. The speed of progression often depends on mobility, health conditions, and how consistently preventative measures are followed.

3. Which stage of bedsore is the most serious?

Later stages, particularly Stages 3 and 4, carry the greatest risk because they involve deeper tissue damage and a higher chance of infection. These stages often require intensive medical treatment and careful oversight.

4. Can bedsores be prevented in nursing homes?

In many cases, yes. Regular repositioning, routine skin assessments, adequate nutrition, and timely response to early signs are standard practices intended to reduce the risk of pressure injuries.

5. When should families worry about nursing home neglect?

Concerns often arise when bedsores worsen, treatment is delayed, or explanations about care feel unclear or inconsistent. Patterns of missed care or lack of documentation may also raise questions.

6. What should I do if my loved one’s bedsore keeps getting worse?

If a bedsore continues to progress, it may help to document changes, request clear medical explanations, and seek outside guidance. Morgan & Morgan can help families understand whether the situation points to inadequate care.