The answer is no, in short. When a facility does not turn a bedbound resident as required, pressure ulcers are considered preventable injuries. The negligent nursing home and its commercial liability insurer are legally responsible for paying the entire cost of treatment, not the resident or family.
Knowing who pays for bed sore treatment in nursing home neglect cases can help families avoid paying bills that should never be their responsibility. Specialized elder abuse attorneys bring civil lawsuits to hold corporate operators responsible for past and future medical care, relocation costs, and significant pain and suffering damages. Here’s the financial responsibility breakdown.
Cost of Advanced Bedsore Treatment
Bedsores are very progressive. Starting at Stage 1, skin redness is minor but can rapidly progress to open wounds that expose muscle, tendon, and bone in Stages 3 and 4. Understanding the financial weight of these injuries helps explain why holding the facility accountable matters.
- Individual costs of treatment: Medical costs for one stage 4 pressure ulcer can be between $30,000 and $150,000. And if the wound becomes infected and sepsis or a bone infection develops, the bill for intensive care can run above $250,000.
- What the treatment involves: These costs include emergency hospitalizations, specialized air-flow mattresses, negative-pressure wound vacuums, surgical removal of dead tissue, IV antibiotics, and reconstructive skin grafts.
Medicare, Medicaid Won’t Cover These Injuries
It’s commonly assumed that a government healthcare program will cover the cost of treating a bed sore that developed inside a facility. Federal regulators, however, disagree.
The Agency for Healthcare Research and Quality classifies Stage 3 and Stage 4 pressure ulcers acquired in a healthcare setting as never events, serious, preventable conditions that should not occur with appropriate care. Medicare and Medicaid won’t pay nursing homes higher reimbursements to treat bed sores that occurred on their watch. Federal billing rules are violated if a facility attempts to bill the family directly or uses the resident’s Medicaid allotment for wound care.
The Lawsuit That Forces the Facility to Pay
Families work with elder abuse attorneys to file civil lawsuits against the facility and its corporate ownership to recover these costs and to obtain proper care. Many nursing homes are owned by private equity groups or corporate chains, and the lawsuits go after those parent entities directly.
Evidence of Understaffing Systemic
The legal discovery process allows attorneys to subpoena internal payroll records and staff-to-patient scheduling logs. They take these records and match them with the resident's medical charts in an effort to prove that the facility intentionally understaffed its shifts, leaving no one to turn the resident every two hours as is required by law.
Unlocking Improved Financial Remedies
In states with strong elder protection statutes, such as California’s Elder Abuse and Dependent Adult Civil Protection Act, proving corporate recklessness by clear and convincing evidence opens the door to serious financial penalties. This allows the family to pursue punitive damages and requires the nursing home to pay 100% of private attorney fees.
Handling Medical Liens and Insurance Settlements
If the insurance carrier offers a settlement, your attorney must be cautious with the way the funds are allocated. This is where medical liens become an important consideration.
- The insurance settlement: Most of these claims are resolved by the facility’s commercial liability or medical malpractice insurance, which typically has limits of $1 million to $5 million or more.
- Removing liens: If the bed sore was treated outside and was initially paid for by a private insurer, Medicare, or Medicaid, those entities will place a legal lien on your settlement. Your law firm’s lien resolution team negotiates these debts, often reducing them from 30% to 50%, to maximize the net amount going into a secure trust for the resident’s ongoing care.
Conclusion
When a bed sore develops due to a failure to provide basic care, the nursing home and its insurance company are financially responsible. These are preventable injuries, and federal programs will not subsidize them. Families should never pay for costs that belong to the negligent operator. An elder abuse attorney can hold abusers accountable, recoup treatment costs, and obtain the resources your loved one needs to continue proper care.
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