What is a bedsore and how are they prevented?

Episode 70
Categories: Bedsores, Neglect & Abuse

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This is the Nursing Home Abuse Podcast. This show examines the latest legal topics and news facing families whose loved ones have been injured in a nursing home. It is hosted by lawyers Rob Schenk and Will Smith of Schenk Law LLC, a personal injury law firm based in Atlanta, Georgia. Welcome to the show.

Schenk: Hello out there and welcome to the Nursing Home Abuse Podcast. My name is Rob Schenk.

Smith: And I’m Will Smith.

Schenk: And we are trial attorneys focusing in the areas of nursing home abuse and

neglect in the state of Georgia. Happy Memorial Day everybody.

Smith: Happy Memorial Day.

Schenk: Will, as a Marine, what is the difference between Veteran’s Day and Memorial


Smith:   Veteran’s Day is when we honor anyone who has served and then Memorial Day

is when we remember those who have died in service to their country.

Schenk: That’s right. I think that’s a difference that most people don’t realize.

Smith: Right, you wouldn’t tell someone, “Happy Memorial Day” thanking them for

their service because they’re alive.

Schenk: Right.

Smith: You’re talking to them.

Schenk: Correct.

Smith: Yeah.

Schenk: Of lesser importance, with the exception of my stomach, what is June 1st?

Smith: June 1st

Schenk: Which is Friday.

Smith: June is a very special month because it is my birthday and it is also the birthday

month of my brother’s first child, Emma. She hasn’t come just yet, but she’s due.

Schenk: As we record this…

Smith: As we record this, but she is due some point in June. We’re hoping that she can

stay inside until June 12th.

Schenk: Memorial Day–important. The birth of your niece, not quite as important as I

June 1st, as I was mentioning Friday, which is National Donut Day. National Donut Day.

Smith: What’s June 6th?

Schenk: Okay, June 6th is– Oh, you got me on that one.

Smith: You know, it’s close to June 1st because they’re both D-Days.

Schenk: Oh, June 6th is the– it will be the 70th anniversary…

Smith: Invasion of Normandy.

Schenk: of the invasion of Normandy– of The Allied Invasion of Normandy.  What was that movie? It wasn’t D-Day it was Dunkirk.

Smith: Yeah, Dunkirk. That was different.

Schenk: And then, Darkest Hour also has a little bit to do with that.

Smith: Yeah.

Schenk: Anyways.

Smith: Where Gary Oldman plays Winston Churchill.

Schenk: Correct. It’s pretty wild because the movie is just a philosophical look at whether or not Britain should have capitulated, or negotiated, peace terms versus fight until the last man.

Anyway, we keep getting off the topic, which is Donut Day and I plan–I have the Krispie Kreme App. I’m ready. I am lock, stock, and barrel. Ready to go and get my however many free they give you for National Donut Day, which I think it one is free.

Smith: I thought this was a joke.

Schenk: It’s National Donut Day June 1st.

Smith: I did not know that.

Schenk: So, be ready this year because those are the types of things that sneak up on

  1. Like, National Taco Day and Taco Bell’s giving away one free taco. National Donut Day is June 1st, this Friday, you probably are going to get a free donut everywhere that they have donuts, be ready.

Alright, and speaking of donuts…

Smith: Well, I am not a huge fan of that segue because I’m not sure how this is speaking

about donuts. Other than, last time that we had him on here he confided to us later that he had accidently eaten too many Cadbury eggs that day. So, I can only imagine that on National Donut Day he might make a fool of himself. But, we have him back on here, my brother, Clay Smith, the RN.

Schenk: Welcome back, Clay.

Clay: Hey Everyone, and National Donut Day, isn’t that great?

Smith: Yeah. I do want to talk about what you told us after the podcast last time you

were on, is that you thought that you may have eaten too many Cadbury eggs.

Clay: Right, well…

Smith: How many did you eat?

Clay: Well I guess what I have learned is that with Cadbury eggs I mean– you’re really

playing kind of Russian Roulette here. You know? I mean is one too many? Is six too many? I don’t know. I’m not a doctor

Schenk: Nobody’s scientists here. Really quickly here Will, I mean–you and I know that he’s your brother. What does the audience need to know about Clay’s background?

Smith: Clay is a Registered Nurse. He practices in a PCU, which is a Progressive Care Unit, up in North Georgia. He has worked in ICUs, which are just above Progressive Care Units, which have more intensive care and he’s worked in Med Surg units, which are below PCUs. He has also been a former carmy…carmy? I’m thinking about Cadbury eggs again. A former Army Medic. He was EMT and he has also worked in the nursing homes for a really long time. He has been in the health care industry now for about ten years. We even worked together in nursing homes in Georgia. Welcome aboard, Clay.

Schenk: Yay!

Clay: Hey Everyone.

Schenk: Clay, this episode we want to get into the nuts and bolts of…

Smith: Bed sores.

Schenk: Bed sores.

Smith: Yeah.

Schenk: Pressure Ulcers. Your interactions with them. Specifically getting into who’s at risk for them? In terms of if a listener or audience member has a loved one that’s going into a skilled nursing facility, what should they be concerned about with regard to preventing pressure ulcers or bed sores?

Clay: What I would say first is that you should know if your loved one is not mobile, right? So, they’re not getting up on their own. If they’re in bed, or in a chair, or any sort of sitting position in which they’re immobile for any length of time. It doesn’t have to be all day, but for hours on end, they’re at risk of getting a bed sore or a pressure ulcer. There’s a scale that a lot of hospitals like to use, it’s called the Braden Scale. This first came out in the early eighties, but it essentially looks at a patient’s risk of getting a pressure ulcer. They use this scale in nursing homes too, but at a hospital it’s standard that every single patient, it doesn’t matter how young or how old, how mobile they are. They have to have the Braden Scale assessment placed on them because pressure ulcers are potentially very dangerous.

Smith: Now, why would it be that–And you may not know the answer to this, I would imagine that in a nursing home you must have the Braden Scale assessment rather than you must have it in a hospital.

Clay: Well, part of the thing is, it really kind of depends on what kind of nursing home or what kind of hospital you go into. This may be going to in depth, but typically most hospitals in the United States are actually non-profit. Because of this they have to have some kind of accrediting agency that they use, either JCO or whatever because they use Medicare and Medicaid. Because of that they have a lot of protocols and a lot of things in place to prevent things from happening. Pressure ulcers, as far as the Federal Government is concerned, is one hundred percent preventable. Now, whether that’s actually true medically speaking is kind of irrelevant. But, hospitals are going to do whatever they can to make sure that they do not get a pressure ulcer. If they do they are not reimbursed for the care of that. And pressure ulcers, depending on how severe they are and other co-morbidities that a patient might have, they can take weeks, months, to years. I mean, they may never be completely healed. They are very very expensive, very time consuming, and potentially very deadly.

Smith: I’ve got you. That’s very interesting because I don’t think that we’ve ever encountered because its counter intuitive that these hospitals would have it more of a requirement than a nursing home. Because you would imagine the nursing home residents are typically more at risk. But the reason is that they want that accreditation from the joint commission or whomever it may be and so they’ve got these policies in place. It sounds like something nursing homes should do, they don’t do of course, but they should do it.

Clay: Right, and a lot of this depends on what kind of nursing home. A lot of Nursing

homes are private care. This is something else I would want to investigate if I was looking for a nursing home to send my loved one. So, private care facilities, while not always the case, kind of notoriously have worse care because their bottom line is always going to have to be profit they are going to try to skimp on whatever they possibly can. That includes staffing, that includes the proper care and all of these things that are in place that non-profit facilities don’t really have those issues.

Smith: What is the difference between non-profit and private?

Clay: Back in the sixties, most hospitals in the United States were actually profit based. That means that you could treat them like a company, they could have shareholders, they had a profit margin that they were trying to reach. With the advent of Medicare and Medicaid that kind of changed everything. With hospitals, one of the most important things you have to remember with a profit based margin is that they could actually decline care to patients. Now, we don’t usually experience this because most hospitals in the United States are on a non-profit model, so they can’t deny care to individuals, no matter what it is. So, if you come into the ER and you’re having a heart attack, they don’t stop you and say, “well what kind of insurance do you have?” They have to treat you right away. With a non-profit hospital, they have to treat you. The plus side to a non-profit is they’re not paying taxes, so they–for example their employees may have what is called a 403b instead of a 401k. You know, most things are deducted. Their bottom line isn’t profit. They’re going to treat whomever they have to no matter what. So, with a profit based model that’s obviously different. The largest for-profit hospitals I can think of would be like the Kaiser hospitals.

Smith: Got you. Well that’s interesting. I took us off topic there just for a second. The

Brayden Scale, we’ve learned that it’s an assessment done in most hospitals and nursing homes. Can you describe what the Brayden Scale is? What the assessment looks at?

Clay: Sure, so a Brayden scale is every single patient has a physical assessment that’s

done throughout the day by every nurse. One of the assessments is looking at the Braden Scale. This pretty much just looks at how much of a risk a person is in getting a pressure ulcer. It’s a scale of basically zero through twenty-three. Twenty-three being no risk and anything less than six means that they are going to be at an extreme high risk of getting a pressure ulcer. The things they look at the most are going to be sensory perception, so does the patient have an altered level of consciousness? Are they able to even tell you if they’re in pain? Is there activity? Are they immobile? Are they able to get up on their own? Do they have proper nutrition? Do they have increased moisture in certain areas? Are they incontinent? Are they sweating to much? They look at these things, it creates a score, and based off that score they look at, well what’s the risk of this person getting a pressure ulcer?

Schenk: So, let me jump in there really quickly, Clay. In terms of the symptoms or

characteristics that you just named off, so for example: Tell me why the mental and cognitive impairments, if any, are important in your assessments. Why is that important?

Clay: If you think about if a person is in pain. So, typically, if you’re in pain you’re going to say something. You have very simple signs. You’re going to cry out or you’re going to ask somebody “hey, I’m in pain, something is wrong.” One of the first signs of developing a pressure ulcer is pain. You have increased redness on the skin. It’s irritating and it hurts. So, that’s a problem. If somebody has an altered mental status or they’re unconscious then they’re not able to tell you anything. Or, they’re dementia may be so severe that they’re constantly screaming out and you dont really know it’s the in pain or if that’s just their natural state at this moment.

Schenk: What about incontinence? What importance does incontinence, or from a broader stand point moisture play?

Clay: Incontinence is huge. A lot of that has to do with the fact that the main area where people get pressure ulcers the most are on bony prominences of the body. So that’s on your sacrum or coccyx, which is your tail bone, and on your heels and sometime on your cranium, or the back of your head, and that’s because these bony prominences with added pressure, when you’re not mobile, can decrease capillary refill and make it difficult for blood flow to go through. So, these bony prominences are very common to where you’re going to get these pressure ulcers. Now, on your sacrum, when your immobile and your urinating on yourself or you have lots of feces, this can cause more skin irritation and can cause skin breakdown:

Smith: What is skin breakdown? I mean it sounds like you would be able to figure it out, but actually describe skin breakdown.

Clay: Anytime, especially with urine, it’s very acidic and so is your stool. It’s not made to be on your skin for any period of time. So, someone who is incontinent and is constantly urinating on themselves or constantly having feces on themselves and it’s sitting on their skin for a long time will start to develop redness. That affects the integrity of the skins cells, you can start getting sores and you can start getting breakdowns. If you’re already developing a pressure ulcer, it can exacerbate that.

Schenk: I just wanted to highlight, you had mentioned about the fact that, particularly where there are bony prominences, the likelihood of bed sores increases because of the impact that the bone and the surface has on the capillaries. The real reason within that is because without full blood flow, when blood flow’s restricted or completely eliminated, the blood functions as the deliverer of oxygen to the tissue and to the skin. So, when there no blood flow, there’s no oxygen, there’s no nutrients. There’s no nutrients to it. That’s what’s really the underlying problem.

Clay: That correct and there’s more things you have to consider then just that, that’s the beauty of the brain scale. You have to also consider things like nutrition. For example, people with diabetes already have impaired wound healing. Because when you have elevated sugar in your blood all the time, you don’t heal as well. People who are not eating as well and that don’t have adequate protein intake. Protein is essential for wound healing as well.

Smith: Why is protein important?

Clay: Protein is one of the macro-nutrients that you use for rebuilding tissue. So, if you notice body builders eat tons and tons and tons of protein. The reason why they are doing that is because they are constantly destroying muscle fiber and rebuilding it up.

Smith: And so, that’s because they’re, andI’m just putting the dots together here, they have that huge wound on them, they want it to cover up. They want it to grow back together.

Clay: Essentially. I’d say really quick, because this is a question I get a lot in the hospital and I’ve really had just in anywhere. How quickly can someone get a pressure ulcer? This is actually a very hard thing to answer. If you try to find research on it, it’s hard because it really depends on a whole number of different things. Essentially, if someone is immobile, completely immobile, for even a few hours, they can develop a Stage I pressure ulcer.

Schenk: I was going to say, at least in our experience with our clients we’ve had, it can be over the course of a shift. After a surgery, or if for some reason somebody is immobile, particularly with the symptoms you’ve listed including some of our clients are morbidly obese and that adds obviously to the likelihood.

Smith: Of course, we’re not talking about a stage IV in a matter of hours.

Schenk: No, we are talking about a stage I on its way to getting worse because of all the factors that are there.

Smith: Actually, I don’t know that he covered the different stages.

Schenk: Let’s do this, let’s come to the stages. But, I want to keep knocking off the list on the Braden Scale. Clay, if you don’t mind, tell me about the numbering system within that. We’ve talked about the mental capacity. We’ve talked about incontinence, moisture. We’ve talked about blo–Actually, we didn’t finish with the blood. So, we talked about protein is important and the blood sugar, tell us more about how blood sugar affects the wound repair with someone with a bed sore.

Clay: So, this is actually something that doctors have noticed for a long time. Which is that patients with uncontrolled diabetes and high blood sugar typically have pore blood flow to certain areas and it’s not just with diabetes. It’s also people with vascular disease or heart failure. Anytime where you’re having impairment of blood breeching certain tissue and then returning with that waste product, not getting oxygen to those areas, you’re going to have impaired would healing.

So, when you start to develop a wound, if someone has someone has heart failure or heart disease and they’re diabetic, they are at an extreme risk for having issues with necrosis or trying to heal these wounds. This one of the reasons why you notice a lot of diabetic patients may be missing limbs, because they start to have really bad blood flow and over time this tissue becomes to the point where it’s not salvageable.

Schenk: Okay, so you’re conducting your assessment of your patient–of the resident, Clay. And, you’re checking all these boxes. What’s the calculation? What does the document look like that your using? What do the numbers mean? Literally, is it one to six in the terms of individual characteristic? Walk us through that.

Clay: Sure, so if I have a patient and I am going through the Braden Scale, there’s the main assessments I’m looking at are: sensory perception, moisture, activity, mobility, nutrition, and something called friction and sheer. Now, this is something that we didn’t cover, but this is also something that is very important.

A patient who is immobile and is constantly sliding back and forth on the bed, can have what they call a friction experience on this skin and this increases the risk of someone developing one of these sores. So, someone who is constantly having to be readjusted in the bed, or they’re constantly falling out of the bed and a staffer is constantly having to pick them back up in the bed. This can make issues even wore. Now there are certain beds that you can use to help prevent this from exacerbating. But nonetheless this is the scale that we look at.

To answer your question, as far as the numbers itself, we go from zero to twenty-three. Each one of these categories has a number, usually from zero to six and we will place a number. Like for example, sensory perception, are they fully awake and alert and with it, or are they just completely unconscious? So, I can give either a zero or a six. At the end of this, I’m going to look at my score.  If they’re twenty-three, if they’re twenty, if they’re nineteen, that means that they’re at a very low risk of developing a pressure ulcer. Anytime someone is less then fifteen, they are at what they call a moderate to severe risk of getting a pressure ulcer.

Smith: Here’s the question that I have, why do you give somebody a five versus a four? Or a three versus a four?

Schenk: In each of the individual category.

Clay: The number is not arbitrary. It will say something like–So for moisture, it could say something like, “is it very moist?” So, every single time you come into do an assessment you notice that they have incontinent episodes. You notice that they are always very moist. Is it rarely moist? So, there is a little bit of…

Schenk: Wiggle room.

Clay: Kind of guessing on here.

Schenk Yeah.

Clay: But, the point is that the scale is a wide enough, that it’s not like if someone is a sixteen instead of a fifteen, then it’s like, “oh they’re at a low risk, we’re not going to worry about it.”

Schenk: I’ve got you.

Clay: The drop from sixteen to fifteen is pretty significant.

Smith: It sounds like though, that it’s like the Likert scale. Where it’s like, “how likely are you to visit Blockbuster again?” You know one is not very likely to six is extremely likely.

Clay: Unfortunately, this is still a nurse assessment. If a nurse is going a bad assessment they could be put a higher score than they should be putting.

Schenk: That’s a good segue, Clay. So, you’ve assessed the resident, you’ve assigned a number. In this instance, Clay, let’s go with the most about of risk. They are in the thirteen–fourteen–fifteen range. Okay? They are more of a moderate to more of a risk. What do you do with that knowledge? What is the actions that you take once you’ve made that assessment to prevent a bed sore.

Clay: Hospitals actually have something very interesting in place. Most hospitals now use electric documentation and there’s been more of a push to send out these automatic alerts when patients have certain types of criteria. Sepsis is one thing that we look at and it’s obviously something we can talk about on another day. But, for the Braden Scale in particular, if I’m making an assessment on a patient, and let’s say I have a Braden score of ten. That’s going to automatically send out an alert to that patient and to everyone who has access to that patient’s medical record, “Listen, this person has a low Braden score. We need to start implementing a plan of care to prevent them from getting a pressure ulcer.” So, one of the first things that it does is, it alerts the staff, it alerts the MD and we can consult a wound care specialist. Then somebody will come out and then start making assessments and make recommendations to prevent them from getting more of a pressure ulcer. Is the incontinence so severe, for example, that we need to put in a Foley catheter or a rectal tube in place, for example? Or, do we need to put them on a very strict turning schedule? Or do we need to put barrier creams? Or types of equipment or padding? Or change the bed itself to prevent them from having this in place.

Smith: What’s barrier cream? Did you say barrier cream?

Clay: Barrier cream. Yes.

Smith: What’s barrier cream?

Clay: Barrier cream is essentially, they come in different varieties, but essentially when someone is incontinent and you place this barrier cream on them, it prevents the urine or feces from actually touching the skin itself.

Schenk: So, Clay, you’ve assessed the resident, you’ve assessed them as a moderate to high risk. You’ve sent out the red alert. You’ve done these preventative measures. Let’s say that the wound gets worse, can you walk us through the stages of a bed sore? What are the stages of a bed sore? Walk us through what the prevention methods at each of the different levels of the bed sore. What would you do at each level?

Clay: Sure, so the first stage. Stage I. This is when you have in tact skin, but its non-blanchable. Okay? So, what I mean by that is this, if you were to take your arm and press your finger down on your skin and let go, you’ll notice that the skin will probably turn white and red and then would go back into being your normal skin color. That’s what we mean by what we call a blanchable skin. Okay?

If you notice a red spot on your sacrum. The first thing you would do is put some gloves on, press down on it, and if you notice that it’s still read, it’s non-blanchable, that’s a sign that they may be developing a stage one.

Smith: So, it’s internal. It’s inside them at first.

Clay: That’s correct. So, with a stage one, but it’s very localized. It’s generally not very deep. You’re on the epidermis, you’re not really into the dermis itself. And, also too, depending on the skin color of the patient, it can be kind of difficult to assess the stage one. But, a stage one should be a high alert. It does not mean that, if I see a stage one, we’re like, “oh, we’re not worried about it.” Stage I is the most concerning that we should be because you really want to prevent any sort of bed sore from happening. So, stage I is when you really want to pull out all the stops to try to do everything you can to prevent this from progressing any further. Stage I can actually recover, usually, within a couple of days.

Smith: And let’s say that they haven’t done that, then you’re at a stage two. What’s a stage II?

Clay: Stage II is when you have partial thickness loss of the dermis itself. Okay?

Smith: What does that mean?

Clay: This is when it no longer looks red. It’s going to start looking kind of pink. It hasn’t gone down to the point of where its actually below the dermis itself, or the skin layer, you’re getting to the muscle or the fatty tissue. Stage two you can also have what’s called a flossing of the tissue itself.

Smith: So, it looks like a wound at this point.

Clay: Yeah, exactly. It looks like a wound and again this can be tricky to heal. Typically, it can take a week or so, maybe a little longer, but that’s what a stage two looks like.

Smith: At this point you have an open wound. What we non-medical people would say open wound.

Clay: Exactly, it’s an open wound. It’s definitely a site of infection. It would be something that you would have to be very diligent about to prevent it from getting any worse.

Smith: What do they do at this stage to try to make it stop getting bigger?

Clay: You try to find what’s causing the pressure. Are they just not getting turned enough? Do they need to increase their mobility? All these things would need to be in place. As far as the wound itself, alot of times at the hospital we use what’s called a Mepilex. It looks like essentially a giant Band-Aid with cotton on it and this helps prevents the friction issue that you might have when we’re talking about the Braden Scale. So, when people are getting pulled back and forth in the bed, they’re not rubbing on that sore and making it worse.

Smith: Okay. Let’s say they still haven’t stop this yet and it goes up to a stage III. What are we looking at now?

Clay: Okay. Stage III is when it gets very serious. Right? Stage III is when you have full thickness tissue loss. You may even have subcutaneous fat tissue that’s being exposed. But, you’re not going to see bone, you’re not going to see tendon, you’re not going to see muscle or anything like that. Stage III looks like a pretty bad wound. It would be very very noticeable. Stage III, depending upon other types of co-morbidities that the patient might have, can take anywhere between a couple of weeks to even months to heal.

Smith: What’s the main avenue of treatment at this point?

Schenk: And we’ll say that for example, it’s a sacrum ulcer.

Smith: Yeah. It’s a sacrum wound.

Smith: The best thing you can do is to relieve the pressure, they need to be off that wound as much as they possibly can. This is going to require a very diligent turning schedule. This is going to require either placing some sorts of equipment like creams, bandages, anything that you can possibly on it. By this point a wound care nurse or a skin specialist is now going to be consulted and that patient is going to be seen very regularly.  That wound is going to constantly be covered and you’re going to have to do everything you can to keep it nice and clean.

Smith: Let’s say that, again, they haven’t prevented it from getting bigger, we’re in a stage IV. What is a stage four like?

Clay: Stage IV would be the worst. Stage IV is very dangerous, very severe, and at this point it’s possible that they may never actually heal this wound. That’s when you have full thickness tissue loss, you may even see bone tissue. You can also develop something that’s called tunneling.  Tunneling is when, just due to the reality of how tissue damage look, there might be swelling on top, but the wound itself actually extends deeper down into the tissues of that person. Stage four is very very very dangerous.

Schenk: Do you ever see a misdiagnosis between stage III and stage IV? Is it sometimes difficult? Because obviously there’s not a bright line or a right line scale, you have to eye-ball it sometimes. I know in our experience some things are charted as stage III, when really, they are stage IV by most definitions.

Smith: Yeah.

Clay: Well I’d say that stage II and stage III are probably the ones that people mix up the most because there’s still read and there’s kind of confusion on how deep is it actually going? Stage IV you would know. It is very hard to misdiagnose a stage IV.

Smith: Do you think that’s because of the tunneling issue?

Clay: It’s very deep. There’s going to probably even be a smell. You may even notice the smell when you walk into the room.

Smith: Yeah. You will always remember that smell too.

Clay: Yeah.

Smith: I have always thought of it as, stage one is just a red mark. It’s easy to figure out what a stage I. If it’s even blanchable. If it its non-blanchable its stage I. Stage II and III looks like, I’m imaging for me that you fell off your bike and scrapped your skin. Stage II, it hurts, you scrapped you skin. Stage III, it’s like hm… you really scrapped your skin. And then stage IV, it looks like somebody drilled a hole in you.

Clay: That’s correct. Stage IV looks like somebody took a chunk of tissue out of your body.

Smith: Yeah. It’s not mistakable.

Schenk: Clay, what does the term unstageable mean?

Clay: Unstageable is when full thickness tissue that’s so severe, it’s just hard to really determine what stage it is. Or, it’s either just due to the anatomy of the person or the location of the ulcer, they can’t really give an accurate stage. I like to think that sometimes it’s just kind of a cop out with some people we use for unstageable. It’s a stage IV, but they’re not comfortable placing it a stage IV. Unstageable just means that it’s too difficult for us to determine what this is. Or, they may have a lot of necrotic tissue so it’s just impossible for them to really know. Unstageable is also not very good. This would be a very bad thing to have.

Smith: Got you.

Schenk: Well Clay, this has been very informative. A lot of good information. We really appreciate it. I mean, you’ve got a lot of experience with this and it really comes through with the knowledge you have brought today.

Smith: Yeah.

Clay: Yeah, and I just want to say, pressure ulcers, they are preventable. No matter what people say to you. You may have a loved one who is very sick and very immobile. Perhaps they’re overweight. Perhaps they have all these other things in place and you might have staff say this. I have heard staff and I’ve heard doctors say this before, “Well, unfortunately, this is unpreventable.”   That’s not true. You can prevent these from happening. It may require a lot of work and it may require diligence, but just because the right thing is hard to do, does not mean it’s shouldn’t be done.

Smith: Amen, brother.

Schenk: Awww…

Smith: Well Clay… We had on my brother, we talked about bed sores, and we even mentioned Blockbuster, but we–Nobody likes my alliteration? I’ve been thinking about it for a while.

Schenk: Wow. It went over my head.

Smith: Oh, okay. Anyway, we really appreciate you coming on. We’ll have to have you on again whenever your life slows down from taking care of baby Emma. Whenever that may be in a couple months. But, love you buddy and glad you came on.

Clay: Thank you guys, anytime.

Schenk: Alright, I will say this, we should have–Clay is your younger brother. Okay, but he’s a twin.

Smith: Yes, I have two younger brothers.

Schenk: Okay, so we need to have the other brother on. It’s an all brother’s episode.

Smith: Yeah, Jake never worked in a nursing home, I can’t imagine him doing that.

Schenk: We can have a teaching English as a second language episode.

Smith: Yeah, he teaches English in Korea. He can probably talk about how Korea doesn’t have a nursing home epidemic like we do. Just like our new intern was telling us, that they don’t have that big of an issue in South Africa either because people in other countries respect their elderly.

Schenk: More do than here.

Smith: Yeah, more so than here.

Schenk: Well, I guess that does it for this episode, number 70. Again, Happy Memorial Day. I hope everybody takes a few moments to remember the sacrifices of those in the armed forces, and National Donut Day.

Smith: National Donut Day.

Schenk: National Donut Day.

Smith: I’m looking forward to it now.

Schenk: Krispie Kreme glazed donut. Hot.

Smith: Just down the road.

Schenk: Just down the road. Anyways.  Alright guys, until next time. Wait, not until next time. We will see you–Wait! Wait! Wait! Okay, hang on. How can we consume each and every episode? Now, we have to do this…

Smith: Oh! Well, you can go to our website: SchenkSmith.com or nursinghomeabusepodcast.com

Schenk: nursinghomeabusepodcast.com

Smith: Or anywhere that you can download MP3s or Audio, if people still download MP3…I don’t think that they do.

Schenk: You can go to Pod Puppies…

Smith: You can go to Stitcher. You can go to Spotify. You can find it on YouTube.

Schenk: Podcast Bandits.

Smith: Yep.

Schenk: Anywhere that you can get podcasts.

Smith: Anywhere that you can get podcasts. Where? You wouldn’t go anywhere to download MP3 now. Would you?

Schenk: Maybe on Napster you can still find our episodes.

Smith: Yeah.

Schenk: Anyways, with that, we will see you next time.

Smith: See you next time.

Thanks for tuning into the Nursing Home Abuse Podcast. Please be sure to subscribe to this podcast on iTunes or Stitcher and feel free to leave us some feedback. And for more information on the topics discussed on this episode, check out the show website – NursingHomeAbusePodcast.com. That’s NursingHomeAbusePodcast.com. See you next time.