Pressure ulcers don’t usually appear without warning. Many Hermitage families first notice changes during day-to-day visits—new redness over the tailbone, heels, hips, or shoulder blades—or they hear that “it just started getting worse.”
In real settings, pressure injuries often surface when a resident’s risk level isn’t matched by consistent care. That may involve:
- Turning and repositioning not happening on the care plan schedule
- Delays in responding to early skin changes
- Inadequate toileting/hygiene support that contributes to skin breakdown
- Limited mobility without the required assistance
- Wound care that doesn’t align with the resident’s documented needs
It’s also common for families to hear conflicting explanations—sometimes blaming the resident’s condition rather than the facility’s response. That’s why early documentation and medical record review matter.


