How Nursing Homes Fail to Use the Braden and Norton Scales Properly

Our Tampa attorneys can hold negligent facilities accountable

Nursing homes have a duty to assess patients for pressure ulcer risk and take steps to prevent these painful, life-threatening wounds. Two widely used tools help medical staff evaluate a patient’s vulnerability to developing bedsores: the Braden Scale and Norton Scale.

When used correctly, these scales guide nursing homes in providing necessary care, such as repositioning immobile residents, maintaining skin hygiene, and ensuring proper nutrition. However, when staff ignore or misuse these assessments, patients suffer. Preventable bedsores develop, leading to infections, amputations, and even wrongful death.

If you or a loved one suffered a bedsore in a nursing home that resulted in serious complications, you have the right to take legal action. While your options might not seem clear initially, Armando Personal Injury Law can offer guidance and legal advocacy every step of the way. To find out how we fight for victims of nursing home abuse and neglect in Tampa, contact us for a free consultation.

What are the Braden and Norton scales?

Both the Braden Scale and Norton Scale assess bedsore risk, but they use different criteria. Nursing homes should use these tools as a first line of defense against pressure ulcers.

The Braden Scale

The Braden Scale assigns a score based on six key risk factors:

Sensory perception: Can the patient feel pain or discomfort?
Moisture: How often is the skin exposed to moisture (urine, sweat, etc.)?
Activity: Can the patient move independently?
Mobility: Can the patient reposition themselves?
Nutrition: Is the patient getting enough nutrients to maintain healthy skin?
Friction and shear: Does the patient experience skin rubbing or pressure when moving?

Each category is scored from 1 (highest risk) to 4 (lowest risk). A total score of 12 or lower indicates a high risk of developing bedsores. Nursing homes should take immediate preventive measures when patients receive low scores.

The Norton Scale

The Norton Scale is an older tool that evaluates patients based on five factors:

Physical condition: Overall health status.
Mental state: Level of alertness and awareness.
Activity: Ability to move independently.
Mobility: Range of movement.
Incontinence: Frequency of exposure to moisture.

Each category is scored from 1 to 4, with a total score below 14 indicating high risk. This scale is simpler but less detailed than the Braden Scale.

How do nursing homes fail to use these scales correctly?

Even though these assessment tools exist, many nursing homes fail to use them properly. Neglect, understaffing, and poor training all contribute to preventable pressure ulcers.

Some nursing homes fail to conduct thorough risk assessments for new patients. Instead of carefully evaluating each factor, overworked staff members rush through the process, making assumptions rather than carefully scoring each category.

Some facilities skip assessments entirely, leaving high-risk residents vulnerable to developing bedsores. Without proper evaluations, staff won’t take necessary precautions, such as turning patients every few hours or providing special pressure-relieving mattresses.

Do nursing homes ignore high-risk patients?

Even when a resident scores as high-risk on the Braden or Norton Scale, some nursing homes fail to implement necessary interventions. Patients who are immobile, malnourished, or incontinent need extra attention to prevent pressure ulcers. However, in many facilities:

Staff fail to reposition bedridden residents regularly.
Patients do not receive enough fluids or protein-rich meals.
Skin hygiene is neglected, increasing the risk of infections.

Instead of following a clear prevention plan, some facilities allow vulnerable patients to sit in wheelchairs or lie in beds for hours without movement. This leads to stage 4 bedsores, which can result in deep infections, sepsis, and even death.

Do nursing homes falsify records to cover neglect?

Unfortunately, some nursing homes manipulate risk assessments to hide their failure to provide care. This includes:

Falsifying Braden or Norton Scale scores to make residents seem at lower risk.
Recording assessments that were never actually performed.
Marking down that residents were repositioned when they were left in the same position for hours.

Families often discover this neglect too late, when a loved one develops a deep, infected bedsore. By that point, irreversible damage has already occurred.

Do nursing homes fail to reassess patients regularly?

Bedsore risk is not static. A resident’s condition can change due to illness, weight loss, surgery, or declining mobility. Nursing homes must reassess patients at least once a week or whenever their health status changes.

Negligent facilities fail to do this, which leaves residents at risk for preventable wounds. If a high-risk patient is not reassessed and provided with additional care, bedsores can develop quickly and sometimes within days.

Can a nursing home be held liable for ignoring these risk assessments?

When a nursing home fails to use the Braden or Norton Scale properly, it can be held liable for negligence. These scales are not just recommendations; they’re industry standards. To remain compliant, facilities must:

Conduct an initial bedsore risk assessment for every patient.
Follow a care plan based on the assessment results.
Reassess patients regularly and update their care plans accordingly.

If a nursing home fails to prevent a bedsore due to improper assessments, you can file a lawsuit for medical neglect.

What should I do if a loved one develops a preventable bedsore?

If your loved one has developed a bedsore in a nursing home, here’s what you should do to protect your loved one and begin building a case:

Request medical records: Ask for documentation of all Braden or Norton Scale assessments. If records are missing, incomplete, or falsified, that may indicate negligence.
Document the bedsore: Take clear photographs of the wound and track its progression. Bedsore staging is crucial in proving that the injury worsened due to neglect.
File a complaint: Report the nursing home’s failure to assess and prevent pressure ulcers to the Florida Agency for Health Care Administration (AHCA) or the Florida Department of Elder Affairs.
Get legal help: If your loved one’s bedsore resulted from neglect, you may be entitled to compensation for medical expenses, pain and suffering, and wrongful death. An experienced personal injury lawyer can help you hold the nursing home accountable.

How can Armando Personal Injury Law help?

If your loved one developed a painful, preventable bedsore in a nursing home, it’s more than just a medical issue, it’s a sign of neglect. Pressure ulcers don’t happen overnight. They form when caregivers ignore basic care such as repositioning, hygiene, and proper nutrition. Armando Personal Injury Law believes families deserve answers when a nursing home fails to protect their loved ones.

No one should suffer like this, especially when it’s entirely preventable with proper care. If a nursing home allowed this to happen to your loved one, you have every right to demand justice. Our team will investigate, uncover the truth, and fight to hold the facility accountable. We’ll work to secure the compensation your family deserves for medical expenses, pain and suffering, and the emotional toll of neglect.

Your family’s well-being matters, and we’re here to stand by your side. Contact us today for a free consultation, and let’s take the first step toward justice together.