Pressure ulcers, otherwise known as bedsores or decubitus ulcers, can occur in residents who spend a good deal of their time in a bed or in a wheelchair. These sores can develop at the bony prominences of the body such as the sacral bones, the hip bones, shoulder blades and the heels. The primary causes of bedsores are immobility, malnutrition, dehydration, incontinence and failure of the nursing home staff to properly and timely reposition the nursing home resident. When the skin is subjected to prolonged and unrelieved periods of pressure in these bony prominence areas of the body, it can cause underlying tissue damage. The pressure ulcers range in severity. A Stage I pressure ulcer is least severe and presents itself as a small red wound about the size of a quarter. Stage IV bedsores are the most severe and can involve a gaping wound with complete skin tissue breakdown including necrotic tissue. Stage IV heel ulcers, in certain instances, result in amputation.