What Is the Braden Scale and Its Use Case in Nursing Homes?

What is the Braden Scale? It’s a standardized clinical tool designed to evaluate a patient’s risk of developing pressure ulcers. Created to guide early intervention, the tool provides a structured way for medical professionals to measure pressure injury risk and take preventive steps before wounds form.

It has become a routine part of care in hospitals, skilled nursing facilities, and long-term care homes across Chicago and the United States. Staff members trained in wound care or general nursing complete the Braden Scale assessment upon admission and at routine intervals to adjust care based on a resident’s changing condition.

The Importance of Predicting Pressure Injury Risk

Residents in nursing homes often face limited mobility, chronic conditions, and compromised nutritional intake. These risk factors make predicting pressure ulcer risk vital for timely and appropriate care. Pressure injuries cause immense pain, require prolonged recovery, and, in some cases, lead to fatal complications. 

They also come with substantial financial costs for families and care facilities. Identifying a patient’s risk early using the Braden Scale allows care teams to act before damage occurs, preserving quality of life.

Using the Braden Scale for Pressure Ulcer Prevention

The main goal of the Braden Scale assessment is to prevent pressure ulcers. Early identification of risk levels helps nursing staff implement customized strategies to reduce the chances of pressure injuries forming. 

When residents receive proactive care based on their Braden Scale score, their risk for skin breakdown, infection, and prolonged exposure to pressure points decreases significantly.

Should facilities fail to provide this, a Chicago nursing home bed sore attorney can help you take legal action.

Who Developed the Braden Scale?

The Braden Scale was developed in 1987 by Dr. Barbara Braden and Dr. Nancy Bergstrom. Their research focused on creating a scientifically valid method for pressure ulcer risk assessment, and their model became a standard across the nursing and wound care fields. Decades later, their tool remains a foundational part of pressure injury prevention in healthcare.

The Six Key Risk Factors Assessed by the Braden Scale

The Braden Scale consists of six subscales: 

1. Sensory Perception
2. Moisture
3. Activity
4. Mobility
5. Nutrition
6. Friction/Shear

These categories capture a broad range of critical factors that contribute to developing pressure ulcers. 

Each area of evaluation highlights where intervention is necessary to minimize skin breakdown and related complications.

Subscale 1: Sensory Perception 

The Sensory Perception subscale assesses how well a resident can feel and respond to pressure-related discomfort. When that ability is impaired, the patient’s risk of developing pressure ulcers increases due to prolonged pressure on the skin. This is particularly useful for individuals who are nonverbal, sedated, or living with neurological conditions.

The scoring is based on the following criteria, with lower scores indicating a higher risk of developing pressure ulcers:

• Completely Limited: Unresponsive to painful stimuli due to diminished level of consciousness or sedation or limited ability to feel pain over most of the body. (High risk)
• Very Limited: Responds only to painful stimuli. Cannot communicate discomfort except by moaning or restlessness. (High risk)
• Slightly Limited: Has some sensory impairment that limits the ability to feel discomfort or pressure in one or two extremities. (Mild risk)
• No Impairment: Fully able to feel and respond to discomfort and can move independently to relieve pressure. (Mild risk)

Subscale 2: Moisture Exposure Risk

Moisture is a major risk factor for skin breakdown. The Moisture subscale measures how often the patient’s intact skin is exposed to substances like sweat, urine, stool, or wound drainage. Constant exposure to moisture weakens the skin’s structure and strips away the protective skin barrier. 

Scores range from constantly moist to rarely moist, helping staff assess how aggressive incontinence care or skin assessment needs to be. Staff must check incontinence pads frequently, especially if stool incontinence is present.

A thorough skin assessment helps determine whether frequent or significant changes to care routines are needed.

Scoring Breakdown (Moisture Subscale):

• Constantly Moist: Skin is always damp; linens must be changed every shift.
• Very Moist: The skin is often moist and must be checked and changed at least once per shift.
• Occasionally Moist: Skin is moist intermittently; requires routine monitoring.
• Rarely Moist: Skin is usually dry; only occasionally exposed to moisture.

Subscale 3: Patient Activity Level

This subscale measures how frequently a resident engages in physical activity. Patients who are bedfast or chairfast face a greater danger of hospital-acquired pressure injuries because they are unable to relieve pressure on vulnerable skin areas. This subscale differs from the mobility subscale by focusing on overall activity, not just the ability to shift body or extremity position.

This subscale evaluates the patient’s ability to shift positions without support. Limited physical activity and insufficient repositioning increase the patient’s risk for skin breakdown, especially in pressure-prone areas. 

Residents with moderate risk may need routine turning schedules or assistive devices. A lack of muscle strength often signals the need for hands-on care or physical therapy.

Scoring Breakdown (Mobility Subscale):

• Completely Immobile: Cannot make even slight changes in body or extremity position without help.
• Very Limited: Can sometimes make slight changes but cannot reposition frequently or fully.
• Slightly Limited: Moves independently but with difficulty; repositioning is not consistent.
• No Limitations: Moves independently and maintains comfortable positioning without assistance.

Subscale 4: Mobility (Ability to Change Position)

The Mobility subscale evaluates a patient’s ability to change their body position while lying or seated. This assessment helps determine the level of assistance needed to reduce pressure on high-risk areas. 

When patients lack sufficient muscle strength, they struggle to move independently and are at moderate risk for skin breakdown and pressure ulcers. These risks increase when someone cannot maintain or return to a relatively good position over time.

A resident who is unable to shift independently may need a physical therapy consult or scheduled turning. Staff should perform regular skin assessment checks to identify early signs of damage and determine if the resident maintains a good position between repositioning intervals. 

Frequent monitoring and movement support are critical components of pressure ulcer prevention, especially for those needing regular repositioning.

Scoring Breakdown (Mobility Subscale):

• Completely Immobile: Cannot change any body position without total assistance.
• Very Limited: Makes occasional small changes but is largely dependent on others.
• Slightly Limited: Moves somewhat independently but not consistently.
• No Limitations: Fully mobile and able to maintain or adjust to a good position on their own.

Subscale 5: Nutritional Status

Nutrition plays a critical role in pressure ulcer prevention. This Braden Scale subscale evaluates the patient’s nutritional status, especially in residents who consume a less-than-optimum amount of food or fluids. Poor intake weakens skin integrity, delays healing, and raises the risk of skin breakdown.

When a patient’s ability to eat or drink is impaired due to swallowing issues, fatigue, or loss of appetite, they may need a liquid dietary supplement. Staff must also monitor nutritional intake and record dietary intake consistently to track trends and detect declines early. Should they fail to do so, a Chicago nursing home malnutrition attorney can help you take legal action.

Residents who regularly eat under 50% of meals or take fluids poorly are considered high-risk and may need a tailored nutrition plan.

Scoring Breakdown (Braden Scale – Patient’s Nutritional Status Subscale):

• Very Poor: Rarely eats more than 1/3 of meals. This inadequate fluid and protein may require the patient to use a tube feeding.
• Probably Inadequate: Eats half of meals. This means the patient needs supplements as fluid and protein intake vary.
• Adequate: Eats more than half of meals, getting regular fluid and protein intake.
• Excellent: Consumes balanced nutritional intake. No supplements are needed, showing stable hydration and nutrition.

Subscale 6: Friction and Shear Risk During Movement

This portion of the Braden Scale evaluates how friction and shear impact the skin during repositioning. Friction occurs when the skin rubs against a surface.  Shear involves deeper tissue damage caused by underlying layers sliding against each other, commonly seen when a resident slides down in bed.

The level of the patient’s ability to assist with repositioning plays a major role in this risk. Those with limited mobility who slide or require maximum help are more prone to skin damage. 

To reduce these risks, staff should use moisture barrier ointments, teach frequent small shifts in position, and implement lift techniques to minimize drag. These efforts can help prevent skin cracks and long-term deterioration.

Scoring Breakdown (Friction and Shear Subscale):

• Problem: Frequently slides; completely dependent and unable to lift.
• Potential Problem: Occasionally slides; has some lifting ability.
• No Apparent Problem: Moves independently or lifts without friction.

How the Braden Scale Scoring System Works

Each of the six subscales is scored, most commonly on a 1–4 scale, with Friction and Shear using a 1–3 range. These values are added for a total score which falls between 6 and 23. Lower scores reflect higher bedsore risk and the need for rapid action. 

Nursing teams must always strive for an accurate assessment by applying the scale and observing real-time patient changes.

Interpreting Braden Scale Pressure Sore Risk Numbers

A total score of 19–23 indicates low or no risk. Scores of 15–18 represent mild risk. Moderate risk falls between 13 and 14, while high risk spans 10 to 12. A score of 9 or less indicates severe risk. 

Identifying a resident in the severe risk category often means planning major and frequent changes in body position and using pillows to elevate pressure points. These changes are especially important for patients who walk very short distances or require frequent repositioning.

Using the Braden Scale Assessment to Guide Care Plans

The Braden Scale assessment informs individualized interventions. For example, a low Mobility score prompts the need for timely repositioning, while a low Moisture score may involve moisturizing dry, unbroken skin treatments. 

A Nutrition score indicating concern may involve supplementing meals. Staff must also avoid massaging pressure points, which can worsen cracked skin. These steps are crucial for preventing pressure ulcers and injuries.

Using the Braden Scale for Predicting Pressure Ulcer Risk

The Braden Assessment helps healthcare teams identify patients at risk of developing pressure injuries by evaluating multiple risk factors that contribute to skin breakdown. 

Assessing patients at routine intervals ensures care plans stay responsive as conditions change.

• The assessment includes six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
• Each is scored from 1 to 4, except Friction and Shear, which range from 1 to 3.
• Scores are added to calculate a total score between 6 and 23.
• Lower total scores indicate greater risk, signaling the need for more frequent monitoring and individualized care.
• Performing the Braden Risk Assessment at routine intervals helps track changing risk factors and prevent escalation.

Understanding how these scores reflect a patient’s condition allows providers to intervene early, limit skin damage, and create safer, more responsive care environments.

Limitations and Considerations When Using the Braden Scale

The Braden Scale is designed to guide, not override, clinical judgment. A frequent, though slight, change score may not indicate immediate concern but still warrants close observation. Similarly, occasional slight changes in body position may not suffice for those at high risk. 

Each subscale contributes to an accurate assessment, but the caregiver’s awareness remains essential.

How Braden Scale Failures Can Indicate Nursing Home Neglect

Neglect can occur when nursing homes fail to perform the Braden Scale assessment, ignore subscale scores, or miss signs that a resident is developing pressure ulcers.  If interventions aren’t aligned with risk categories like moderate to maximum assistance needs or requiring repositioning, that can be grounds for legal review.

Contact a Nursing Home Neglect Attorney Near You for a Free Consultation

If your loved one has suffered pressure ulcers due to failures in pressure ulcer risk assessment or missed opportunities in pressure injury prevention, contact our Chicago nursing home abuse attorneys. We can review records for pressure ulcer mistreatment, evaluate risk patterns, and identify errors in timely and accurate reporting. Reach out now for a free consultation.

Contact us at (888) 424-5757 or through our online form to discuss your options.

All content undergoes thorough legal review by experienced attorneys, including Jonathan Rosenfeld. With 25 years of experience in personal injury law and over 100 years of combined legal expertise within our team, we ensure that every article is legally accurate, compliant, and reflects current legal standards.