When enterprising minds discovered that nurses had lost their way and bedsores were a result they engineered a vast array of products and devices designed to fill this vacuum. That few of these items delivered any material benefit was beside the point. Nurses needed help and reached out to embrace the salesmen's promised outcomes. And since bedsores were prevalent in such great numbers and were so horrifically severe the regulators had little to say about redirecting funding in order to reimburse the providers who deployed these items.

    One of the marvels of engineering that paved the way was the air-fluidized specialty bed. This technology is presently owned by Hill Rom a division of Hillenbrand Industries but they did not invent it. As I heard the story an engineer created it after experiencing a personal sorrow over a loved one suffering from serious burns. This was in the late 1960's. The technology consists of a bathtub like basin filled with tiny spherical ceramic beads that are activated by a powerful compressor. This creates a fluid-like medium which supports the body while equalizing the pressure on the body. It is as close as one can get to floating in a pool of water. Its purpose was to relieve the suffering of burn victims. It also was discovered to facilitate the healing of serious bedsores. It soon became the device of choice for bedsores.

    However, it weighs about a ton, consumes lot's of electricity and is described by patients as intimidating; noisy, hot etc.. The regulators began reimbursing acute care hospitals >$400/day for its use. Other manufacturers saw this goldmine and rushed their engineering teams to design something comparable. The trouble was that a patent existed and this secured its holder against anything comparable. To this day air-fluidized technology exist only in the Hill Rom line. But here's the rub. The regulator buckles under pressure and expands the definition in the code in order to admit other devices that are made up of deep cushions and calls this air-fluidized. This of course creates the competition that starts bringing the costs down. From >$450/day in the 1970's to about $125/day today. These specialty beds still weigh about a ton, consume lot's of electricity and are described as uncomfortable by patients but they have the virtue of facilitating tissue healing.

    The regulator then responded to yet other manufacturers inquiries and the nursing profession joined the fray. No one claimed that prevention was practical but perhaps the regulator should warrant a range of reimbursement rates for lesser effective devices so that they could feel better along the way from intact healthy skin through the stages of bedsore development. The regulator acquiesced and there are now literally thousands of products and devices on the market. This is very big business and baby boom demographics insure lots to go around for all the players. 

    A relative peace exists. As long as a prospective player understands the established rules of engagement they are allowed in. Bedsores are inevitable (a cash generating bonanza for all) and treatment is the only reasonable thing that we can do. Anyone that claims that prevention might be possible is an enemy. Anyone that claims that prevention could cost less than treatment is painted as a fool. And yet not one of the many dozens of insiders that I have confronted with my finding has disputed it in any way. Mostly they get very silent and the look is revealing. They no longer take my calls. I no longer make them. My nest egg long depleted I must work at hard labor in order to eat.