Why pressure injuries matter at home
A pressure injury can begin in a few hours and take weeks or months to heal. Most are preventable with routines a family or caregiver can learn.
A pressure injury, often called a pressure sore, pressure ulcer or bedsore, is damage to skin and the tissue underneath it caused by pressure that goes on too long, usually over a bony part of the body. The pressure squeezes the small blood vessels that feed the skin. Without blood flow, the tissue starts to die, sometimes from the inside out, so what looks like a small mark on the surface can be a deeper injury underneath.
They matter because they are painful, they can become infected, and once established they heal slowly. They also matter because they are one of the clearest cases in home care where steady, ordinary attention prevents a serious problem.
Who is at risk
Anyone who spends most of the day in a bed or a chair and cannot easily shift position on their own is at risk. Risk rises further with any of the following: incontinence, which keeps skin damp; poor eating or drinking; weight loss; diabetes or poor circulation; reduced feeling in part of the body, for example after a stroke or spinal cord injury; and confusion that means the person does not notice or report discomfort.
Someone recovering from surgery or a hospital stay is especially worth watching. They may be spending far more time lying down than usual, and the first days home are often when a routine has not yet been established.
Where to look
Pressure injuries form where bone sits close to the skin and takes weight. In someone lying on their back: the tailbone, the heels, the shoulder blades and the back of the head. Lying on a side: the hip, the side of the knee, the ankle and the ear. Sitting in a chair or wheelchair: the buttocks, the tailbone and the backs of the shoulders. Heels are easily missed and are one of the most common sites.
Check these areas every day, ideally at a time that is already part of the routine, such as washing or changing. Good light helps.
Early warning signs
- Redness that does not fade when you press it lightly and release, on lighter skin.
- On darker skin, a color change may be harder to see. Look for areas that are darker than the surrounding skin, purplish or bluish, and feel for differences in warmth, coolness, firmness or sponginess compared with nearby skin.
- Pain, tenderness or itching over a bony area, or the person repeatedly avoiding a particular position.
- A blister, an open area, or skin that looks shiny or broken. At this point the injury has already started and needs a clinician's attention.
The core of prevention: move the pressure
The single most important thing is regular changes of position, so that no area takes weight for too long. For someone in bed, many care plans use a repositioning schedule of roughly every two hours, though the right interval depends on the person and should come from their care team. For someone sitting, shorter intervals are common, and a person who can shift their own weight can be encouraged to do so frequently.
How you move someone matters as much as how often. Dragging a person across a sheet causes friction and shearing, which damage skin even when the pressure is brief. Use a draw sheet or slide sheet and two people where needed. Our guide to helping someone move safely at home covers techniques that protect both the person and the caregiver's back.
Small positioning details help: a pillow between the knees when lying on the side, heels supported so they float just off the mattress rather than resting on it, and the head of the bed kept no higher than necessary, because a raised bed causes the body to slide down and shear the skin at the tailbone.
Skin, moisture, food and water
Keep skin clean and dry. If the person has incontinence, change them promptly, clean gently with a mild cleanser rather than scrubbing, pat dry, and use a barrier cream if their clinician recommends one. Our guide to incontinence care at home has more detail. Avoid massaging red areas over bones; it was once common advice and is now discouraged because it can add to the damage.
Nutrition and fluids are part of skin care. Skin needs protein, calories and water to stay resilient and to heal. If the person is eating or drinking poorly, or losing weight, raise it with their physician. The guide on helping someone eat and drink enough has practical ideas.
Equipment worth asking about
Pressure-redistributing mattresses, mattress overlays and wheelchair cushions can lower risk for people who spend long periods in one place. They do not replace repositioning. Ask the person's physician, home health nurse or an occupational therapist what is appropriate; some equipment may be covered by Medicare or Medicaid when ordered by a clinician and supplied through an approved vendor, so ask before buying privately. Doughnut-shaped ring cushions are generally not recommended, because they can concentrate pressure around the ring.
When to call a clinician
Call the person's physician or home health nurse if you see broken skin, a blister, an area that stays discolored, or a sore that is getting bigger. Seek care urgently for signs of infection such as spreading redness, warmth, swelling, pus, a bad smell, or a fever. Do not try to treat an open wound with home remedies.
Building it into a care routine
Prevention is a set of small tasks repeated many times a day, which is exactly what slips when one family member is doing everything. Writing the routine down helps: when to reposition, which areas to check, what to report and to whom. Put it in the person's care plan so every caregiver follows the same steps.
If you are looking for help with personal care, you can search The Care Royal by zip code to see independent caregivers and agencies listing services in the area. Ask anyone you consider how they approach repositioning and skin checks. Hiring and background checks are decisions you or the agency make.
General information for families, not medical advice. Pressure injuries need assessment by a qualified clinician. Speak with the person's physician or nurse, and in an emergency call 911.