Preventing Pressure Sores at Home

Why Pressure Sores Happen

Pressure sores — also called pressure ulcers, pressure injuries, or bedsores — develop when sustained pressure on a bony prominence cuts off blood flow to the skin and underlying tissue. The sacrum (base of the spine), heels, hips, shoulder blades, and the back of the head are the most vulnerable spots. A bedbound or chair-bound parent who cannot shift their own weight is at immediate risk.

The damage starts invisibly. A Stage 1 pressure injury is intact skin with a non-blanchable red area — you press on it and the redness does not fade. By Stage 3, there is full-thickness skin loss with visible fat tissue. Stage 4 exposes muscle or bone. The National Pressure Injury Advisory Panel (NPIAP) classification system defines these stages, and understanding them matters because an early Stage 1 injury may improve with prompt pressure relief, while Stage 3 or 4 can take months to heal and carries serious infection risk.

The Braden Scale: Knowing Your Parent's Risk Level

Clinicians use the Braden Scale for Predicting Pressure Sore Risk to quantify how vulnerable a patient is. It scores six domains: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Each domain scores 1–4 (friction/shear scores 1–3), giving a total range of 6–23. Lower scores mean higher risk:

• 19–23: Minimal risk — standard care
• 15–18: Mild risk — add a repositioning schedule
• 13–14: Moderate risk — pressure-redistribution surfaces needed
• 10–12: High risk — full prevention protocol
• 9 or below: Severe risk — specialized mattress, nutrition intervention, wound care team

You do not need clinical training to note these risk factors, but a description alone does not establish a Braden score. If your parent is bedbound, incontinent, eating poorly, and cannot reposition themselves, arrange a formal risk assessment and prevention plan.

The Repositioning Schedule

Repositioning is the single most effective prevention measure. For a bedbound parent, use a clinician-guided schedule tailored to their risk and support surface rather than assuming a universal two-hour interval. For a parent who sits in a wheelchair or recliner for extended periods, use the pressure-relief schedule recommended by their clinician or therapist, and help them stand only if that transfer is part of their safe care plan.

Use pillows or foam wedges between the knees (when side-lying) and under the calves (when supine) to keep bony surfaces from pressing against each other or the mattress. A pillow under the calves floats the heels off the bed entirely — heels are a common pressure injury site.

A 30-degree side-lying position is the clinical standard: it avoids direct pressure on the hip bone (greater trochanter). Lying flat on the side at 90 degrees puts the full body weight directly on the trochanter and is a major cause of hip pressure injuries.

Skin Checks During Personal Care

Every bathing session, diaper change, or clothing change is an opportunity to inspect the skin. Check:

• Sacrum and buttocks — the highest-risk zone, especially with incontinence
• Heels — lift each foot and look at the back and bottom
• Hips — both sides, at the bony prominence
• Shoulder blades and elbows — common when the person spends time in a semi-reclined position
• Behind the ears — from oxygen tubing or pillow pressure

What you are looking for: redness that does not blanch (press briefly and release; if the area stays discolored, that is a warning sign of a possible Stage 1 injury). On darker skin tones, non-blanchable redness may appear as a purple or maroon discoloration, or the area may feel warmer or firmer than surrounding skin.

Moisture Management and Skin Care

Incontinence is a pressure sore accelerator. Urine and stool break down the skin's acid mantle, making it more vulnerable to friction damage. If your parent is incontinent:

• Change wet or soiled briefs immediately — do not wait for a scheduled change
• Clean the perineal area with a pH-balanced cleanser (not regular soap, which strips protective oils)
• Apply a barrier cream containing dimethicone or zinc oxide after every cleaning to protect intact skin
• Use moisture-wicking incontinence pads rather than plastic-backed pads that trap heat

During bathing, avoid hot water (it dries the skin) and vigorous scrubbing (it damages fragile skin). Pat dry rather than rubbing. Apply a fragrance-free moisturizer to dry areas — hydrated skin resists friction better than dry skin.

Nutrition and Hydration

Pressure injury healing and prevention require adequate protein and hydration. A malnourished parent heals slower and breaks down faster. Because needs vary with kidney, heart, and other conditions, ask the primary care clinician or a registered dietitian to set protein and fluid targets. Eggs, Greek yogurt, chicken, and fish can help meet an individualized plan.

Do not start vitamin C, zinc, or other supplements solely for pressure-injury prevention without clinician or dietitian advice.

If your parent is eating less than half of their meals consistently, flag this with their primary care physician and ask whether a registered dietitian referral is appropriate and covered under their plan.

When to Call the Doctor

A Stage 1 injury (non-blanchable redness on intact skin) may improve with immediate repositioning, pressure offloading, and skin care, but persistent redness needs clinical advice. Call the physician or wound care nurse if:

• The redness does not resolve within 30 minutes of offloading pressure from that area
• You see broken skin, a blister, or an open wound (Stage 2 or higher)
• There is drainage, odor, or warmth around the site — signs of possible infection
• The wound appears deep or has dark tissue at the base

Do not apply over-the-counter wound care products to an open pressure injury without clinical guidance. Hydrogen peroxide, Betadine, and alcohol-based products damage granulating tissue and delay healing.

Building Prevention Into Daily Routines

The Bathing, Dressing and Personal Care Techniques guide includes a daily care log template with a skin-check section and a repositioning schedule tracker — building pressure injury prevention into the same workflow as bathing, dressing, and transfer assistance rather than treating it as a separate protocol.

Prevention is not complicated, but it requires consistency. Every repositioning session, every skin check during personal care, and every nutritional choice compounds. The caregivers who prevent pressure sores are the ones who build these checks into a non-negotiable daily routine rather than reacting after damage has already started.