Pressure sores are prevented by three habits: regular position changes, a daily whole-skin check, and keeping skin clean and dry. A household that holds those three habits, day after day, will almost always keep a bed-bound or chair-bound person sore-free — and a household that lets them slip for even a week can find a wound that takes months to close.
I put it that starkly because pressure injuries are the most preventable serious harm in home care, and the most unforgiving. They develop quietly, over hours, on the parts of the body nobody looks at. This article is the routine I teach families after a stroke, a fracture or a long hospital stay leaves someone spending most of the day in bed or a chair.
Where sores form: know the pressure points
A pressure sore forms where body weight squeezes skin between bone and a surface, cutting off blood flow. The map is predictable:
- Lying on the back: tailbone (the most common site of all), heels, shoulder blades, back of the head.
- Lying on the side: hip bone, ankle, knee, ear, shoulder.
- Sitting: the sitting bones under the buttocks, tailbone, and heels resting on a footplate.
Two habits follow directly from the map. Heels deserve special protection — a pillow under the calves so the heels float free of the mattress costs nothing and removes one of the worst sites entirely. And never position someone directly on an area that is already red; red skin is skin already in trouble, and more pressure on it is how a stage-one mark becomes an open wound.
Friction and shear do quiet damage too. Sliding down the bed drags skin against the sheet, and being dragged up the bed instead of lifted does the same. Keep the head of the bed no higher than needed, and reposition by rolling or lifting, never dragging — technique I cover in safe transfers.
The turning rhythm
For someone in bed most of the day, the classic rhythm is a position change roughly every two hours, rotating through back, left side and right side. In practice:
- A side position should be a gentle tilt of about thirty degrees onto the fleshy part of the buttock, held there with a pillow behind the back — not a full ninety-degree roll onto the point of the hip, which just moves the pressure to another bone.
- Pillows are the main equipment: behind the back, between the knees and ankles when side-lying, under the calves to float the heels.
- Write the turns down. A simple chart on the wall — time, position, initials — is the difference between a rhythm and a rough intention, especially when helpers change shifts. At night, pair turns with product changes or settling so sleep is broken as little as possible.
Chair sitters are the group families underestimate. Sitting concentrates the whole upper body’s weight onto the small area of the sitting bones, so damage arrives faster than in bed. Someone who cannot shift their own weight needs help to lean, stand briefly or be repositioned every fifteen to thirty minutes, and long uninterrupted hours “comfortable in the chair” are exactly how chair-shaped sores happen.
Around-the-clock turning is a real workload, and it is one of the honest reasons families move to a live-in caregiver arrangement rather than stretching one exhausted family member across every night.
The daily skin check, and why handover is the moment
Once a day — bath time is natural, since the skin is already uncovered — someone looks at every pressure point on the map above. Good light, no rushing, and actually looking at the tailbone and heels rather than assuming.
What you are looking for: redness over a bony point that does not fade shortly after the pressure comes off. Press a fingertip on the red patch; healthy skin blanches pale and pinks back, while skin in trouble stays stubbornly red. On darker skin — most of the people I see — colour change is unreliable, so use your hands as much as your eyes: an area that feels warmer, firmer, boggy or unusually tender compared with the surrounding skin is the same warning.
Where care is shared between family and hired help, make the skin check a fixed part of the handover between caregivers: the person finishing their shift states, in the note or out loud, that the skin was checked and what was seen. “Skin intact, small red patch left heel, kept off it since 2pm” is one line, and it means a new mark is never discovered three days late because everyone assumed someone else had looked. In post-hospital care this matters doubly, because people frequently come home from a hospital stay with early damage already started.
Mattresses and cushions: helpful, never sufficient
Pressure-relieving equipment buys time between position changes; it does not replace them.
- For beds, options range from foam overlays to alternating-pressure air mattresses whose cells inflate and deflate in cycles. The higher the person’s risk — thin, immobile, previous sores — the stronger the case for the air type. Pharmacies and medical suppliers rent as well as sell, which suits recovery periods.
- For chairs, a proper pressure-relief cushion under the sitting bones matters more than most families expect. One firm rule: not a ring or “donut” cushion, which cuts off blood flow around its rim and makes things worse.
- Whatever the surface, the turning rhythm continues. The most common way I see sores start is a family buying a good mattress and quietly retiring the turning chart.
Equipment sits alongside the other costs of a long care period; the cost guide helps put the whole picture together.
Moisture, nutrition and the quiet contributors
Pressure does the damage, but two background factors decide how well the skin resists it.
Moisture. Skin softened by urine, stool or sweat breaks under a fraction of the pressure dry skin tolerates. Prompt changes, thorough drying inside skin folds, and barrier cream where needed — the same routine described in managing incontinence with dignity — are pressure-sore prevention as much as they are skin care. In our heat, a bed-bound person sweats into the sheet all afternoon; light cotton bedding, a fan across the bed and an extra wash-down on hot days all count.
Nutrition. Skin is rebuilt from protein and fluid, and a frail person eating poorly is losing the raw material for repair. Someone whose appetite is fading while they are bed-bound is at double risk, and the practical side of keeping them eating and drinking is its own subject — I cover it in nutrition and hydration for frail elderly.
The hard boundary: broken skin is a clinical matter
Everything above is prevention, and prevention belongs squarely with families and trained caregivers. The boundary is broken skin, and it is worth stating once, without softening: an open sore — broken skin, a blister over a pressure point, a dark patch that looks bruised without an injury to explain it — is a nurse or doctor matter, that day, not something to watch over a weekend or dress from the household first-aid box. These wounds extend deeper than they look from the surface, and early clinical care is the difference between weeks and months of healing. The caregiver’s role from that moment is to keep all pressure off the area, keep it clean and dry, and report exactly when it was found and how it has changed — the same division of work explained on the caregiver vs nurse page.
Held daily, the routine is not complicated: turn on rhythm, float the heels, check the skin in good light, keep it clean and dry, feed the body that has to do the repairs, and escalate the moment the skin breaks. Families who keep that rhythm through months of bed-bound care hand the doctor a person with intact skin — and that is one of the quiet triumphs of home caregiving.