Pressure ulcers (bedsores) can develop quickly but are often preventable. Let’s reveal how to spot early warning signs and implement protective measures for your loved ones. I still remember the first time I saw a pressure ulcer on my grandmother’s heel: a small, angry red spot that wouldn’t fade when I pressed it. At the time, I didn’t realize that this seemingly minor mark was a stage 1 pressure ulcer, the first warning sign of what could become a life-threatening wound if left untreated. That moment sent me down a path of learning everything I could about pressure ulcer prevention, first as a concerned granddaughter, then later as a nursing home volunteer. What I discovered is that while these injuries are common, affecting about 1 in 10 nursing home residents, they’re also largely preventable with proper care and vigilance. 

Pressure ulcers develop when prolonged pressure cuts off blood flow to vulnerable areas of the body. The bony prominences are most at risk—heels, hips, tailbone, elbows, and the back of the head. In the early stages, the skin may appear red or discolored but remains intact. If you notice an area that stays red after pressure is relieved, feels warmer or cooler than surrounding skin, or has changes in texture (hard or boggy), these are early warning signs. My grandmother’s heel had that telltale persistent redness, which we caught just in time. 

Mobility is key to prevention. For individuals who spend long periods in bed or seated, repositioning every two hours is crucial. When I volunteered at a skilled nursing facility, we used a simple clock system, residents were turned from back to left side to right side in a predictable rotation. For wheelchair users, small weight shifts every 15 minutes make a big difference. Caregivers at home can use pillows strategically to keep pressure off vulnerable areas; a pillow under the calves lifts heels off the mattress, while one placed between the knees helps when side-lying. 

Skin inspection should be daily routine. During my grandmother’s care, we made skin checks part of her morning and evening routine, examining all high-risk areas with good lighting. Darker skin tones require extra attention since redness may appear as purple, blue, or darker discoloration. We kept her skin clean and dry, using pH-balanced cleansers rather than harsh soaps, and applied moisturizer to dry areas but avoided massaging bony prominences directly as this can cause tissue damage. 

Nutrition plays an unexpected role in prevention. A dietitian at the nursing home taught me that protein, vitamin C, and zinc are essential for skin integrity. We adjusted my grandmother’s meals to include more eggs, citrus fruits, and lean meats after learning her blood tests showed mild malnutrition. Hydration matters too, dehydrated skin is more prone to breakdown. Simple changes like offering water throughout the day (we used a marked bottle to track intake) and adding broth-based soups made a measurable difference. 

Specialized support surfaces can redistribute pressure. In the nursing home, we used alternating pressure mattresses that automatically shifted support points. At home, less expensive options like egg crate foam pads or gel cushions for wheelchairs can help. The key is ensuring these surfaces are properly maintained, I once saw a pressure-reducing cushion that had flattened over time, doing more harm than good. 

Moisture management is critical. Incontinence increases ulcer risk dramatically, so keeping skin dry is essential. When my grandmother had occasional accidents, we used gentle cleansers followed by barrier creams to protect her skin. Breathable, moisture-wicking fabrics for clothing and bedding helped prevent sweat buildup. For perspiration in bedbound patients, absorbent pads that pull moisture away from the skin can be lifesavers. 

Education empowers caregivers. The nursing home staff taught me that friction and shear, when skin drags across surfaces can be just as damaging as pressure. We learned proper transfer techniques using lift sheets rather than pulling my grandmother across the sheets. Even how we positioned her mattered, keeping the head of the bed raised no more than 30 degrees prevented sliding that could damage tailbone tissue. 

Early intervention makes all the difference. That small red spot on my grandmother’s heel? With prompt attention, regular repositioning, protective dressings, and nutritional adjustments, it never progressed beyond stage 1. I’ve since seen what happens when ulcers advance: the painful open wounds that can extend down to muscle and bone, the infections that threaten lives, the months-long healing processes. Prevention isn’t just easier, it’s kinder. 

For caregivers feeling overwhelmed, remember that small, consistent actions create protection. Set phone reminders for turning schedules. Keep skin inspection checklists. Celebrate small victories like maintaining intact skin for another week. And don’t hesitate to ask for help, home health nurses can teach proper techniques, and nursing home staff should welcome family involvement in prevention plans. My grandmother’s skin remained ulcer-free for the rest of her life not because we did anything extraordinary, but because we did the ordinary things with extraordinary consistency. 

References

Centers for Medicare & Medicaid Services. (2025). CMS pressure ulcer guidelines for nursing homes (F686 explained). https://www.nursinghomelawcenter.org/bed-sores-in-nursing-home/cms-guidelines/

National Institute of Health, National Library of Medicine. (2019). Preventing pressure ulcers in nursing homes using a care bundle. *International Wound Journal*, 16(2), 497-506. https://pmc.ncbi.nlm.nih.gov/articles/PMC6618244/

National Institute for Health and Care Excellence (NICE). (n.d.). Helping to prevent pressure ulcers | Quick guides to social care topics. https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/helping-to-prevent-pressure-ulcers

The Joint Commission. (2021). What are some actions staff can take to prevent pressure ulcers in high risk residents? https://www.jointcommission.org/en/standards/standard-faqs/nursing-care-center/national-patient-safety-goals-npsg/000001603/