When my grandmother developed a pressure injury, I learned that wound care in nursing homes is about so much more than bandages. It’s a philosophy, a commitment, and often the difference between suffering and dignity. Here’s what every family should know.

My grandmother was never one to complain. A farm wife who raised four children and buried one, she carried pain the way other people carry handbags, close, necessary, and never discussed. So when she moved to a nursing home after her stroke, I expected her to be stoic about the adjustment. What I didn’t expect was the wound.

It started small, or so they told me. A red spot on her sacrum, the bony area at the base of the spine. The staff mentioned it in passing during one of my visits, a casual “We’re keeping an eye on her skin” that floated past me like background noise.

I nodded, trusting that eyes were indeed being kept, that systems were in place, that my grandmother was being cared for by people who knew what they were doing.

Two weeks later, the red spot was a pressure injury. A Stage 2, they called it, which sounded clinical and manageable until I saw it myself, an open wound on her fragile frame that made me catch my breath and turn away so she wouldn’t see my face.

That wound became my education. In the months that followed, I learned more about wound care than I ever wanted to know. I learned that pressure injuries, or bedsores, are largely preventable.

I learned that once they develop, they are notoriously difficult to heal, especially in elderly, malnourished, or immobile patients. I learned that the presence of a wound is often less about the wound itself and more about everything that led to it, the turning schedules not followed, the nutrition not prioritized, the training not provided, the vigilance not maintained.

And I learned that a comprehensive wound care program isn’t just a protocol. It’s a philosophy. It’s a facility’s declaration that every resident, no matter how frail or nonverbal, deserves skin that stays intact.

The first thing I discovered was that wound prevention starts long before any wound appears. It starts with admission. When a new resident arrives, a truly comprehensive program includes a full skin assessment within hours. Every inch examined. Every existing scar or redness documented. This baseline isn’t paperwork; it’s a map. Without it, you can’t know what’s new, what’s worsening, or what needs attention.

For my grandmother, that initial assessment should have flagged her risk factors immediately. She was over eighty. She had limited mobility after the stroke. Her appetite was poor, which meant her nutrition was compromised. She was incontinent, which meant moisture on her skin. Every single one of these factors is a flashing red light for pressure injuries. A comprehensive program doesn’t just note these risks; it builds a care plan around them.

That plan, I learned, has layers. The first layer is repositioning. A resident who can’t move independently needs to be turned and repositioned every two hours, around the clock. Not “when we remember.” Not “when she asks.” Every two hours, like clockwork, regardless of staffing levels or how busy the morning gets. The pressure on bony areas needs to be relieved before the skin starts to break down. It’s that simple and that demanding.

The second layer is support surfaces. This is fancy language for mattresses and cushions, but the right equipment makes an enormous difference. Pressure-relieving mattresses, alternating air overlays, specialized wheelchair cushions, these aren’t luxuries. They’re medical necessities for residents at risk. My grandmother’s facility had them, but I learned to ask: Is she on the right surface for her risk level? Has it been checked recently? Is it working properly?

The third layer is nutrition and hydration. Wounds don’t happen in a vacuum. Skin needs protein to maintain integrity and to heal. Vitamin C and zinc play critical roles in tissue repair. If a resident isn’t eating well, if they’re losing weight, if they’re dehydrated, their skin becomes fragile, more susceptible to breakdown, slower to heal. A comprehensive wound care program doesn’t just treat the wound; it treats the whole person, with dietary interventions, supplements, and careful monitoring of intake.

I saw this firsthand when the facility’s dietitian got involved after my grandmother’s wound appeared. She increased my grandmother’s protein, added a wound-healing supplement to her meals, and tracked her weight weekly. It took time, but eventually, the wound began to close. The bandages mattered, yes. But the nutrition mattered just as much.

The fourth layer is incontinence care. This one is undignified to discuss but impossible to overstate. Moisture breaks down skin. Period. A resident who lies in wet or soiled bedding for extended periods is at dramatically increased risk for skin breakdown. Comprehensive programs have rigorous, respectful protocols for checking and changing incontinent residents. They use barrier creams and moisture-wicking products. They treat the skin with the same urgency they treat the vital signs.

And when a wound does appear, despite all precautions, the response must be immediate and systematic. This means standardized wound assessment tools that measure size, depth, color, and drainage. It means documentation with photographs so progress can be tracked objectively. It means wound care protocols based on the type and stage of the injury, not whatever supplies happen to be in the cabinet. It means involving wound care specialists when needed, whether they’re on staff or brought in as consultants.

I learned to ask questions I never knew existed. What’s the wound care team’s protocol for cleaning? What dressings are they using and why? How often is the wound being reassessed? Who is overseeing the plan? What happens if it’s not healing?

The answers told me everything about the facility’s commitment. Some facilities treat wounds as inevitable, as just another part of aging and decline. The best facilities treat them as failures—system failures, prevention failures, vigilance failures, and they work tirelessly to prevent the next one.

My grandmother’s wound eventually healed. It took months. It took advocacy, questions, and a family member who learned to speak the language of wound care. It took a facility that, to their credit, responded when we pushed. But I’ll never forget that initial red spot that became something more because nobody acted soon enough.

Here’s what I want every family to know: pressure injuries are not inevitable. They are not a normal part of aging. They are a sign that something in the system isn’t working. And while some wounds are unavoidable despite the best care, most are not. Most can be prevented with vigilance, with protocols, with staffing levels that allow for two-hour turning schedules, with nutrition that supports skin integrity, with a culture that values prevention over reaction.

When you’re choosing a nursing home, ask about their wound care program. Ask to see their data—their pressure injury rates, their healing rates, their protocols. Ask how they train staff to recognize early signs of breakdown. Ask what happens when a wound is identified. Ask about nutrition and turning schedules and support surfaces. Ask until you understand.

Because the person you love may not be able to tell you when something is wrong. The skin doesn’t lie, but it doesn’t speak either. It falls to us, families and facilities together, to be the eyes and voice that protect it. My grandmother taught me that. Not in words, but in a wound that should never have happened, and in the hard, holy work of making sure it never happens again.

References

Bloch, N., et al. (2023). Managing complex wounds in skilled nursing facilities (SNFs): A case study. Cureus, 15*(10), e47567. https://pmc.ncbi.nlm.nih.gov/articles/PMC10666797/

Brickyard Healthcare. (2022, November 10). Wound care management in the long-term care setting. Retrieved from https://www.brickyardhc.com/2022/11/wound-care-management-in-the-long-term-care-setting/

Ousey, K., et al. (2022). Establishing a comprehensive wound care team and program. Journal of Wound, Ostomy & Continence Nursing, 49(6), 498–504. https://pubmed.ncbi.nlm.nih.gov/36243471/

Centers for Disease Control and Prevention. (n.d.). *A unit guide to infection prevention for long-term care staff*. Agency for Healthcare Research and Quality. Retrieved from https://www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/guides/infection-prevent.html

Minnesota Department of Health. (2022). *Wound care infection prevention recommendations for long-term care*. Retrieved from https://www.health.state.mn.us/facilities/patientsafety/infectioncontrol/woundcare.pdf