What Caregivers Need to Know About Bedsores

Stage 2. The skin is broken and the sore looks like a blister with discolored skin surrounding it.

Stage 3. The sore is deeper and will look like a crater. You may be able to see body fat in the ulcer. There may be dark patches of skin around the edges of the sore.

Stage 4. At this point, the sore is so deep that it’s caused damage to muscles, bones, tendons or joints. Life-threatening infections are possible.

When should I see a doctor about bedsores?

If you are new to caregiving or don’t have any experience with pressure sores, talk to your loved one’s doctor before attempting to treat one on your own. 

Your primary care provider may give you instructions to manage stage 1 sores at home. But once the skin breaks, you need specialized guidance from a health care professional.

“That is a stage 2 pressure ulcer, and it needs to be managed,” Conant says. “If it’s very shallow, sometimes we can get away with just adding barrier ointment and keeping it clean, and it will heal.

“But this is where we are starting to get into specialized dressings and wound care,” she says. “So we would often get home health involved.”

How should I treat early stage bedsores?

To familiarize yourself with the care of pressure ulcers, these are the steps your health care provider is likely to recommend for stage 1 bedsores.

Take the pressure off.  As soon as you see a red or purple mark in a high-pressure spot that does not turn white when you press it, “You’ve got to get the pressure off that area,” Conant says. Your health care provider can suggest ways to reposition the person so they are not sitting or lying on the sore spot. For example, if sores are on the heels, they may tell you to elevate the feet.

Add padding. “There are lots of great options out there to redistribute pressure,” Conant says. Your health care provider will take into account the location and cause of the sore and can give you a recommendation on the type of padding — air, gel, water or foam, as well as types of cushions or mattresses — to use.

But be mindful about the type of padding. Whatever you do, Conant says, “please, please do not sit on a donut cushion. It cuts off all blood supply to the tailbone and makes it worse instead of better.”

If the tailbone is the problem area, use a c-shaped cushion or pad the area with a solid piece of cushioning.

Clean the sore. For a sore that hasn’t broken the skin, your health care provider will probably advise you to gently clean the area with mild soap and water.

If the sore is in an area that might get exposed to urine or feces, protect it with a barrier cream. Once the skin is broken, indicating a stage 2 sore, your doctor may recommend different ways to properly clean the wound, as well which barrier cream to use.

Cover the sore. Depending on the size and stage of the sore, your doctor or home health specialist may recommend dressings such as film, gauze, gel or foam to help prevent infection and encourage healing.

What’s the best way to prevent bedsores?

The ideal treatment for pressure ulcers is to stop them from happening. To help keep your loved ones safe, have them:

Eat a well-balanced diet. Eating required daily nutrients — and enough calories — can help prevent ulcers from forming.

“Many older adults don’t get enough protein,” Conant says. “You want them to have at least a gram per kilogram of body weight every day.” That may mean eating high-protein foods at every meal and snack.

Stay hydrated. Hydration stimulates blood flow, which can help prevent pressure sores. Aim for at least six to eight cups of water a day.

Move daily. If it’s possible for your loved ones to move daily to improve circulation and prevent sores, they should. If they are bedridden, a caregiver can gently move their limbs daily.

A home health professional can offer advice.

Reposition often. Ideally, you want to move someone who is bedbound at least every two hours and someone in a chair or wheelchair about every 15 minutes.

You will likely need the help of another person or an assistive device, such as a sliding board or draw sheet. Home health professionals can teach you how to move your loved one safely.

But be careful as you move your loved one. “You want to make sure that you’re not pulling so hard you’re shearing the skin because then the skin gets damaged and it’s at even more risk for breaking down,” Conant says.

Redistribute pressure. Use cushions and padding to take pressure off any bony areas that might be pressing into a chair or mattress. Padded bandages may also be recommended.

“It softens the pressure between the bone and the surface, which is a part of both treatment and prevention,” Zhou says. You can get recommendations from your health care provider or home health professional on the best fit.

Check high-pressure spots on your loved one’s skin daily. “Whether you’re giving them a shower or helping them in the bathroom, look at the skin for redness that isn’t going away,” Conant says.

Pay close attention to these areas:

• Ankles
• Back
• Back of head
• Buttocks
• Elbows
• Heels
• Hips
• Shoulders