Preventing pressure sores when someone is in bed or a chair

Why this is so important

After her fall, Roberta became far less mobile. That is when a second danger appears: pressure sores. A pressure sore (also called a bed sore or pressure injury) is skin and tissue damage from staying in one position too long, usually over a bony spot like the tailbone, hips, or heels.

They matter because they are one of the most common paths from a fall to the hospital. An open sore can become infected, and that infection can turn serious quickly. The hard truth — and the hopeful one — is that most pressure sores are preventable with steady, ordinary care.

Don't wait for the skin to break

The biggest mistake is waiting until there's an open wound. The first warning sign is a patch of skin that looks red or discolored and does not turn pale when you press it. On darker skin it may look purple or feel warmer, cooler, firmer, or more tender than the skin around it. That is the moment to act — not after the skin opens.

Check the skin at least once a day, more if the person can't move much. Look closely at the tailbone, hips, heels, ankles, shoulder blades, and the back of the head. If you see a spot that won't fade, keep pressure off it and tell the doctor or nurse right away.

The daily basics that prevent them

Reposition often. A person in bed should be shifted about every two hours; in a chair, more like every hour. Small changes count — a pillow to tilt the hips, floating the heels off the mattress with a pillow under the calves so the heels touch nothing.

Keep skin clean and dry, and manage any moisture from sweat or incontinence quickly, because damp skin breaks down faster. Support good nutrition and fluids — skin needs protein and water to stay intact and to heal. And avoid dragging the person across the sheets, which shears the skin; lift or use a slide sheet instead.

Ask the care team for a wound-care nurse or a skin-care plan early. You do not have to wait for a problem to ask for prevention.

The right mattress — and how to advocate for it

A regular mattress concentrates pressure on bony spots. Pressure-redistributing support surfaces spread that load, and Medicare covers them as durable medical equipment in three levels, matched to risk and to any wound that already exists.

Group 1 is a basic foam or gel overlay or mattress for someone at risk. Group 2 is powered — an alternating-pressure or low-air-loss mattress — for higher risk or for existing sores. Group 3 is an air-fluidized bed, reserved for advanced (stage 3 or 4) wounds in someone who is bedridden, and only after a month of other treatment hasn't worked; it usually needs prior authorization.

This is where advocacy matters. Coverage for the powered surfaces isn't automatic — the doctor or wound-care nurse has to document the risk or the wound and why a basic surface isn't enough. Ask them directly: given this person's mobility and skin, which group is appropriate, and will you document it? Don't accept a standard mattress for a bedbound person by default. The right surface, requested early and documented well, is one of the most effective things you can do.

Checklist

• Check the skin daily — tailbone, hips, heels, ankles, shoulders, back of head.
• Treat non-fading redness as an alarm; keep all pressure off that spot.
• Reposition about every 2 hours in bed, every hour in a chair.
• Float the heels off the mattress with a pillow under the calves.
• Keep skin clean and dry; manage moisture and incontinence quickly.
• Support protein and fluids — skin needs both to stay intact.
• Ask for a wound-care nurse and a skin plan before there's a problem.
• Ask the doctor which pressure-mattress group fits — and to document it.