Wound Care for Caregivers of Bedbound or Immobile Loved Ones

A pressure injury, also called a bed sore or pressure ulcer, is damage to the skin and the tissue beneath it. It usually develops over bony areas such as the tailbone, hips, heels and shoulder blades, where sustained pressure or friction can limit blood flow.

Pressure injuries are commonly described in stages. Stage 1 is typically intact skin with redness that does not fade. Stage 2 involves a partial-thickness opening or blister. Stage 3 is a deeper wound that extends into the fatty layer. Stage 4 is deeper still and may reach muscle or bone. Some wounds are "unstageable" because the base is covered, or described as a deep tissue injury when the skin looks purple or maroon.

Only a licensed clinician can look at a wound and determine its stage, its cause and what is going on beneath the surface. Skin can look different on different skin tones, and early changes are sometimes easy to miss, which is one reason professional evaluation matters.

Pressure injury care has traditionally centered on relieving pressure on the affected area. Clinicians and care teams have often used repositioning schedules set by a professional, along with specialty mattresses, cushions and heel-offloading devices.

Wound care professionals have also traditionally looked at the whole picture: skin cleanliness and moisture, nutrition and hydration, circulation, and other health conditions that influence healing. Dressings are chosen by a clinician based on the wound's characteristics, and some wounds may need the removal of non-healthy tissue, which is done by a trained provider.

For more complex wounds, specialists sometimes consider options such as negative pressure wound therapy, which is well-established, or other advanced approaches. Skin substitutes and amniotic or placental products vary in FDA status, since many are regulated as minimally manipulated tissue rather than FDA-approved drugs, and coverage differs by product and payer. Families wanting to read further on amniotic products specifically can visit amnioticdoctors.com, which is an independent resource and is not affiliated with WoundKare. A licensed clinician decides what is appropriate after an evaluation.

The right wound care specialist or home health nurse may help you understand what you are seeing and what it could mean. A visit often includes a review of your loved one's health history, a look at the skin and the wound, and a conversation about their daily routine, equipment and who provides care. Home health nurses may be able to do this in the home, which can be easier when moving your loved one is difficult.

A provider may measure and describe the wound, check surrounding skin, and talk with you about the surfaces your loved one rests on and how care is shared among family members and aides. They may also coordinate with a primary care doctor, dietitian, physical or occupational therapist, or equipment supplier. What they recommend depends entirely on your loved one's evaluation.

Good questions to ask a licensed provider include: What is the cause and stage of this wound? What are the treatment options? How long might healing take? What signs should prompt me to call you right away? What supplies or equipment might be needed, and what does insurance cover? Who can I call after hours? You can also ask what training you can receive to support care safely.