Bedsores & Pressure Injuries
Expert pressure ulcer care for all stages—mobile treatment preventing complications in skilled nursing, home care, and hospice patients.
Pressure ulcers (also called bedsores, pressure sores, or decubitus ulcers) are injuries to skin and underlying tissue caused by prolonged pressure on skin. They develop when constant pressure reduces blood flow to vulnerable areas, causing tissue death. Over 2.5 million Americans develop pressure ulcers annually, primarily affecting immobile, bedridden, or wheelchair-bound individuals. Pressure ulcers are staged I-IV based on depth and tissue involvement.
Pressure ulcers become chronic wounds due to ongoing pressure combined with multiple risk factors:
Unrelieved pressure compresses capillaries, blocking oxygen delivery. Tissue dies within 2-6 hours of constant pressure. If patient cannot reposition independently, pressure continues damaging tissue faster than it can heal.
Healing requires adequate protein, calories, vitamin C, and zinc. Immobile patients often have poor appetite and inadequate nutrition. Without building blocks, body cannot create new tissue.
Urine and feces create moisture that macerates skin. Bacteria from incontinence cause infection. Moisture + pressure = rapid tissue breakdown.
Sliding down in bed or improper transfers create shear forces that tear tissue layers. Friction during repositioning damages fragile skin.
Pressure ulcers are classified by the National Pressure Injury Advisory Panel staging system:
Stage 1: Non-Blanchable Redness
Intact skin with persistent redness that doesn't blanch (turn white) when pressed. May feel warmer or cooler than surrounding skin. Pain or itching possible. 100% reversible with intervention.
Stage 2: Partial Thickness Skin Loss
Shallow open ulcer with red/pink wound bed. May present as intact or ruptured blister. Epidermis and possibly dermis lost. No slough or eschar present.
Stage 3: Full Thickness Skin Loss
Full thickness tissue loss. Subcutaneous fat may be visible, but bone/tendon/muscle not exposed. Slough may be present. May include undermining and tunneling.
Stage 4: Full Thickness Tissue Loss
Full thickness with exposed bone, tendon, or muscle. Slough or eschar may be present. Often includes undermining and tunneling. High infection and osteomyelitis risk.
Unstageable: Depth Unknown
Full thickness tissue loss covered by slough (yellow/tan/gray) or eschar (black/brown) in wound bed. Cannot determine true depth until debris removed via debridement.
Untreated pressure ulcers rapidly progress to deeper stages. Stage 1 can become Stage 4 within days in high-risk patients. Complications include: cellulitis and sepsis (life-threatening bloodstream infection), osteomyelitis (bone infection requiring months of IV antibiotics), septic arthritis if near joints, chronic pain, extended hospital stays, and mortality—pressure ulcers are associated with 60,000 deaths annually in the US.
Our comprehensive approach treats the wound while addressing underlying causes:
Establish every-2-hour turning schedule. Pressure-relieving mattresses or overlays. Proper positioning with pillows. For wheelchair users, pressure relief lifts every 15-30 minutes. Offloading devices for heels (boots, pillows).
Sharp debridement removes necrotic tissue, slough, and eschar to reveal viable tissue. Converts unstageable wounds to stageable. Reduces infection risk. See debridement details.
Stage-specific dressing selection. Foams for moderate drainage, alginates for heavy exudate, hydrogels for dry wounds. Antimicrobial dressings for infected ulcers. Dressing options.
For Stage 3-4 ulcers, NPWT accelerates healing by removing excess fluid, increasing blood flow, and promoting granulation tissue. NPWT information.
Coordinate with dietitian for high-protein diet (1.25-1.5g/kg/day), vitamin C supplementation, zinc if deficient. Healing requires adequate calories—wounds won't close without proper nutrition.
Comprehensive 45-60 minute visits include: full wound assessment with staging, measurements, and photography; debridement as indicated; dressing selection and application; pressure relief assessment and recommendations; caregiver education on turning schedules and skin inspection; nutrition review; infection monitoring; supplies for care between visits; coordination with facility staff or family caregivers; and detailed documentation for regulatory compliance.
Emergency signs requiring immediate medical attention: fever with wound, rapid ulcer enlargement, foul-smelling drainage, crepitus (crackling feeling around wound suggesting gas-forming bacteria), exposed bone, severe pain, red streaks extending from ulcer, confusion or altered mental status. These indicate serious infection requiring hospital intervention.
Medicare Part B covers pressure ulcer treatment including mobile visits, debridement, advanced dressings, NPWT, and skin substitutes for Stage 3-4 ulcers. For skilled nursing facility residents, coordinate coverage with facility or bill resident's Medicare. Learn more about Medicare coverage.
Skilled nursing facilities, assisted living, and home patients—we provide comprehensive onsite care.
Request CareExpert mobile care for pressure ulcers—all stages treated at home, nursing facilities, and hospice with advanced wound care.
Pressure ulcers (also called bedsores, pressure sores, or decubitus ulcers) are injuries to skin and underlying tissue caused by prolonged pressure on the skin. They most commonly develop on skin covering bony areas—sacrum (tailbone), heels, hips, ankles, and shoulder blades. Pressure ulcers affect 2.5 million Americans annually and are the second most common medical complication after urinary tract infections in long-term care facilities.
Pressure ulcers occur when sustained pressure restricts blood flow to tissue. Without blood flow, tissue dies. Several factors prevent healing:
Continued Pressure
If pressure isn't completely eliminated, wounds cannot heal. Even brief periods of pressure (2+ hours) cause additional tissue damage.
Moisture and Incontinence
Urine and feces create moist environment promoting bacterial growth and skin breakdown. Moisture also weakens skin's protective barrier.
Poor Nutrition
Inadequate protein, vitamins C and D, and zinc prevent tissue repair. Many patients with pressure ulcers are malnourished, creating vicious cycle.
Underlying Health Conditions
Diabetes, vascular disease, paralysis, and terminal illnesses all impair healing. Advanced age compounds these factors.
Stage 1: Non-Blanchable Redness
Intact skin with non-blanchable redness (doesn't turn white when pressed). Skin may be painful, firm, soft, warmer or cooler than surrounding tissue. Reversible with immediate intervention.
Stage 2: Partial Thickness Loss
Shallow open ulcer with red/pink wound bed. No slough. May present as intact or ruptured blister. Epidermis and part of dermis lost.
Stage 3: Full Thickness Tissue Loss
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, muscle not exposed. Slough may be present. May include undermining and tunneling.
Stage 4: Full Thickness Tissue Loss with Exposed Structures
Bone, tendon, or muscle exposed. Slough or eschar often present. Often includes undermining and tunneling. High risk of osteomyelitis.
Unstageable: Obscured Full Thickness
Full thickness tissue loss with wound bed covered by slough or eschar. Cannot determine true depth until debridement performed.
Deep Tissue Injury (DTI)
Purple or maroon localized area of discolored intact skin or blood-filled blister. Tissue beneath may already be necrotic. Can rapidly deteriorate despite optimal treatment.
Untreated pressure ulcers progressively worsen, advancing through stages rapidly. Complications include: sepsis (bloodstream infection with 40% mortality), osteomyelitis requiring IV antibiotics for 6+ weeks, extensive tissue destruction requiring surgical flap reconstruction, and chronic pain significantly reducing quality of life. Stage 4 pressure ulcers have 50% mortality within 6 months in frail elderly patients. Early treatment is literally life-saving.
Pressure Relief Strategies
Repositioning schedules every 2 hours, pressure-redistributing mattresses, heel offloading boots, cushions for wheelchair users. Complete pressure elimination is non-negotiable.
Aggressive Debridement
Stage 3-4 ulcers require sharp debridement to remove necrotic tissue and promote granulation. Performed bedside with local anesthesia. Debridement details.
Advanced Dressings
Stage-appropriate dressings: hydrocolloids for Stage 2, foams for moderate drainage, alginates for heavy exudate, antimicrobial dressings for infection. Dressing options.
Negative Pressure Wound Therapy
For Stage 3-4 ulcers, NPWT accelerates granulation tissue formation and wound contraction. Reduces healing time by 50%. NPWT info.
Nutritional Optimization
Coordinate with dietitian for high-protein diet, vitamin C/D/zinc supplementation. Wounds can't heal without adequate nutrition. May require feeding tube consultation.
Mobile specialists bring everything needed: complete wound assessment with staging, measurements, and photography, debridement if indicated, appropriate dressing application with supplies for changes between visits, pressure relief device recommendations, nutrition assessment and recommendations, caregiver education on repositioning schedules, and coordination with facility nurses or family caregivers. All documentation provided same-day to physicians and facilities.
Emergency room evaluation needed if:
Medicare Part B covers pressure ulcer treatment including mobile visits, debridement, advanced dressings, NPWT, and pressure-relief devices. Skilled nursing facilities can bill separately. Home patients: Medicare pays 80%, you pay 20% (typically $0 with Medigap). Full coverage details.
Mobile wound care specialists treating all stages—SNF, assisted living, home, and hospice patients.
Find a Provider