Margaret noticed it on day three. Her 78-year-old mother had been home from the hospital for less than a week when she spotted a persistent red mark on her mother’s right hip during a morning bath. It didn’t fade when she pressed it. Knowing how to prevent bed sores in elderly family members at home could have caught this sooner.

If you’re caring for a senior loved one, Margaret’s story probably sounds familiar, or terrifyingly possible. Pressure injuries (commonly called bed sores or pressure sores) affect approximately 2.5 million people in the United States each year, and roughly 60,000 die from complications directly related to them.¹ The total annual cost to the U.S. healthcare system exceeds $26.8 billion, according to a hospital-perspective Markov simulation model published in BMJ Quality & Safety.² A single pressure injury can cost between $20,900 and $151,700 to treat, depending on severity.¹

The good news? Up to 95% of pressure injuries are preventable with the right approach.³ This guide gives you a practical, research-backed 7-step bedsore prevention plan you can start using today, even if you have zero medical training.

What Are Bed Sores and Why Do They Develop So Fast?

Think of it like a garden hose. When you step on a hose, water stops flowing. When sustained pressure compresses the soft tissue between a bony area (like the hip, tailbone, or heel) and a surface (like a mattress or wheelchair cushion), blood flow to that tissue slows or stops entirely. Without oxygen and nutrients, skin breakdown begins.

What surprises most family caregivers is how quickly this happens. Mechanobiology research shows that cell deformation from pressure loads can begin within minutes, and the resulting ischemic cascade can produce visible tissue damage in as little as two hours of unrelieved pressure.³ For older adults with thinner skin, reduced circulation, or limited mobility, the process can be even faster.

The National Pressure Injury Advisory Panel (NPIAP) classifies these injuries into four bed sore stages:

Stage 1: Intact skin with a non-blanchable red area (or discoloration on darker skin tones). The spot doesn’t turn white when you press it.
Stage 2: Partial-thickness skin loss, a shallow open wound, blister, or abrasion.
Stage 3: Full-thickness skin loss. Fat may be visible, but bone and muscle are not exposed.
Stage 4: Full-thickness tissue loss with exposed bone, tendon, or muscle. This is a medical emergency.

The jump from Stage 1 to Stage 2 can happen in a single day if the pressure isn’t relieved. That’s why prevention matters far more than treatment, by the time you see a wound, damage has already occurred beneath the skin.

Who’s at Highest Risk? A Quick Assessment for Caregivers

Not every elderly person who spends time in bed will develop a pressure injury, but certain factors dramatically increase the risk. Ask yourself these five questions about your family member:

Mobility: Can they shift their weight independently, or do they need help repositioning? The less they can move on their own, the higher the risk.
Continence: Are they managing incontinence? Moisture from urine or stool breaks down the skin’s protective barrier. A meta-analysis of 58 studies found that patients with mixed urinary and fecal incontinence had nearly five times the odds of developing a pressure injury (OR 4.99, 95% CI 2.62-9.50).⁴
Nutrition: Are they eating enough protein and staying hydrated? Poor nutrition slows skin repair and makes tissue more fragile.
Circulation: Do they have diabetes, peripheral vascular disease, or heart failure? Reduced blood flow means less oxygen reaches vulnerable tissue.
Sensation: Can they feel discomfort and pain? Conditions like neuropathy, stroke, or spinal cord injury can eliminate the natural warning signals that prompt healthy people to shift position.

If you answered “yes” to even one of these, your loved one is at elevated risk. Two or more means prevention should be a daily priority, not something you’ll get around to eventually.

The 7-Step Prevention Plan to Prevent Bed Sores at Home

This plan is built from the 2019 EPUAP/NPIAP/PPPIA International Clinical Practice Guideline and adapted for home caregivers without medical training.³ Each step is something you can implement today.

Step 1: Reposition Every 2 Hours (With a Realistic Night Plan)

The single most important thing you can do to prevent bed sores in elderly loved ones at home is change their position regularly. The 2019 International Guideline conditionally recommends that either two-hourly or three-hourly repositioning could be implemented for most at-risk individuals, provided they are also on an appropriate pressure-redistribution support surface.⁵ The guideline emphasizes that this is a starting point, not a rigid rule, and that schedules must be individualized based on tissue tolerance, mobility, and the support surface in use.

Importantly, the traditional “every 2 hours” rule originated from small observational studies conducted over 25 years ago, and the evidence supporting any specific fixed interval is rated as “very low certainty” by the international guideline.⁵ Modern practice prioritizes individualized schedules based on your family member’s specific risk factors and skin response.

Here’s the nighttime reality: waking someone every two hours disrupts sleep for both the caregiver and the person in the bed. Sleep deprivation itself creates health risks. A practical approach:

Use a 30-degree lateral tilt rather than a full side-lying position. This redistributes pressure while being less disruptive than a complete turn.
Invest in a pressure-redistributing mattress (see Step 2) that extends safe repositioning intervals.
Set a gentle alarm or use a turning schedule posted near the bed.
During the day, aim for every two hours. At night, a high-quality support surface may safely extend this to every three to four hours, but monitor the skin closely and adjust based on what you see.

Key positions to rotate through: back (with 30-degree head elevation), 30-degree left tilt, 30-degree right tilt. Avoid positioning directly on the hip bone (greater trochanter), this concentrates pressure on a small area.

Step 2: Use the Right Support Surface

The mattress your family member sleeps on matters enormously. A standard innerspring mattress creates concentrated pressure points at the sacrum, heels, and shoulder blades. A proper support surface redistributes that pressure across a larger area.

A 2021 Cochrane overview of systematic reviews found that alternating pressure air surfaces may reduce pressure ulcer incidence compared to foam surfaces, with a relative risk of 0.63 (95% CI 0.42-0.93), meaning approximately 39 fewer people per 1,000 develop a pressure ulcer compared to standard foam.⁶ The same review found that reactive air surfaces showed an even greater effect, with a hazard ratio of 0.20 (95% CI 0.04-1.05) compared to foam.⁷

Here’s what to look for in a support surface:

Reactive (constant low pressure): High-density foam or gel mattresses that conform to the body’s shape and spread pressure across more surface area. The 2019 guideline strongly recommends starting with a high-specification foam mattress for at-risk individuals.³
Active (alternating pressure): Powered mattresses with air cells that inflate and deflate in cycles, periodically relieving pressure from different areas. Consider these for individuals at moderate or high risk, or those who have already developed a pressure injury on a foam surface.
Hybrid systems: Combine reactive foam layers with active air components for both comfort and pressure relief.

One thing many caregivers don’t realize: layering multiple products reduces effectiveness. Putting a foam topper on top of an alternating pressure mattress actually interferes with the pressure redistribution. Choose one quality surface and use it as designed.

For home use, practical considerations matter: alternating pressure mattresses require a constant power supply, produce pump noise (typically 30-45 dB), and need a battery backup plan for power outages.³ These factors affect whether a given surface will work well in your specific home setting.

SonderCare’s pressure redistribution mattresses are specifically designed for home care settings, combining clinical-grade pressure relief with the comfort needed for extended use. Options range from the Comfort Mattress ($899) for standard pressure redistribution to the Alternating Pressure Air Mattress ($2,999) with 18 air bladders and a pump system for active wound care. They’re worth evaluating as part of your prevention system.

Step 3: Master Skin Inspection (Including Darker Skin Tones)

Daily skin checks are your early warning system for catching bed sores at home before they progress. Catch a Stage 1 pressure injury and you can reverse it. Miss it, and you may be dealing with a wound that takes months to heal.

Check these high-risk areas every day: sacrum (tailbone), heels, hips, shoulder blades, back of the head, and elbows. Look and feel for changes.

For lighter skin tones, the classic sign is a red area that doesn’t blanch (turn white) when pressed with a fingertip.

For darker skin tones, the blanching test is unreliable and can lead to missed or delayed diagnoses. The NPIAP’s 2023 state-of-the-science paper confirms that non-blanchable erythema may not be visible at all in darkly pigmented skin.⁸ Instead, assess for:

Temperature changes: The area feels warmer (or sometimes cooler) than surrounding skin. Compare to the contralateral (opposite) side of the body.
Firmness or bogginess: The tissue feels different, harder (induration), softer, or spongy, compared to the area around it.
Pain or tenderness: Ask your loved one if they feel discomfort at pressure points, even if you can’t see anything. Localized pain over a bony prominence can be an early sign of underlying tissue damage before any visible changes appear.
Color changes: Look for purple, dark brown, maroon, or ashen areas rather than redness. The skin may also appear shiny or taut. Compare both sides of the body, asymmetry is a warning sign.

Pro tip: Use good lighting (natural daylight is best) and check at the same time each day so you notice trends. Keep a simple log, even a notebook by the bed, to track any findings.

Step 4: Optimize Nutrition for Skin Health

Skin is the body’s largest organ, and it needs raw materials to maintain itself and repair damage. For older adults cared for at home and at risk of pressure injuries, nutrition isn’t optional, it’s a core prevention strategy.

The 2019 international guideline recommends 1.25 to 1.5 grams of protein per kilogram of body weight per day for adults at risk of pressure injuries, with a B1 strength of evidence rating.⁹ For a 150-pound person, that’s roughly 85 to 102 grams of protein daily, significantly more than many seniors consume. The guideline also recommends 30 to 35 kilocalories per kilogram of body weight per day to ensure the body has enough energy for tissue maintenance and doesn’t burn protein for fuel.⁹

A randomized controlled trial by Cereda and colleagues found that an oral nutritional supplement enriched with arginine, zinc, and antioxidants achieved a pressure injury healing rate of 16.9%, compared to just 9.7% with standard high-calorie, high-protein supplements alone.¹⁰ While you don’t necessarily need specialty supplements, the principle is clear: targeted nutrition makes a measurable difference.

Practical food sources to prioritize:

Protein: Eggs, Greek yogurt, chicken, fish, cottage cheese, beans, and lentils
Zinc: Pumpkin seeds, beef, chickpeas, and fortified cereals
Vitamin C: Citrus fruits, bell peppers, strawberries, and broccoli (supports collagen synthesis essential for tissue repair)
Hydration: Aim for 6-8 cups of fluid daily unless medically restricted. Dehydrated skin is more vulnerable to skin breakdown and pressure sore development.

If your loved one has a poor appetite, common in older adults, especially those on multiple medications, smaller, more frequent meals often work better than three large ones. A protein shake between meals can bridge the gap.

Step 5: Manage Moisture and Incontinence

Moisture is one of the most underappreciated risk factors for pressure injuries. When skin stays wet, from perspiration, wound drainage, or incontinence, it becomes softer, more fragile, and more susceptible to friction and skin breakdown.

Incontinence deserves special attention. Urine and stool contain enzymes that actively damage the skin’s protective barrier. The International Pressure Ulcer Prevalence Survey found that pressure ulcer prevalence was 16.3% in incontinent patients compared to just 4.1% in continent patients, a nearly fourfold difference.¹¹ That’s a stronger risk factor than many people realize.

Your moisture management routine:

Clean promptly: Change soiled linens and clothing as soon as possible. Don’t wait for the next scheduled repositioning. Use a pH-balanced, no-rinse cleanser rather than harsh soap.
Use a barrier cream: Apply a dimethicone-based barrier cream or a zinc oxide product after every cleaning. This creates a protective layer between the skin and moisture.
Pat dry, don’t rub: Friction from vigorous drying damages fragile skin. Gently pat the area dry before applying barrier cream.
Consider absorbent products: Modern incontinence briefs wick moisture away from the skin far more effectively than older products. Change them frequently.
Address the underlying cause: Talk to your loved one’s physician about managing incontinence. Scheduled toileting programs can reduce the frequency and duration of skin exposure to moisture. Treatments exist, it doesn’t have to be accepted as inevitable.

Step 6: Use Positioning Features on an Adjustable Bed

If your family member is spending significant time in bed, an adjustable home hospital bed isn’t a luxury, it’s a prevention tool. The positioning capabilities directly support pressure injury prevention in ways a standard bed simply cannot.

Head-of-bed elevation: A meta-analysis cited in the 2019 International Guideline found that restricting head-of-bed elevation to 30 degrees or less was associated with fewer pressure injuries compared to elevations of 45 degrees or higher (OR 0.59).¹² Higher elevations create shearing forces on the sacrum, the skin stays in place while the body slides downward, damaging tissue layers beneath the surface. An adjustable bed lets you set precise angles rather than propping pillows and guessing.

Knee break: Raising the knee section slightly prevents the person from sliding toward the foot of the bed when the head is elevated. This technique, sometimes called the “Gatch” function, stabilizes the patient and directly reduces the gravitational shear on the tailbone.¹²

Height adjustment: Being able to lower the bed close to the floor reduces fall risk, while raising it to a comfortable working height protects the caregiver’s back during repositioning. When you’re repositioning someone eight to twelve times a day, caregiver ergonomics matter.

Heel offloading: The 2019 guideline explicitly states that heels should be “free from the surface of the bed” for all at-risk individuals, using a device specifically designed for heel suspension rather than simple pillows or towels, which can slip or compress.³ Elevating the foot section and using proper heel-float positioning is one of the most effective ways to prevent heel pressure injuries, one of the most common and slowest-healing locations.

SonderCare’s adjustable home hospital beds include features like the Aura Premium’s full profiling system with Trendelenburg, Zero Gravity, and Comfort Chair positions, plus FallSafe ultra-low height positioning (10-inch platform height) and quiet motors designed for home settings. Starting at $6,999 for the Aura Premium, these aren’t clinical-looking machines, they’re furniture-grade beds with hospital-level capabilities built for the people who actually live with them.

Step 7: Know When to Call for Help

Even with an excellent prevention plan, you need clear escalation criteria. Knowing when to call a healthcare professional prevents small problems from becoming serious ones.

Call your loved one’s doctor or wound care specialist if you notice:

A Stage 1 pressure injury (non-blanchable redness or skin changes) that doesn’t improve within 24-48 hours of relieving pressure
Any Stage 2 or higher injury, open wounds, blisters, or exposed tissue
Signs of infection: increasing redness spreading beyond the wound edges, warmth, swelling, foul odor, yellow or green drainage, or fever
Rapid worsening: Any pressure injury that appears to be getting worse despite your prevention efforts
Pain at a pressure point that your family member reports, even if you can’t see visible changes yet

Don’t wait to see if it gets better. Early intervention from a wound care professional can mean the difference between a two-week recovery and a months-long ordeal involving specialized wound care, potential surgery, and hospitalization. Remember, treating a single severe pressure injury can cost upward of $75,000 to $150,000.²

What to Do If a Bed Sore Is Already Developing

If you’ve discovered a pressure injury despite your best efforts, don’t blame yourself. Even in hospitals with trained staff and specialized equipment, pressure injuries still occur. What matters now is your response.

For Stage 1 (non-blanchable redness, intact skin):

Immediately relieve all pressure from the area. Do not position the person on that spot.
Increase repositioning frequency.
Apply a transparent film dressing or thin hydrocolloid to protect the area from friction.
Monitor every few hours, Stage 1 injuries should begin improving within 24-72 hours once pressure is relieved.

For Stage 2 (shallow open wound, blister, or abrasion):

Relieve pressure completely from the area.
Gently clean the wound with saline or clean water, not hydrogen peroxide or iodine, which damage healing tissue.
Apply an appropriate moist wound dressing (hydrocolloid for shallow wounds, foam dressings for moderate drainage).
Ensure adequate nutrition: for Stage 2 or higher wounds, the guideline recommends high-calorie, high-protein oral nutritional supplements enriched with arginine, zinc, and antioxidants.¹⁰
Contact a healthcare provider for wound care guidance.

Escalate immediately if: the wound is Stage 3 or 4, you see exposed bone or muscle, there are signs of infection, or the wound isn’t improving after one week of consistent care. These situations require professional wound management, often from a specialized wound care nurse or clinic.

Frequently Asked Questions

Do I really need to turn my family member at night?

Nighttime repositioning is important, but it doesn’t have to mean fully waking someone every two hours. Using a 30-degree tilt (rather than a full turn), combined with a quality pressure-redistribution mattress, can safely extend nighttime intervals to three to four hours for many people. The 2019 international guideline does advise against routinely extending intervals to four to six hours, but notes this is a conditional recommendation with very low certainty of evidence.⁵ Monitor the skin daily and adjust your schedule based on what you observe, not a rigid clock.

Does Medicare cover pressure-relief mattresses or hospital beds?

Medicare Part B may cover a hospital bed and therapeutic support surface if a doctor certifies medical necessity. This typically requires documentation of a condition that necessitates specific positioning (like congestive heart failure or a musculoskeletal condition). A pressure injury diagnosis can also qualify. Your doctor’s office or a durable medical equipment supplier can help navigate the paperwork. Note that Medicare-covered options are often basic, a premium support surface or adjustable bed may require out-of-pocket investment.

How do I check for bed sores on dark skin?

Traditional guidance focused on “look for redness,” which is inadequate for darker skin tones. The NPIAP’s 2023 state-of-the-science paper recommends using touch and comparison instead of relying solely on visual color changes.⁸ Feel for temperature differences (warmer or cooler than surrounding skin), firmness changes (induration or bogginess), and ask about tenderness or pain. Compare the same body area on both sides, asymmetry in how the skin looks or feels is a key indicator. Look for persistent discoloration that appears purple, maroon, or darker than surrounding skin rather than red.

Can an adjustable bed really help prevent bed sores?

Yes, and not just as a comfort feature. An adjustable bed allows precise head-of-bed angle control (keeping it at or below 30 degrees to reduce shearing), knee-break positioning to prevent sliding, and height adjustment for safer repositioning transfers. These are the same capabilities used in hospital settings to prevent pressure injuries. The difference is that a home hospital bed from SonderCare delivers these features in a design that fits your home rather than making it look like a medical facility.

What creams or ointments help prevent bed sores?

Barrier creams (dimethicone-based or zinc oxide products) protect the skin from moisture damage, particularly in areas exposed to incontinence. They don’t prevent pressure injuries directly, no cream can substitute for repositioning and pressure redistribution, but they address moisture, which is a major contributing risk factor. Apply barrier cream after every cleaning, and use a gentle, pH-balanced cleanser rather than harsh soap.

Does caregiver training actually make a difference?

Research shows it does. A 2024 randomized controlled trial found that specialized face-to-face pressure ulcer prevention training for family caregivers led to a significant increase in knowledge compared to routine discharge instructions alone.¹³ A 2023 scoping review confirmed that multi-component training programs, especially those using the “teach-back” method where caregivers explain techniques back to the trainer, consistently improve both knowledge and preventive behaviors.¹⁴ Resources from organizations like the NPIAP and the VA (which offers a free Pressure Ulcer Resource app) can supplement your learning.

Prevention Is a System, Not a Single Fix

Remember Margaret from the beginning of this article? Six months after that first scare with her mother’s hip, she had a system in place: a consistent repositioning schedule, a quality pressure-redistributing mattress, daily skin checks logged in a notebook by the bed, and an adjustable bed that made the physical work of caregiving sustainable. Her mother hasn’t had a single recurrence.

That’s the key insight. Preventing bed sores isn’t about doing one thing perfectly, it’s about building a system where repositioning, nutrition, moisture management, skin monitoring, and the right equipment all work together. No single element is enough on its own, but together they’re remarkably effective.

Your action plan starts now:

Assess your loved one’s risk using the five questions above.
Start daily skin checks at the high-risk areas, sacrum, heels, hips, shoulder blades.
Evaluate your support surface. If your family member is on a standard mattress, upgrading to a pressure-redistributing surface is the highest-impact single change you can make.
Set up a repositioning schedule that’s realistic for your household, including a sustainable nighttime plan.

If you’re considering an adjustable home hospital bed or pressure-redistribution mattress as part of your prevention system, SonderCare’s care specialists can help you evaluate what’s right for your situation. With 25 years of home care experience, they understand the balance between clinical capability and real-world livability. Explore SonderCare’s hospital beds or browse pressure relief mattresses to see how hospital-grade prevention can work in your home, without making it feel like a hospital.

References

National Pressure Injury Advisory Panel. “Pressure Injury Awareness Fact Sheet.” NPIAP, 2022. https://cdn.ymaws.com/npiap.com/resource/resmgr/npiap_pru_awareness_fact_she.pdf
Padula WV, Pronovost PJ, et al. “The national cost of hospital-acquired pressure injuries in the United States.” BMJ Quality & Safety, 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC7948545/
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. “Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline.” 3rd ed. 2019. https://www.internationalguideline.com/2019
Beeckman D, Van Lancker A, Van Hecke A, et al. “A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development.” Research in Nursing & Health, 2014. https://pubmed.ncbi.nlm.nih.gov/24700170/
Gillespie BM, Walker RM, Latimer SL, et al. “Repositioning for pressure injury prevention in adults.” Cochrane Database of Systematic Reviews, 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC7265629/
Shi C, Dumville JC, Cullum N, et al. “Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta-analysis.” Cochrane Database of Systematic Reviews, 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8407250/
Shi C, Dumville JC, Cullum N. “Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta-analysis.” Cochrane Database of Systematic Reviews, 2021. https://pubmed.ncbi.nlm.nih.gov/34398473/
Black J, Cox J, Capasso V, et al. “Current Perspectives on Pressure Injuries in Persons with Dark Skin Tones from the National Pressure Injury Advisory Panel.” Advances in Skin & Wound Care, 2023. https://pubmed.ncbi.nlm.nih.gov/37590446/
NPIAP/EPUAP/PPPIA. “Prevention and Treatment of Pressure Ulcers/Injuries: Nutrition Chapter.” In: Clinical Practice Guideline, 3rd ed. 2019. https://gneaupp.info/wp-content/uploads/2024/02/cpg2019edition-digital-nov2023version.pdf
Cereda E, Klersy C, Serioli M, et al. “A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a randomized trial.” Annals of Internal Medicine, 2015. https://pubmed.ncbi.nlm.nih.gov/25643304/
Lachenbruch C, Ribas J, Sacotte-Gagne J, et al. “Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence Survey.” Journal of Wound, Ostomy and Continence Nursing, 2016. https://pubmed.ncbi.nlm.nih.gov/27167317/
NPIAP/EPUAP/PPPIA. “Repositioning: Head-of-Bed Elevation and Shear Reduction.” In: Clinical Practice Guideline, 3rd ed. 2019. https://www.internationalguideline.com/repositioning
Hancer Tok H, Uzun LN. “Pressure ulcer prevention: family caregiver training effectiveness.” BMJ Supportive & Palliative Care, 2024;15(1):72-78. https://pubmed.ncbi.nlm.nih.gov/38253489/
Effectiveness of Training Programs for Caregivers on Pressure Ulcer Prevention in Home Health Care Patients. PMC, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11550702/

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How to Prevent Bed Sores in Elderly Family Members at Home: A 7-Step Plan Backed by Research