What a pressure injury is

A pressure injury is damage to the skin and the tissue beneath it, caused by pressure that stays on one spot too long. You may know it as a bed sore or pressure ulcer, though it happens in wheelchairs and recliners as well as beds. This pressure injury caregiver guide covers the part families can do: watch the skin, keep up daily habits that help, and report changes early. The treating clinician decides how a wound is assessed and treated.

Who is most at risk

Risk goes up when a person:

  • Stays in a bed or chair most of the day and cannot shift position without help
  • Slides down in the bed or chair, which pulls on the skin
  • Has reduced feeling from diabetes, a stroke or a spinal cord injury
  • Has incontinence, or skin that is often damp with sweat
  • Is eating or drinking poorly, or losing weight
  • Has thin, fragile skin or poor circulation
  • Cannot tell you about discomfort because of memory loss or illness
  • Wears a device that presses on the skin, such as oxygen tubing, a brace or a cast
  • Has had a pressure injury before

Where and how to check the skin

Look where bone sits close to the surface: the tailbone and buttocks, hips, heels, ankles, elbows, shoulder blades, the back of the head and the ears. Check under and around medical devices too.

Check at least once a day, or as often as the care team asks. Bathing, dressing and changing briefs are natural times. Use good light and compare one side of the body with the other.

Early signs to look for:

  • A red patch that does not fade after the pressure has been off it for a while
  • On darker skin, an area that looks darker, purple or bluish compared with the skin around it
  • Skin that feels warmer, cooler, firmer or softer than nearby skin
  • Pain, tenderness or itching in one spot
  • A blister, shiny or peeling skin, or an open area
  • A deep purple or maroon patch that looks like a bruise

The guide to pressure injury stages explains how clinicians describe what they find.

Daily habits that help

  • Change position on schedule. The care team sets how often. Our guide to a repositioning schedule at home shows how to keep track, including overnight.
  • Lift, do not drag. Pulling a person across the sheets stretches and scrapes fragile skin. Ask to be shown safe technique, and read about lifting and turning safely.
  • Protect the heels. Ask the clinician how to keep heels from resting on the mattress.
  • Keep skin clean and dry. Change wet or soiled briefs promptly. See managing incontinence and skin protection.
  • Use the surface that was recommended. Ask before buying anything yourself. The guide to cushions and mattresses for pressure relief explains the types.
  • Do not rub reddened skin over a bone. Massage can do more harm to tissue that is already stressed.
  • Smooth the bed. Check for wrinkled sheets, crumbs, tubing and objects under the person.
  • Notice eating and drinking. Tell the care team about a poor appetite or weight loss.

What to ask the care team

  • What is the turning plan for day and night, and what about time in a chair?
  • Which mattress or cushion is right, and how do we get it?
  • If there is a wound, what is the dressing plan, who changes it, and what do I do if it comes off?
  • Is pain being addressed, especially before repositioning and dressing changes?
  • What is realistic for me to do alone, and where can I get help with the rest?

Gateway arranges pressure injury care with partner clinicians in homes and facilities across Greater St. Louis and the Metro East. Families can call 314-325-0126 or request care directly.

What to report, and when to call 911

Call the treating clinician the same day for:

  • A new patch of discolored skin that does not fade, a blister or an open area
  • A wound that looks larger or deeper
  • More drainage, pus or a new bad smell
  • Redness, warmth or swelling spreading into the skin around the wound
  • Pain that is increasing
  • Fever or chills

Call 911 if the person becomes confused or hard to wake, is breathing fast, has a high fever with shaking chills, or has bleeding that will not stop.

Common questions

How quickly can a pressure injury develop?

Faster than most families expect. In a person who cannot move on their own, tissue damage can begin within hours of steady pressure on one spot. It may not show on the surface until later. That is why position changes are kept on a schedule instead of waiting for the skin to look red.

Does a pressure injury mean someone did something wrong?

Not necessarily. Good care lowers the risk, but some pressure injuries develop anyway, especially in people who are very ill or near the end of life. A new one is still a reason to review the turning plan, the support surface, nutrition and moisture. In a facility, you can ask for a care plan meeting.

Should I use a donut cushion to take pressure off the tailbone?

Ask the clinician before you use one. Ring-shaped cushions are generally not recommended, because they can press on the tissue around the opening and reduce blood flow to the area you are trying to protect. A cushion designed to spread pressure over a larger area is usually suggested instead, chosen for the person and the chair.

What if my loved one refuses to be turned at night?

Tell the care team instead of forcing it or quietly giving up. People refuse for reasons: pain when moved, fear, or broken sleep. The clinician may be able to adjust the plan, for example with a different support surface or better-timed comfort measures. The guide for when a loved one refuses wound care has more.

Related pages

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.

Updated October 2026