Caring for a Pressure Sore Without Making It Worse

How do you care for a bedsore at home?

The plan is simple to state and demanding to keep: no pressure on the sore, ever; gentle cleaning and a dressing kept exactly to the plan the nurse set; and a daily look at the wound and the skin around it so change gets caught early. On hospice, the nurse typically supplies the dressings, teaches the technique, and adjusts the plan — home wound care is a taught skill, not an improvised one.

Hospice is team-based care delivered where the person lives, and supporting the family doing the daily care is part of its design 1Ref 1MedlinePlus, U.S. National Library of Medicine (2024).Hospice Care.That hospice is team-based end-of-life care that can be delivered at home and that supports the family as well as the patient.. Between visits, the line answers 24 hours a day. Two habits make every visit count double: a photo of the wound in good light at each dressing change, so the nurse sees a timeline instead of a memory, and a running list of questions kept next to the supplies.

First, take the pressure off — completely

A pressure sore is skin and tissue dying from being squeezed between bone and a surface, so the treatment starts with subtraction: the sore bears no weight until it heals. In practice that means positioning the person off the wound with pillows and wedges, floating heels off the mattress with a pillow under the calves, and building a turning routine that never parks them on the damaged spot.

The usual sites are wherever bone sits close under the skin: tailbone, hips, heels, ankles, shoulder blades, the ears and the back of the head in someone who no longer turns. Nurses often size up risk with the Braden scale, which weighs things like mobility, moisture, and nutrition; a low score means tighter turning and more protection, not blame. Ask the nurse to sketch a repositioning schedule matched to this person rather than working from folklore — the right interval is individual. And when moving them, use the draw sheet instead of pulling by the arms: dragging a body across bedding shears fragile skin from the tissue underneath, which is how new sores start.

Cleaning and dressing without doing harm

Gentle wins. Wound nurses generally clean pressure sores with saline or a prescribed wound cleanser, pat — never rub — the area dry, and cover with the dressing named in the plan. The old instinct toward stinging antiseptics runs backward: hydrogen peroxide, rubbing alcohol, and iodine straight into an open wound damage the new tissue trying to grow, which is why clinicians keep them off the wound bed.

• Hands first. Washed before and after, every time, however tired you are.
• To the schedule, not past it. Each extra dressing change cools the wound and disturbs the new tissue at its edges. More is not better.
• The skin around the wound matters too. Clean, dry, and — where moisture keeps winning — a barrier cream the nurse names.
• Nothing gets trimmed at home. Loose or dead-looking tissue is the nurse's call, never scissors at the bedside.

If changes hurt, say so instead of bracing through them: hospice teams can time dressing changes to comfort medicines given exactly as their labels direct, and the home comfort kit exists precisely so that symptom rescue between visits is workable for families 2Ref 2Peer-reviewed study (see article) (2014).Comfort Care Kit: Use of Nonoral and Nonparenteral Rescue Medications at Home for Terminally Ill Patients with Swallowing Difficulty.The concept and utility of a home hospice comfort kit of rescue medications, reported by families as workable to use..

When to call the nurse about a pressure sore

Between visits, four changes justify picking up the phone the same day: redness or warmth spreading outward from the wound, drainage that turns thick, cloudy, or foul-smelling, new black or gray tissue in the wound bed, and any fever or new confusion in the person. Hospice lines are answered 24 hours a day, and a wound photo sent or described honestly beats a hopeful wait.

A few changes are worth mentioning at the next visit rather than the same day: the sore measuring larger or deeper, new pain in a wound that did not hurt before, or a fresh patch of skin over another bony point that stays red and does not lighten under a gentle press. That last one is a new sore starting, and catching it at that stage is the whole game.

Why some wounds near the end of life will not heal

Healing is work the body funds, and near the end of life the budget is running out. Hospice clinicians speak of skin failure: like other organs, skin can stop doing its job as the body winds down. The appetite loss and muscle wasting of advanced illness are not reversed by pressing more food or supplements on someone who cannot want them 3Ref 3National Cancer Institute (NIH) (2024).Nutrition in Cancer Care (PDQ) - Health Professional Version.That anorexia-cachexia in advanced illness near the end of life is not reversed by conventional nutrition support.. Some pressure sores in the last weeks are managed, not cured — and that is care, not failure.

When healing stops being achievable, the goals change shape — a wound that does not hurt, dressings that come off without tearing, odor controlled, the person's dignity intact — and quality standards for palliative care place exactly this kind of physical care at the center of the work 4Ref 4Ferrell BR, Twaddle ML, Melnick A, Meier DE (National Consensus Project) (2018).National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, 4th Edition.That physical aspects of care are a domain within the consensus quality standards for palliative care.. Those are real wins, and families who reach them are doing it right.

Is a bedsore a sign of bad care?

Not by itself. Sores can open despite attentive, loving care when circulation is failing, weight is gone, and every position hurts — the same physics that heals skin in a healthy body stops cooperating in a dying one. The honest questions are whether pressure is being relieved on schedule, whether the plan is being followed, and whether the team was told promptly. Yes to those three is good care, sore or no sore.

The same questions travel. In a nursing facility, it is fair to ask how often turning happens and to see it logged. If a deep wound appears suddenly with no explanation and the answers feel thin, raise it with the hospice team or the facility's director of nursing. Asking is advocacy, not accusation — and the teams doing this well will not mind the question.

Help beyond the nurse's visits

Nobody does this alone well. On hospice, aide visits can take over bathing and some of the skin care, and the nurse can add visits when a wound turns demanding. For someone seriously ill but not on hospice — when it isn't hospice yet — a palliative care referral brings symptom-focused clinicians alongside the regular doctors, and wound pain and skin care sit squarely inside their work.

Palliative care is not the same as hospice — it can run alongside curative treatment at any stage of a serious illness 5Ref 5National Institute on Aging (NIH) (2024).Frequently Asked Questions About Palliative Care.That palliative care can be given alongside curative treatment at any stage of a serious illness. — and what happens at a palliative care consult is closer to a long conversation than a procedure. Worth asking either team what equipment can come home, too: pressure-redistributing mattresses and cushions change the arithmetic of off-loading, and asking whether one is available through the benefit is a normal question, not a special request.