Caregiver checking on an older resident resting in bed in a residential care room

Pressure Injury Prevention in Nursing Homes: A Family Checklist

ByNHP Specialist Care Team

A pressure injury can begin with skin that looks different, feels warmer or cooler, or becomes painful before there is an obvious open wound. For a person who spends much of the day in bed or a chair, prevention depends on many small pieces of care happening consistently: movement, skin checks, moisture management, nutrition, support surfaces, and attention to medical devices.

Families sometimes hear a single reassuring statement such as “we turn everyone every two hours” or “we use pressure-relieving mattresses.” Neither statement, by itself, tells you whether the prevention plan fits your parent.

The better question is how the nursing home assesses this resident’s risk and turns that assessment into an individualized daily plan that staff can actually carry out and review.

What federal nursing-home rules require

Federal quality-of-care rules address skin integrity directly. Under 42 CFR 483.25(b), a Medicare- or Medicaid-certified nursing home must provide care, based on the resident’s comprehensive assessment and consistent with professional standards, to prevent pressure ulcers. The regulation says a resident should not develop pressure ulcers unless the individual’s clinical condition demonstrates that they were unavoidable.

If a resident already has a pressure ulcer, the facility must provide necessary treatment and services to promote healing, prevent infection, and prevent new ulcers from developing.

This wording matters. It does not support the simplistic claim that every pressure injury proves neglect. Some injuries can occur despite appropriate care because of the person’s clinical condition. It also does not permit a facility to dismiss a new injury as “just part of aging” without assessing what happened and whether the prevention plan needs to change.

Families can ask for the resident-specific evidence: risk assessment, care-plan interventions, skin findings, treatment orders, and follow-up.

Start with the risk assessment, not the mattress

Pressure injuries are associated with prolonged pressure on skin and underlying tissue. Risk can rise when a person has limited mobility, reduced sensation, incontinence, poor nutritional status, serious illness, fragile skin, or medical devices that press on tissue.

Ask the nursing team:

  • What makes my parent high, moderate, or lower risk right now?
  • When was the skin and mobility risk last reassessed?
  • What changed after the latest hospitalization, weight loss, decline in mobility, or new device?
  • Which specific interventions are in the care plan because of those risks?
  • Who checks whether the plan is actually being followed?

A useful answer connects the assessment to actions. For example, “because she cannot reliably shift her weight and has heel redness, we are using a specific heel-offloading plan, a support surface, scheduled position changes based on her tolerance, and skin checks at defined times.”

A vague answer such as “we have special mattresses” leaves important questions unanswered.

Repositioning should be individualized and documented

Changing position can reduce prolonged pressure, but families should be cautious with a universal schedule repeated without context. Consumer resources sometimes give general timing examples, yet a nursing-home plan should reflect the resident’s assessment, support surface, ability to move independently, skin condition, comfort, medical restrictions, and professional judgment.

Ask what the planned position changes are for your parent, not just the building’s slogan. Then ask how staff know they occurred. If your parent can reposition independently, ask how the team supports and verifies that ability rather than assuming it.

AHRQ’s nursing-home pressure-ulcer prevention resources identify positioning frequency, support surfaces, friction and shear, incontinence, nutrition, pain, and medical-device pressure as elements facilities should consider in prevention planning.

For a resident in a chair, ask how weight shifts, seating, cushions, time in the chair, and transfers are handled. For someone in bed, ask about position choices, heel protection, and whether the mattress or overlay matches the resident’s needs.

Do not add or remove cushions, heel devices, or positioning equipment on your own without discussing it with the clinical team. The wrong device or placement can create new pressure or interfere with another treatment.

Skin checks should focus on change, not just open wounds

Pressure injury prevention includes noticing early changes. Ask which areas are checked and how often the plan calls for checks, especially around bony areas and underneath or beside devices.

MedlinePlus identifies common pressure areas such as the heels, hips, buttocks, elbows, shoulders, back, ankles, and back of the head. The relevant areas depend on the resident’s position and equipment.

Families can ask staff to explain what changes they are watching for without attempting to diagnose or stage an injury themselves. Color changes can look different across skin tones, and deep-tissue injury may not begin as a classic red spot.

If you notice new discoloration, warmth, swelling, tenderness, blistering, an open area, or a change near a device, point it out promptly and ask for clinical assessment. Photographing a skin area can be useful only if the resident consents and the facility’s privacy rules allow it; a family photo is not a substitute for a professional assessment.

Moisture, incontinence, friction, and shear belong in the same conversation

Skin can be more vulnerable when it is repeatedly exposed to urine, stool, sweat, drainage, or friction. Sliding down in a bed or chair can also create shear forces that stress tissue.

Ask how the care plan addresses:

  • toileting and incontinence care;
  • cleansing and moisture protection;
  • transfers that reduce dragging across sheets or cushions;
  • bedding and clothing that stay dry and smooth;
  • whether the resident slides down in bed or a chair;
  • device tubing, oxygen equipment, splints, braces, or catheters that may create pressure.

This is another reason call-bell response and staffing matter. A person who needs help with toileting or repositioning may depend on staff assistance to keep skin clean, dry, and relieved from pressure. Ask the facility directly how residents obtain timely repositioning and toileting help, including what happens when the assigned aide is already assisting another resident.

Nutrition and hydration are part of prevention and healing

Skin integrity is not only a positioning issue. AHRQ prevention materials include nutritional screening, estimated requirements, intake compared with needs, reassessment, and weight patterns among the areas facilities may review for at-risk residents.

Ask whether your parent has had recent weight loss, reduced appetite, swallowing difficulty, dehydration concerns, or changes in the amount they eat. Ask what the team is monitoring and whether a dietitian, speech-language pathologist, clinician, or other professional is involved when appropriate.

Do not assume a supplement drink solves every nutrition problem. The resident’s needs, preferences, medical conditions, swallowing safety, and goals of care all matter. If eating or weight has changed, our article My Parent Is Eating Less and Losing Weight: When Is More Care Needed? can help you organize the broader clinical conversation.

If an injury appears, ask for the treatment and prevention plan together

Once a pressure injury is identified, treatment and prevention of additional injury should be connected. Ask:

  • Where is the injury and how is it being clinically described?
  • When was it first identified and who was notified?
  • What treatment has been ordered?
  • How is pressure being relieved from that area?
  • What changed in the care plan to prevent another injury?
  • How often is healing being reassessed, and what would trigger a change in treatment?

You do not need to become a wound-care specialist to ask these questions. The facility should be able to explain the plan in understandable terms and identify the clinician responsible for follow-up.

MedlinePlus advises contacting a clinician promptly when a pressure sore changes or a new sore forms. Signs that may indicate infection include foul odor or pus, increasing redness or tenderness, warmth or swelling, and fever. If a resident appears seriously ill or is in immediate danger, seek urgent or emergency medical evaluation rather than waiting for the next routine care-plan meeting.

Use facility data as a screening tool, not a personal prediction

CMS publishes nursing-home inspection, staffing, and quality information. Some quality measures include pressure ulcers or pressure injuries. Those data can help families identify questions, but CMS cautions that quality measures are not standards of care and do not describe a single resident’s experience.

Start with our guide to nursing-home inspection reports and nursing-home staffing ratings. Look for repeated concerns involving skin care, assessment, staffing, nutrition, or care planning. Then ask the facility what changed after those findings.

During a tour, our broader nursing-home tour checklist can help you compare the rest of the care environment. A clean room and a new mattress are useful observations, but they cannot substitute for asking how the clinical plan is implemented across shifts.

A practical example

James’s mother returns from the hospital weaker than before. She now needs help turning in bed and has lost weight. The nursing home tells James that she will receive a pressure-relieving mattress, which sounds reassuring.

James asks what else is in the prevention plan. The nurse explains that the team will reassess her skin and mobility risk, protect her heels, assist with position changes based on the plan, monitor moisture and continence care, and refer the weight loss for nutrition follow-up. James asks who documents the interventions and what he should report if he sees a new skin change.

The conversation does not guarantee that a pressure injury can never occur. It does give the family a clear plan to understand, observe, and revisit if her condition changes.

Five questions to bring to the care team

  1. What are my parent’s pressure-injury risk factors, and when were they last reassessed? Ask how recent changes in mobility, weight, continence, sensation, illness, or devices affect the plan.
  2. What is the individualized pressure-relief and repositioning plan? Ask about bed and chair positions, heels, support surfaces, transfer assistance, and how completion is documented.
  3. How are skin and moisture checked across shifts? Ask who reports a new change and how quickly clinical assessment occurs.
  4. How are nutrition, hydration, pain, and medical-device pressure addressed? Ask which professionals are involved when the resident has a problem in one of these areas.
  5. If a pressure injury appears, how will treatment and prevention change? Ask who follows healing, how infection concerns are handled, and when the family will be updated.

If you are comparing facilities, browse communities and use these questions with each nursing home’s actual clinical team. Confirm current services, staffing, care capability, and availability directly with the provider.

Sources and review date

Sources checked October 11, 2026. This article is general U.S. education for families and is not a diagnosis, wound-care order, or substitute for the resident’s clinicians. Individual prevention and treatment should follow the resident’s assessment, professional standards, current orders, and person-centered care plan.

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