Pressure Ulcer Care at Home

Specialized Treatment for Pressure Injuries in the Comfort of Home

Pressure ulcers—also called pressure injuries, bedsores, or decubitus ulcers—develop when sustained pressure damages the skin and underlying tissues. These wounds range from mild skin reddening to deep injuries that expose muscle and bone, and they can develop with frightening speed in vulnerable individuals. At HarvardCare at Home, our wound care specialists provide expert pressure ulcer treatment throughout Los Angeles County, delivering the skilled nursing care needed to heal existing wounds and prevent new ones from forming—all in the comfort of your home.

Pressure ulcers require specialized treatment that addresses not just the wound itself but the underlying causes that allowed it to develop. Our comprehensive approach combines advanced wound care techniques with pressure redistribution strategies, nutritional optimization, and caregiver education. This multifaceted treatment produces better outcomes than wound care alone and helps prevent the recurrence that plagues many pressure ulcer patients.

Understanding Pressure Ulcers

Effective treatment begins with understanding how pressure ulcers form and progress.

How Pressure Ulcers Develop

Pressure ulcers form when sustained pressure compresses soft tissue between a bony prominence and an external surface like a mattress or chair. This compression restricts blood flow, depriving tissue of oxygen and nutrients. Without adequate circulation, tissue begins to die. The damage often starts deep in the tissue and works outward, meaning visible skin changes may underrepresent the extent of injury beneath.

Contributing factors accelerate pressure damage. Friction occurs when skin rubs against surfaces during repositioning. Shear happens when the skin stays in place while underlying tissue shifts, as when someone slides down in bed. Moisture from incontinence or perspiration weakens skin and increases vulnerability. Poor nutrition deprives tissue of resources needed for resilience and repair. And impaired sensation means the person cannot feel the discomfort that would normally prompt position changes.

Stages of Pressure Ulcers

Pressure ulcers are classified by depth of tissue damage.

Stage 1 pressure ulcers present as intact skin with non-blanchable redness—when you press on the area, it does not turn white and then return to red as healthy tissue would. The area may be painful, firm, soft, or warmer or cooler than surrounding skin. This stage is reversible with prompt intervention.

Stage 2 pressure ulcers involve partial-thickness skin loss exposing the dermis. The wound bed is pink or red and moist, and may present as an intact or ruptured blister. These wounds are shallow without slough or eschar.

Stage 3 pressure ulcers involve full-thickness skin loss. Fat may be visible in the wound, and slough may be present. The depth varies by anatomical location—areas with significant subcutaneous tissue can develop very deep Stage 3 wounds.

Stage 4 pressure ulcers involve full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone. Slough and eschar may be present. These wounds often include undermining and tunneling.

Unstageable pressure ulcers have full-thickness tissue loss obscured by slough or eschar. Until enough dead tissue is removed to expose the wound base, true depth cannot be determined.

Deep tissue pressure injuries present as intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, or purple discoloration or epidermal separation revealing a dark wound bed. These indicate damage to underlying soft tissue from pressure or shear, and they may evolve rapidly to reveal full tissue loss.

Common Locations

Pressure ulcers develop over bony prominences where tissue compression is greatest. For patients who spend significant time in bed, common locations include the sacrum and coccyx, heels, back of the head, shoulder blades, elbows, and spine. For patients who sit for extended periods, the ischial tuberosities, sacrum and coccyx, and shoulder blades are most vulnerable. Any bony area under sustained pressure can develop injury.

Our Pressure Ulcer Treatment Approach

Healing pressure ulcers requires comprehensive treatment addressing all factors affecting wound healing.

Thorough Wound Assessment

Effective treatment begins with detailed assessment. We evaluate wound stage, size, and depth, including any undermining or tunneling. We assess the wound bed for tissue types present—granulation, slough, eschar, or necrotic tissue. We examine wound edges and surrounding skin. We document drainage characteristics including amount, color, and odor. We identify signs of infection. And we assess factors affecting healing including nutrition, circulation, pressure exposure, and overall health status. This comprehensive assessment guides treatment planning and provides baselines for measuring progress.

Wound Bed Preparation

Healing requires a clean, well-prepared wound bed. Depending on wound characteristics, preparation may include debridement to remove dead tissue that impedes healing, cleansing with appropriate solutions, management of bacterial burden, and moisture balance optimization. Our nurses are skilled in various debridement methods and select approaches based on wound needs, patient tolerance, and healing goals.

Advanced Wound Dressings

Modern wound care offers numerous dressing options, and selection should match wound characteristics. We utilize foam dressings that absorb drainage while maintaining moisture, hydrocolloid dressings that support autolytic debridement, alginate dressings for highly draining wounds, hydrogel dressings that donate moisture to dry wounds, antimicrobial dressings when bacterial burden is concern, silicone-bordered dressings that protect fragile surrounding skin, and composite dressings combining multiple properties. We select and adjust dressings based on wound response, changing approaches as wounds evolve through healing phases.

Negative Pressure Wound Therapy

For appropriate wounds, negative pressure wound therapy accelerates healing by removing excess fluid, reducing edema, promoting granulation tissue formation, and drawing wound edges together. Our nurses are trained in NPWT application and management, bringing this advanced therapy to your home when indicated.

Infection Management

Pressure ulcers are vulnerable to infection, which can delay healing and cause serious complications including bone infection and sepsis. We monitor carefully for infection signs, obtain cultures when indicated, and coordinate with physicians regarding antibiotic therapy when needed. Prompt infection identification and treatment is critical for healing and safety.

Addressing Underlying Causes

Wound care alone cannot heal pressure ulcers if the factors causing them persist. We address underlying causes as part of comprehensive treatment.

Pressure Redistribution

Continued pressure prevents healing and causes new injuries. We assess your current support surfaces—mattress, cushions, and positioning devices—and recommend improvements when needed. We develop and teach repositioning schedules appropriate for your risk level. We ensure proper technique for turning and positioning. And we address any equipment needs, coordinating with physicians and insurance for specialty support surfaces when indicated.

Friction and Shear Reduction

We teach techniques that minimize friction and shear during transfers and repositioning. Proper lifting rather than dragging, use of draw sheets, and correct bed positioning all reduce tissue damage. These techniques protect healing wounds and prevent new injuries.

Moisture Management

Excess moisture from incontinence or perspiration damages skin and accelerates breakdown. We address incontinence management strategies, recommend appropriate skin protectants, and ensure moisture is controlled to support skin integrity.

Nutritional Optimization

Healing wounds require adequate protein, calories, vitamins, and minerals. Malnourished patients struggle to heal and remain vulnerable to new injuries. We assess nutritional status, identify deficiencies, and coordinate with physicians regarding nutritional interventions. Adequate nutrition is essential for pressure ulcer healing.

Circulation Support

Adequate blood flow delivers oxygen and nutrients needed for healing. When circulation is compromised, we incorporate strategies to optimize blood flow to affected areas and coordinate with physicians regarding any vascular concerns.

Prevention: Protecting Vulnerable Skin

For patients at risk, prevention is as important as treatment of existing wounds.

Risk Assessment

We use validated assessment tools to identify patients at high risk for pressure ulcer development. Risk factors include limited mobility, impaired sensation, incontinence, poor nutrition, altered consciousness, and certain medical conditions. Understanding risk level guides prevention intensity.

Skin Inspection

Regular skin inspection catches problems early when intervention is most effective. We teach patients and caregivers how to inspect skin over bony prominences, what changes to look for, and when to report concerns.

Preventive Positioning

Regular position changes prevent sustained pressure. We develop individualized turning schedules, teach proper positioning techniques, and recommend positioning devices that protect vulnerable areas.

Support Surface Optimization

Appropriate mattresses and cushions redistribute pressure and reduce risk. We assess current surfaces and recommend upgrades when needed to match the patient’s risk level.

Skin Care Protocols

We establish skin care routines that maintain skin integrity—appropriate cleansing, moisturization, and protection from moisture and friction.

Caregiver Education

Family caregivers play essential roles in pressure ulcer prevention and treatment. Our education includes recognizing early warning signs of pressure injury, proper repositioning and turning techniques, correct use of support surfaces and positioning devices, skin inspection procedures, moisture management and incontinence care, nutrition support strategies, and when to contact healthcare providers. This education empowers caregivers to provide effective daily care between nursing visits.

Who We Treat

Our pressure ulcer care program serves patients across the risk spectrum.

Patients with Existing Pressure Ulcers

Whether you have a Stage 2 wound that needs professional management or a complex Stage 4 injury requiring intensive care, we provide the skilled nursing needed for healing.

High-Risk Patients

Patients with spinal cord injuries, severe mobility limitations, neurological conditions affecting sensation, or other high-risk factors benefit from preventive programs that protect vulnerable skin.

Post-Hospital Patients

Patients discharged with pressure ulcers that developed during hospitalization need continued skilled care to complete healing at home.

Patients with Recurring Wounds

Some patients develop pressure ulcers repeatedly despite preventive efforts. We provide intensive assessment and intervention to break the cycle of recurrence.

The Home Care Advantage

Treating pressure ulcers at home offers significant benefits.

Your Actual Environment

We see and address the specific surfaces, equipment, and conditions affecting your skin. Recommendations are tailored to your actual situation rather than generic advice.

Caregiver Involvement

Family members who provide daily care receive hands-on training in your home, learning techniques specific to your needs and environment.

Consistent Monitoring

Regular home visits allow consistent wound monitoring and early intervention if problems develop.

Comfort and Reduced Infection Risk

Healing at home avoids the infection risks associated with healthcare facilities and allows recovery in familiar, comfortable surroundings.

Insurance Coverage

Skilled nursing care for pressure ulcers is covered by Medicare Part A for homebound patients with physician orders. Pressure ulcer treatment is recognized as essential skilled care requiring professional nursing intervention. Medi-Cal and most private insurance plans provide similar coverage. Some specialty equipment and advanced therapies may require additional authorization.

Our team handles verification and authorization so you can focus on healing.

Getting Started

If you or a loved one has a pressure ulcer or is at high risk for developing one, contact HarvardCare at Home today. Our wound care specialists provide expert pressure ulcer treatment and prevention throughout Los Angeles County.

Pressure ulcers can heal with proper care, and new ones can be prevented. Do not let these painful, dangerous wounds persist without expert intervention. Call today for a free consultation and take the first step toward healing.