How Should Nursing Homes Prevent Pressure Injuries?
In last week’s blog, we looked at risk factors for pressure injuries (commonly known as pressure sores or bedsores). Below are some of the key prevention and intervention strategies that nursing homes should implement in order to protect their residents.
Effective prevention of pressure injuries demands a comprehensive approach focused on reducing pressure, protecting skin integrity, and supporting overall health. In elder abuse cases, evaluating whether these preventive measures were implemented is central to determining the standard of care in a facility.
Key Interventions
- Repositioning. The most fundamental intervention. Bedbound residents should be repositioned at least every two hours, while wheelchair users should shift weight even more frequently. These practices distribute pressure and protect bony prominences and other susceptible areas. Nursing homes should implement structured ‘Turning/Repositioning Programs’ — defined by CMS as organized, documented, monitored, and evaluated plans for realigning the body based on the resident’s needs.
- Protective Devices. Items like heel protectors, elbow pads, pillows, and wedges reduce pressure and friction on vulnerable areas. These devices are inexpensive, widely available, and their absence can be a red flag when assessing elder neglect.
- Support Surfaces. Specialized mattresses and cushions—foam, gel, air, low air loss, or alternating pressure designs—help redistribute pressure and manage skin microclimate. Proper use of these surfaces is a key indicator of care quality, while misuse or omission can support liability claims.
- Skin Inspections. Initial and ongoing assessments are essential for early detection. Care staff must monitor for redness, discoloration, warmth, or swelling and document findings. Early intervention is crucial, particularly for elderly or immobile residents whose wounds are difficult to heal once established.
- Skin Care. Maintaining clean, dry skin is critical. Moisturizers preserve hydration, while barrier creams protect against irritants and moisture. Evidence of poor skin care is indicative of neglect and can strengthen a case.
- Nutrition & Hydration. Adequate protein, vitamins, minerals, and fluid intake are essential for wound prevention and healing. Malnutrition or dehydration can directly contribute to injury development and serve as evidence of substandard care.
- Incontinence Management. Proper use of absorbent products, catheters, or bowel management programs helps protect skin from urine and feces. Poor management is a frequent basis for neglect claims.
- Mobility Support. Encouraging movement through therapy, caregiver assistance, and early mobilization after surgeries (e.g. hip repair) is vital for circulation, recovery, and prevention of complications like pneumonia, delirium, and pressure injuries. Physical therapists and all direct caregiving staff should participate in mobility support.
- Friction & Shear Prevention. Safe positioning techniques, such as using draw sheets or lifts instead of dragging, and limiting head-of-bed elevation to 30 degrees when possible, reduce shear forces. Improper handling that causes injury can strongly indicate neglect.
- Vascular Monitoring. Residents with vascular insufficiency require regular pedal pulse checks to assess blood flow. Facilities that fail to monitor and document circulation often face challenges in blaming pre-existing conditions for resulting pressure injuries.
- Caregiver Training & Education. Staff must be trained in repositioning, skin care, and device use. Educating residents and families can also empower them to advocate for care. In litigation, inadequate staff training is frequently cited as evidence of systemic neglect.
\If your loved one is in a nursing home and you suspect they have suffered a pressure injury as a result of neglect, an elder abuse attorney can help you determine whether or not you have grounds for an elder abuse lawsuit. Contact Dudensing Law to talk to an elder abuse attorney in Los Angeles, San Francisco, or Sacramento.
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