How to Care for a Pressure Injury at Home — A Caregiver's Guide

If you're the primary caregiver for a parent, spouse, or family member with limited mobility, you've probably been told to "watch for pressure injuries." Most caregivers aren't trained in what that actually looks like, how to act fast when it happens, or what dressings to use at each stage. This guide is the working version we've assembled with input from home-health wound care nurses.

Important: this guide is educational. Pressure injuries can be serious. Stage 3 and stage 4 injuries should be managed under the care of a wound care clinician. Use this guide to recognize early-stage injuries and act fast, and as a reference between clinic visits.

What a pressure injury is

A pressure injury is tissue damage from sustained pressure on a small area — usually a bony prominence like the tailbone, hips, heels, ankles, or back of the head. The skin and underlying tissue get compressed between the bone and an outside surface (mattress, wheelchair, cast). Blood flow stops, tissue starts to die.

Risk factors: limited mobility, sitting or lying in one position for hours, malnutrition, dehydration, incontinence (moisture damages skin), diabetes, advanced age, neurological conditions affecting sensation.

The four stages, recognized at home

Stage 1 — intact skin, but reddened

Skin looks pink or red on lighter skin tones; purple or darker on darker skin tones. Does not blanch (turn white) when pressed. May be tender, warmer or cooler than surrounding skin. This is the stage where you can usually prevent escalation with pressure relief alone.

Stage 2 — open wound, dermis exposed

The skin has broken or torn. You can see pink or red wound bed, sometimes a fluid-filled blister. The wound is shallow. Painful.

Stage 3 — full-thickness skin loss

The wound now extends through the skin into the subcutaneous fat layer. You may see yellowish slough or some granulation tissue. Often deeper than it looks.

Stage 4 — exposed muscle, tendon, or bone

Wound extends through the subcutaneous layer and exposes deeper structures. Often has slough or eschar (dead tissue). High infection risk.

There are two more categorizations to know: unstageable (the wound is covered in slough or eschar so depth can't be assessed) and deep tissue injury (intact but discolored skin signaling damage underneath, often progresses to a deeper stage).

Step 1: relieve the pressure — immediately

This is the single most important intervention at every stage. No dressing in the world fixes a pressure injury if pressure keeps being applied to it.

  • Reposition every 2 hours if your loved one is in bed. Every 1 hour if seated.
  • Use pillows or wedges to keep bony prominences off the mattress. Float heels off the bed with a pillow under the lower calves.
  • Don't drag — lift. Dragging skin against bedding creates shear injuries that look like pressure injuries.
  • For wheelchair use, push-ups or weight shifts every 15–30 minutes.
  • Consider a pressure-redistribution mattress overlay or cushion. Your insurance may cover this — ask the home health nurse for a Letter of Medical Necessity.

Step 2: care for the wound by stage

Stage 1

  • Pressure relief is the treatment. Do not massage the area (massage doesn't help and can deepen the injury).
  • Keep the skin clean and dry. Use a barrier cream if incontinence is a factor.
  • Reassess every 12 hours. If it's not resolving in 48 hours, escalate to a clinician.

Stage 2

  • Cleanse with sterile saline. Pat dry.
  • Use a hydrocolloid dressing (shallow) or thin collagen dressing for moist wound healing.
  • Change every 2–3 days, or sooner if drainage saturates the secondary cover.
  • Watch for signs of infection (warmth, redness spreading, pus, odor) and escalate immediately.

Stage 3

  • Get a wound care nurse involved. Stage 3 injuries should not be managed by caregivers alone.
  • Typical management: collagen primary dressing sized to the wound, foam secondary dressing for drainage management, change every 1–3 days.
  • Nutrition matters: ensure adequate protein and hydration; wound healing requires both. Most home health nurses will request a nutrition assessment.

Stage 4

  • Clinical management required. Wound care nurse, possibly wound clinic visits, possibly surgical debridement.
  • Standard layered dressing: collagen powder packed into tunneling/dead space, collagen sheet over the wound bed, foam secondary, change every 1–2 days.
  • Watch closely for systemic infection (fever, confusion, lethargy in the person). Escalate to ER if you see these.

Step 3: nutrition and hydration

Wound healing requires building blocks. Pressure injury patients typically need:

  • Increased protein intake — aim for 1.2–1.5g protein per kg body weight per day (your clinician will refine this).
  • Adequate fluids — dehydration slows healing and concentrates urine, which damages already-compromised skin.
  • Vitamin C, zinc, and arginine are micronutrients that support wound healing. Ask the clinician about supplements.

Red flags — when to call a clinician immediately

  • The wound is hot, very red, or producing pus.
  • Red streaks moving away from the wound.
  • The person has a fever, chills, or seems confused.
  • The wound is deeper than it was 24 hours ago.
  • You see exposed bone or tendon.
  • The person has diabetes and the injury is on a heel or foot.

Common mistakes to avoid

  • Massaging the reddened area. Doesn't work and can deepen damage.
  • Using hydrogen peroxide or alcohol in the wound. Damages new tissue. Use sterile saline.
  • Drying out the wound. Moist wound healing is the standard. Cover with appropriate dressing.
  • Reusing dressings. Single-use only. Reuse risks infection.
  • Letting one position become "comfortable" for too long. 2-hour repositioning is non-negotiable.

Putting it together

Pressure injuries are largely preventable and, when caught at stage 1 or 2, fully reversible at home. The recipe is consistent pressure relief, clean dressings appropriate to the stage, adequate nutrition, and fast escalation when anything looks wrong.

For stage 2+ injuries, the Ovena Collagen Wound Care Kit includes sized dressings, sterile saline wash, gloves, and tape — everything for a full dressing change in one package. FSA/HSA eligible. Reimbursement guide here.

Informational only — not medical advice. Always work with your wound care clinician on staging and treatment.

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