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Bed Sores (Pressure Injuries)

Sores that form when skin is pressed against a bed or chair for too long, usually over bony spots such as the tailbone, hips and heels. They can become deep and dangerously infected, but most can be prevented with regular position changes, daily skin checks and good care.

Get medical help right away if a bed sore shows signs of infection:

Possible sepsis is an emergency. An infected sore can lead to sepsis, the body’s extreme, life-threatening reaction to an infection (Cleveland Clinic, CDC). Watch for confusion or disorientation, clammy or sweaty skin, extreme pain or discomfort, fever, shivering or feeling very cold, a high heart rate or weak pulse, and shortness of breath (CDC). Get medical care immediately (CDC, MedlinePlus) — Cleveland Clinic advises going to the emergency room for any symptoms of sepsis (Cleveland Clinic). If the person is very confused, hard to wake or struggling to breathe, call 911.

What is a bed sore?

A bed sore is an area of damaged skin, and sometimes the tissue underneath, caused by staying in one position too long (MedlinePlus, NHS). You may also hear them called pressure injuries, pressure ulcers, pressure sores or decubitus ulcers (Cleveland Clinic). When something keeps pressing or rubbing on the skin, it cuts down the blood flow, and without enough blood the skin can die (MedlinePlus). Damage can start in as little as two hours, and friction, moisture from sweat, urine or stool, and skin being pulled as someone slides down in a bed or wheelchair all make it more likely (Cleveland Clinic).

They are common: more than 2.5 million people in the United States develop pressure ulcers each year, bringing pain and a risk of serious infection (AHRQ).

Where do they form?

Most often over bony areas close to the skin: the tailbone and buttocks, hips, heels, ankles, elbows, shoulder blades, spine and the back of the head (MedlinePlus, Cleveland Clinic). They can also form under medical equipment — for example on the ears or the bridge of the nose from oxygen tubing (Cleveland Clinic).

Who is at risk?

Anyone who can’t easily change position: people who are bedridden, use a wheelchair, or can’t move on their own (MedlinePlus). Cleveland Clinic says people who are older, immobile or bedridden are most at risk (Cleveland Clinic). Other things that raise the risk include:

The stages

Clinicians grade pressure injuries by how deep the damage goes. The National Pressure Injury Advisory Panel updated its definitions in 2016 and uses Stages 1 to 4 plus “unstageable” and “deep tissue” injuries (NPIAP, archived copy). In plain terms:

Stage 3 and 4 sores are the hardest to treat and carry the highest risk of serious infection, including bone and joint infections and sepsis (Cleveland Clinic).

Why prevention matters

Healing can take weeks or months, and healed skin is never quite as strong as it was before (Cleveland Clinic). The good news is that the basics — regular position changes, the right mattress or cushion, daily skin checks, clean and dry skin, and good food and fluids — are things families and care teams can do every day (NHS, MedlinePlus). Hospitals are encouraged to check every patient’s skin from head to toe, assess their risk with a standard tool, and build a care plan around it (AHRQ).

In a nursing home that takes part in Medicare or Medicaid, preventing and treating pressure ulcers is a legal duty (42 CFR 483.1): federal rules say residents must get care to prevent them and must not develop them unless their medical condition made it unavoidable (42 CFR 483.25). See Wellness coaching below for how to speak up if you are worried about someone’s care.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Taking pressure off (regular repositioning, pressure-relieving mattresses and cushions), cleaning and dressing the wound, removing dead tissue (debridement), antibiotics for infection, a nutrition check, and surgery for some deep sores — often with a wound-care nurse or specialist. Medicare Part B can help pay for pressure-reducing mattresses and overlays used at home (some types need prior approval); after the Part B deductible you pay 20% of the Medicare-approved amount. If you qualify for Medicare home health care, skilled nursing including wound care for pressure sores costs nothing. Other wound-care costs: estimate being researched. Early sores can often be cared for at home with guidance; deep sores need a specialist and can take weeks or months to heal. Healed skin stays fragile, so prevention carries on.
Chiropractic Being researched — coming soon.
Acupuncture Being researched — coming soon.
Herbal medicine Medical-grade honey dressings, used by a clinician; and making sure the person gets enough calories, protein and fluids, with supplements only if a dietitian finds a shortfall. Cost estimate being researched. Honey has only very-low-quality evidence for pressure sores (one small trial). Supplements may slightly help sores heal but the evidence is uncertain, and they may make little or no difference to preventing them. Never put kitchen honey or other home remedies on an open wound.
Massage therapy Not a treatment for bed sores. Never massage or rub reddened skin, bony areas, or skin on or near a sore. Cost estimate being researched. We found no evidence that it prevents or heals bed sores. Guidelines advise against massage or rubbing to prevent pressure sores, and it can cause more damage near an ulcer. Ask the care team before any massage for someone at risk.
MBHA Wellness Coach A daily caregiver routine: skin checks, a turning schedule, wheelchair pressure reliefs, clean and dry skin, incontinence care, food and fluids, safe moving — plus help speaking up in a hospital or nursing home and reaching the Long-Term Care Ombudsman. Long-Term Care Ombudsman services are free and confidential. MBHA coaching cost estimate being researched. Steady daily habits are the heart of prevention, and a spinal-cord-injury resource center says most pressure sores are preventable. Coaching works alongside the care team, never instead of it.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on how deep the sore is. Stage 1 and 2 sores can often be cared for by you or a caregiver with guidance; Stage 3 and 4 sores usually need a wound-care specialist (Cleveland Clinic, MedlinePlus). See a doctor if you think you or someone you care for has a pressure sore (NHS).

1. Take the pressure off

Nothing heals while the pressure continues. Changing position regularly relieves pressure and helps prevent new sores (NHS). MedlinePlus suggests changing position about every 2 hours in bed and about every 15 minutes in a wheelchair, and avoiding positions that press on the sore (MedlinePlus). The right schedule depends on the person, so ask the care team to set one (MSKTC).

2. Clean and dress the wound

  • A Stage 1 area is washed gently with mild soap and water; a Stage 2 sore is usually cleaned with saline (salt water) or a cleanser the provider recommends (MedlinePlus).
  • Dressings — such as film, foam, gel (hydrogel), hydrocolloid or alginate — protect the sore and keep it moist; the provider will say which to use and how often to change it (MedlinePlus, Cleveland Clinic).
  • Don’t use hydrogen peroxide or iodine cleansers unless a provider tells you to — they can damage the skin (MedlinePlus).
  • Which dressing works best? A large 2017 Cochrane review couldn’t tell: the studies were small and mostly low or very low certainty, so clinicians choose based on the wound, their experience, the patient’s wishes and cost (Cochrane review).

3. Remove dead tissue (debridement)

Dead tissue slows healing. A clinician may cut it away (often after numbing the area) or use ointments or special dressings that help the body break it down (Cleveland Clinic, NICE). This is a job for a trained professional, not something to try at home.

4. Treat infection

Antibiotics are used when a sore is infected (NHS, Cleveland Clinic). NICE advises antibiotics by mouth or vein for signs of spreading infection such as sepsis, spreading cellulitis or bone infection (osteomyelitis), but not simply to make a sore heal (NICE). Tests may include blood cultures, X-rays or MRI scans to look for deeper infection (Cleveland Clinic).

5. Nutrition

Good nutrition supports healing (MedlinePlus). NICE recommends that adults with a pressure ulcer get a nutrition assessment from a dietitian or other trained professional, and supplements if they have a nutritional shortfall (NICE) — see Herbal medicine below for what the research shows.

6. Surgery

Some severe sores need surgery to clean and close the wound, for example with a skin graft (NHS, Cleveland Clinic).

Who to see

Start with the person’s doctor or nurse. For deeper sores, a wound specialist is usually involved (Cleveland Clinic). MedlinePlus has a helpful list of questions to take to the appointment — about which areas to check, which dressings and mattresses to use, how often to turn, and which signs mean the sore is getting worse (MedlinePlus).

What it costs

  • Pressure-reducing mattresses and overlays (Medicare): Part B covers durable medical equipment that a provider orders for use at home, from a Medicare-enrolled supplier (Medicare.gov). Certain powered air mattresses, air-flotation beds and advanced overlays need prior authorization: the supplier and provider send the paperwork to Medicare first, and a denial can be appealed (Medicare fact sheet). After the Part B deductible you pay 20% of the Medicare-approved amount if the supplier accepts assignment (Medicare.gov).
  • Home health wound care (Medicare): if a doctor certifies that the person is homebound and needs part-time skilled care, Medicare home health covers skilled nursing, including wound care for pressure sores, and you pay nothing for the covered home health services (Medicare.gov).
  • Wound-clinic visits, private-pay supplies and surgery: MBHA cost estimate being researched.

How well it works — what to expect

Healing can take weeks or months; Stage 3 and 4 sores are the hardest to treat (Cleveland Clinic). Because healed skin is weaker than before, the prevention routine carries on after the sore closes (Cleveland Clinic).

Find a medical doctor in our directory

Approach 4 of 6

Herbal medicine

There is no herb that heals a bed sore. Two topics come up often, though: honey dressings and nutrition supplements.

Medical-grade honey dressings

Honey has been used on wounds since ancient times (Cochrane review). Here is what the evidence shows:

  • The 2015 Cochrane review of honey for wounds found only one small trial in pressure ulcers (40 people), where honey healed sores faster than saline soaks — but the evidence was rated very low quality. Overall, the reviewers found it hard to draw conclusions about honey for most wounds (Cochrane review).
  • Memorial Sloan Kettering notes that small studies suggest manuka honey may help wound healing, but some trials found it no better than standard treatment, and it advises patients not to treat themselves with honey products (Memorial Sloan Kettering).
  • Medical-grade honey is sterilized and meets safety standards for medical use, while ordinary commercial honey has weaker antibacterial activity (review, JAR Life, 2024 — note that two of its authors work for a company that makes honey wound dressings).

Safety. Don’t put kitchen honey, sugar, oils or other home remedies on an open wound. If honey is an option, it should be a medical-grade dressing chosen and checked by the person’s nurse or doctor (Memorial Sloan Kettering). People allergic to honey should avoid it, and the sugar in manuka honey may raise blood sugar in people with diabetes (Memorial Sloan Kettering).

Protein, zinc, vitamin C and other supplements

Eating enough calories and protein and drinking plenty of water helps keep skin healthy (MedlinePlus), and poor nutrition is a known risk factor (MedlinePlus). But do special supplements help? The 2024 Cochrane review of 33 trials found:

  • Prevention: energy, protein and micronutrient supplements, or protein supplements alone, may make little or no difference to whether a person develops a pressure ulcer (low-certainty evidence) (Cochrane review).
  • Healing: energy, protein and micronutrient supplements may slightly increase the number of sores that heal (low-certainty evidence). Collagen supplements probably helped sores shrink in one study. The evidence for vitamin C, zinc and several other supplements on their own was very uncertain (Cochrane review).
  • Overall, the reviewers concluded that the benefits are uncertain and there may be little or no difference compared with a standard diet (Cochrane review).

This matches NICE, which recommends a nutrition assessment for anyone with a pressure ulcer and supplements for people with a nutritional shortfall — but not supplements for people who are already eating well (NICE). Ask the care team or a dietitian before starting any supplement, especially if the person takes other medicines. We don’t list doses here.

Approach 5 of 6

Massage therapy

Don’t massage or rub reddened skin, bony areas, or skin on or near a sore. Rubbing the skin on or near a pressure ulcer can cause more damage (MedlinePlus), and the UK’s NICE guideline says not to offer skin massage or rubbing to prevent pressure ulcers in adults or children (NICE).

It can be tempting to rub a red spot, but current guidance says not to (see above). The helpful thing to do with a red area is to take the pressure off it and tell the care team (MedlinePlus).

We found no evidence that massage prevents or heals bed sores. If someone who spends a lot of time in bed or a chair would like massage of other areas for comfort, be careful: older people have a higher risk of injury from massage, and rare serious problems such as blood clots, nerve injury or broken bones have been reported, more often with vigorous techniques such as deep tissue massage (NCCIH). Discuss it with the person’s health care provider first, and don’t use massage to put off seeing a provider about a medical problem (NCCIH). Any therapist should be told which areas are at risk so they can stay well away from them.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Most of the work of preventing bed sores happens at home and at the bedside, day after day, and it often falls to family members. The Model Systems Knowledge Translation Center, a spinal-cord-injury resource, says most pressure sores are preventable (MSKTC). An MBHA Wellness Coach can help caregivers set up a routine that sticks, keep track of it, and know when and how to speak up.

A daily skin check

Turning and positioning in bed

Wheelchair users

  • Shift weight often — MedlinePlus suggests every 15 to 20 minutes (leaning forward and side to side), and MSKTC suggests a pressure relief every 15 to 30 minutes lasting at least 30 to 90 seconds (MedlinePlus, MSKTC). A phone timer makes this easier to remember.
  • Use a foam or gel cushion that fits the chair, and have the chair’s fit checked once or twice a year, or sooner if the person gains weight (MedlinePlus).

Clean, dry skin and incontinence care

Food and fluids

Help the person eat enough calories and protein and drink plenty of water each day (MedlinePlus, Cleveland Clinic). Poor nutrition keeps tissue from rebuilding and fighting infection (MSKTC). If appetite is poor, ask for a dietitian. Not smoking helps too (NHS).

Working with the care team

Ask for a pressure-sore risk assessment so the care team can make a prevention plan (NHS), and bring the MedlinePlus list of questions to appointments (MedlinePlus). If the person is going home from the hospital, ask whether they qualify for Medicare home health care, which can include wound care for pressure sores (Medicare.gov), and whether a pressure-reducing mattress or cushion should be ordered (Medicare fact sheet).

If your loved one is in a nursing home

Nursing homes that take part in Medicare or Medicaid (42 CFR 483.1) must give residents care, in line with professional standards, to prevent pressure ulcers, and must give residents who have them the treatment needed to heal them, prevent infection and stop new ones forming (42 CFR 483.25). It is fair to ask staff how often your loved one is being turned, what mattress they are on, and when their skin was last checked.

If you are worried, you can:

  • Raise it with the care team first — the nurse in charge, the director of nursing or the administrator — and write down dates, names and what you saw.
  • Contact the Long-Term Care Ombudsman. Every state has an ombudsman program that advocates for residents of nursing homes, assisted living and board-and-care homes, and investigates and resolves complaints about quality of care. Anyone can contact it, it follows the resident’s wishes, and its services are free and confidential (National Long-Term Care Ombudsman Resource Center). In California, every long-term care facility must post the local ombudsman’s number and the statewide Ombudsman Hotline, 1-800-231-4024, which takes calls 24 hours a day; you can also find your county’s office on the California Department of Aging website (California Department of Aging).
  • File a complaint with your State Survey Agency, the state office that inspects nursing homes. Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) to get its contact details (Medicare.gov). In California this is the Department of Public Health’s Licensing and Certification Program: you can file online through its Cal Health Find database, or by phone, fax or letter to the district office, which will tell you the results in writing (California Department of Public Health).
  • For a quality-of-care concern with any Medicare provider, you can also contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) (Medicare.gov).

If you think someone is in immediate danger, call 911. A coach can help you prepare notes and make these calls, but a coach is never a substitute for the person’s doctors and nurses.

Still being researched: Chiropractic, Acupuncture. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Bed Sores (Pressure Injuries)? Tell us.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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