or pressure sores. People who lay or sit in one position for long periods of time often develop pressure sores. Pressure sores are also known as bedsores or decubitus ulcers. Pressure on the skin prevents blood vessels from carrying nutrients to the affected area. This causes skin breakdown which can lead to large sores, infections and severe pain if not treated. Poor nutrition and certain medical conditions may also lead to development of pressure sores.

Nursing homes must make sure that residents do not develop pressure sores during their stay and that residents who have them are given treatment to promote healing and prevent infection. Residents confined to a bed or a chair should have their position changed (turned) every two hours – more often if the resident is uncomfortable. If needed, supportive devices, special mattresses, pads and pillows should be used to maintain normal body pressure and to relieve pressure on the skin. Residents should receive daily help with walking and exercise to help maintain or improve their circulation, strength and use of their body.

The U.S. Department of Health and Human Services has published three excellent booklets on pressure sore prevention. One of the booklets is for consumers, "Preventing Pressure Ulcers, a Patient’s Guide." Two other versions are designed for professionals: "Pressure Ulcers in Adults: Prediction and Prevention," Clinical Practice Guidelines and a Quick Reference Guide for Clinicians.

The booklets are free. To order, call toll free 1.800.358.9295, or write to:

Center for Research Dissemination and Liaison

AHCPR Clearinghouse

PO Box 8547

Silver Springs, MD 20907

DRESSING: Residents should be dressed in their own clean, comfortable clothing each day, including appropriate footwear when out of bed. Staff should ask residents which shirt or dress he/she wants to wear on a daily bases.

TOILETING: Residents who have control of their bowel and bladder should receive help using the toilet as often as needed. Call lights should be answered promptly.

However, many nursing home residents are incontinent, meaning they have lost control of their bowel or bladder. Incontinent resident should receive care to help restore as much bowel and bladder control as possible, This care often involves increasing fluid intake and helping residents toilet on a regular schedule or as indicated by residents behavior.

Catheters should only be used for medical reasons. Special caution should be taken to prevent urinary tract infections for residents who use a catheter, as well as other residents who are at risk of infection. Another Fact Sheet, "Incontinency Care in Nursing Homes" is available which deals specifically with incontinence care and cloth and disposable diapers.

Any resident who become wet or soiled should be cleaned and changed quickly.

EATING: Residents who need help with eating should receive timely assistance. For example, if needed, the staff should help open packages, provide special utensils, and assist resident with eating. Food should be served at appropriate temperatures. Residents should not be feed by feeding tubes unless medically necessary. Another Fact Sheet, Food and Nutrition in Nursing Homes" gives more information on meals and nutritional issues. Ask your local Ombudsman office for a copy.

FLUID INTAKE: Each resident should receive sufficient fluids to maintain good health and prevent

dehydration. Fresh water and drinking cups must be available on each bedside table.

During warm weather, extra effort must be taken to give residents enough water.

VITAL SIGNS: Residents must be weighed, and their blood pressure, temperature, respiration rate, and pulse taken at admission and at least monthly, or more often if ordered by the physician.

SPECIAL NEEDS: Nursing homes must arrange for special services residents may need such as a physical, speech and occupational therapy, mental health evaluation and treatment, podiatry services, respiratory care, and vision and hearing services.