Bed sores (pressure ulcers): prevention, stages and when to worry

Bed sores, also called pressure ulcers or pressure sores, are areas of damaged skin and tissue caused by pressure, usually over bony parts such as the heels, hips and tailbone. The first sign is a patch of skin that stays discoloured when you press it, often with warmth, firmness or pain. Most can be prevented by changing position regularly, using the right mattress and cushion and checking skin daily. See a GP if you suspect one, and get an urgent GP appointment or call NHS 111 if it looks infected.

In short

• Early warning sign: discoloured skin that does not change colour when pressed. It looks red on white skin and may look purple or blue on black or brown skin.
• Pressure ulcers are graded in 4 categories, from intact discoloured skin (category 1) to deep wounds exposing muscle or bone (category 4).
• NICE guideline CG179 advises repositioning adults at risk at least every 6 hours, and those at high risk at least every 4 hours.
• Pressure-relieving mattresses and cushions are usually provided free on loan after an NHS assessment, typically arranged by a district nurse.
• Get an urgent GP appointment or call 111 if there is pus, spreading redness or swelling, a high temperature or worsening pain. Call 999 for signs of sepsis.
• Most pressure ulcers are a clinical issue, but serious or multiple ulcers where care was not delivered can be a sign of neglect.

Who is most at risk

Anyone who spends long periods in a bed or chair can develop a pressure ulcer, and they can form within a few hours. According to the NHS, the risk is higher for people who:

• have difficulty moving or changing position by themselves;
• have had a pressure ulcer before;
• have recently been seriously ill or had surgery, for example after a hip fracture;
• are underweight or not eating and drinking well;
• have damp, sweaty or broken skin, which includes skin exposed to incontinence;
• have poor circulation, fragile skin or reduced feeling, for example from diabetes or a stroke.

An older parent with dementia, limited mobility and incontinence may tick several of these boxes at once. If your parent is cared for at home and you think they are at risk, ask the GP or district nurse for a pressure ulcer risk assessment so a prevention plan can be agreed.

The stages (categories) of pressure ulcers

NHS teams in the UK usually describe pressure ulcers using the international NPUAP-EPUAP categories, which NICE recommends. Knowing them helps you understand what nurses write in care notes.

Not every red or sore patch is a pressure ulcer. Skin damage from moisture, such as soreness in the groin from urine or faeces, and skin tears are classed separately, though they still need attention and can lead to pressure damage.

How to prevent bed sores at home

Move regularly

Relieving pressure is the single most important step. NICE advises that adults at risk should change position frequently and at least every 6 hours, and at least every 4 hours if at high risk. Your parent’s nurse may advise more often. A simple chart by the bed, noting the time and position, helps carers and family stay on track, and makes it easy to show the nurse what has been happening. Make sure everyone involved understands why repositioning matters, especially at night.

Use the right equipment

Specialist foam or air mattresses and cushions spread pressure more evenly. NICE recommends considering a high-specification foam or equivalent cushion for adults who use a wheelchair, and, for people at high risk of a heel pressure ulcer, a plan to take pressure off the heels; ask the nurse to show you how. The district nurse can usually arrange equipment on loan through the community equipment service. Our guide to mobility aids and wheelchairs explains how wheelchair seating is assessed, and free equipment and OT assessments covers council-provided kit such as bed levers and hoists.

Look after the skin

• Check the skin every day, especially heels, hips, base of the spine, elbows, shoulder blades and the back of the head. On darker skin, look for changes in colour and feel for warmth or hardness.
• Keep skin clean and dry. Change wet pads promptly and ask the nurse whether a barrier cream is needed. If pads are not lasting, see our guide to free NHS incontinence products.
• Do not rub or massage red areas. NICE advises against skin massage or rubbing to prevent pressure ulcers.
• Avoid dragging your parent up the bed; use slide sheets so skin is not torn by friction.

Eat and drink well

Poor nutrition and dehydration make skin more fragile and slow healing. If your parent is losing weight or eating little, ask the GP about a nutrition assessment. NICE recommends offering supplements to adults with a pressure ulcer who have a nutritional deficiency.

When to worry: getting medical help

Use this as a guide, and trust your instincts if your parent seems unwell.

• See the GP or contact the district nurse if you notice skin that stays discoloured when pressed, a blister or broken skin over a pressure point.
• Get an urgent GP appointment or call NHS 111 if a sore has hot, swollen or red skin around it (which may look purple or blue on darker skin), pus coming from it, a high temperature or severe or worsening pain.
• Call 999 or go to A&E if your parent is breathing very fast, is newly confused, has slurred speech or is not making sense, has blue, pale or blotchy skin, or seems very unwell. These can be signs of sepsis.

Treatment depends on severity and may include dressings, cleaning the wound, pressure-relieving equipment, antibiotics for infection and, for severe ulcers, surgery. Healing a deep ulcer can take a long time, and the care needed may be substantial. If your parent has complex, intensive or unpredictable nursing needs, check whether they could qualify for NHS Continuing Healthcare using our CHC checker.

When a pressure ulcer may be neglect

Some pressure ulcers develop despite good care, particularly near the end of life. But they can also be a sign that care was not given. The government’s safeguarding protocol on pressure ulcers treats them first as a matter for clinical investigation, while setting out when a safeguarding concern should be raised with the council. Warning signs it highlights include:

• skin deteriorating to category 3 or 4, or several category 2 ulcers, since the last assessment;
• actions in the care plan, such as repositioning or equipment, not being carried out;
• someone preventing access to care, or necessities such as food, medication and heating being withheld.

If your parent develops a serious ulcer in a care home, hospital or under a home care agency, ask to see the repositioning charts, the risk assessment and the care plan. You can raise a safeguarding concern with the council’s adult social care team. Our guides to signs of neglect by a carer and how to complain about a care home explain next steps. Complaints about NHS care in England can go to the Public Service Ombudsman (formerly the Parliamentary and Health Service Ombudsman) if local complaints procedures do not resolve them.

Scotland, Wales and Northern Ireland

The clinical advice is the same across the UK, and NHS health boards in Scotland and Wales and Health and Social Care Trusts in Northern Ireland provide district nursing and pressure-relieving equipment. Safeguarding concerns go to the local council in Scotland and Wales, and to the Health and Social Care Trust in Northern Ireland.

Frequently asked questions

What does the start of a bed sore look like?

The earliest sign is a patch of skin over a bony area that stays discoloured when you press it. It looks red on white skin and may look purple or blue on black or brown skin. It may feel warm, spongy or hard, and can be painful or itchy. This is a category 1 pressure ulcer and needs prompt action to relieve pressure.

How often should a bedbound person be turned?

NICE guidance says adults at risk of pressure ulcers should change position frequently and at least every 6 hours, and at least every 4 hours if they are at high risk. A nurse may advise more often depending on skin checks. Keep a repositioning chart so everyone caring for your parent can see when they were last moved.

What are the 4 stages of bed sores?

Category 1 is unbroken skin that stays discoloured when pressed. Category 2 is a shallow open wound or blister. Category 3 is a deeper wound through the full thickness of skin, possibly showing fat. Category 4 is a deep wound exposing muscle, tendon or bone. Ulcers covered in dead tissue are called unstageable until the depth can be seen.

When should you worry about a bed sore?

Get an urgent GP appointment or call NHS 111 if a sore has hot, swollen or red skin around it, pus, a high temperature or severe or worsening pain. Call 999 if your parent is breathing very fast, is newly confused, has blue, pale or blotchy skin or seems very unwell, as these can be signs of sepsis.

Are bed sores a sign of neglect?

Not always. Some develop despite good care, especially in very frail people or near the end of life. But a category 3 or 4 ulcer, several category 2 ulcers, or an ulcer where repositioning or equipment in the care plan was not provided can indicate neglect. Ask to see the care records and raise a safeguarding concern with the council if worried.

Can you get a pressure-relieving mattress on the NHS?

Yes. If your parent is assessed as at risk, the district nurse or community health team can usually arrange a pressure-relieving mattress or cushion on loan, free of charge, through the community equipment service. Wheelchair users can be assessed for a pressure-relieving cushion by the NHS wheelchair service. Ask for a review if the equipment does not seem to be working.

Sources

• NHS: Pressure ulcers (pressure sores)
• NICE CG179: Pressure ulcers – prevention and management
• GOV.UK: Safeguarding adults protocol – pressure ulcers and raising a safeguarding concern
• NHS: Sepsis
• HSC Public Health Agency (NI): pressure ulcer definitions document (2024)

General information, not legal or financial advice. Figures for 2026/27, checked October 2026.

Reviewed by The Care Panel team on 29 October 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.