Bedsores & Pressure Injuries
Mobile pressure ulcer treatment specialists serving Los Angeles, Orange County, Riverside, San Bernardino, Ventura, Santa Barbara, and Kern County. Expert bedsore care for Stage 1, Stage 2, Stage 3, and Stage 4 pressure ulcers including sacral ulcers, heel ulcers, and decubitus ulcers. Advanced treatment with pressure relief, debridement, negative pressure wound therapy (NPWT), skin substitutes, and infection management. Board-certified wound care specialists provide in-home pressure sore treatment for skilled nursing facility residents, assisted living patients, hospice patients, and home care patients. Medicare Part B covered mobile wound care serving Beverly Hills 90210, Anaheim, Irvine, Riverside, San Bernardino, Oxnard, Santa Barbara, Bakersfield, and all Southern California.
Pressure ulcers (also called bedsores, pressure sores, or decubitus ulcers) are injuries to skin and underlying tissue caused by prolonged pressure on skin. They develop when constant pressure reduces blood flow to vulnerable areas, causing tissue death. Over 2.5 million Americans develop pressure ulcers annually, primarily affecting immobile, bedridden, or wheelchair-bound individuals. Pressure ulcers are staged I-IV based on depth and tissue involvement.
Pressure ulcers become chronic wounds due to ongoing pressure combined with multiple risk factors:
Unrelieved pressure compresses capillaries, blocking oxygen delivery. Tissue dies within 2-6 hours of constant pressure. If patient cannot reposition independently, pressure continues damaging tissue faster than it can heal.
Healing requires adequate protein, calories, vitamin C, and zinc. Immobile patients often have poor appetite and inadequate nutrition. Without building blocks, body cannot create new tissue.
Urine and feces create moisture that macerates skin. Bacteria from incontinence cause infection. Moisture + pressure = rapid tissue breakdown.
Sliding down in bed or improper transfers create shear forces that tear tissue layers. Friction during repositioning damages fragile skin.
Pressure ulcers are classified by the National Pressure Injury Advisory Panel staging system:
Stage 1: Non-Blanchable Redness
Intact skin with persistent redness that doesn't blanch (turn white) when pressed. May feel warmer or cooler than surrounding skin. Pain or itching possible. 100% reversible with intervention.
Stage 2: Partial Thickness Skin Loss
Shallow open ulcer with red/pink wound bed. May present as intact or ruptured blister. Epidermis and possibly dermis lost. No slough or eschar present.
Stage 3: Full Thickness Skin Loss
Full thickness tissue loss. Subcutaneous fat may be visible, but bone/tendon/muscle not exposed. Slough may be present. May include undermining and tunneling.
Stage 4: Full Thickness Tissue Loss
Full thickness with exposed bone, tendon, or muscle. Slough or eschar may be present. Often includes undermining and tunneling. High infection and osteomyelitis risk.
Unstageable: Depth Unknown
Full thickness tissue loss covered by slough (yellow/tan/gray) or eschar (black/brown) in wound bed. Cannot determine true depth until debris removed via debridement.
Untreated pressure ulcers rapidly progress to deeper stages. Stage 1 can become Stage 4 within days in high-risk patients. Complications include: cellulitis and sepsis (life-threatening bloodstream infection), osteomyelitis (bone infection requiring months of IV antibiotics), septic arthritis if near joints, chronic pain, extended hospital stays, and mortality—pressure ulcers are associated with 60,000 deaths annually in the US.
Our comprehensive approach treats the wound while addressing underlying causes:
Establish every-2-hour turning schedule. Pressure-relieving mattresses or overlays. Proper positioning with pillows. For wheelchair users, pressure relief lifts every 15-30 minutes. Offloading devices for heels (boots, pillows).
Sharp debridement removes necrotic tissue, slough, and eschar to reveal viable tissue. Converts unstageable wounds to stageable. Reduces infection risk. See debridement details.
Stage-specific dressing selection. Foams for moderate drainage, alginates for heavy exudate, hydrogels for dry wounds. Antimicrobial dressings for infected ulcers. Dressing options.
For Stage 3-4 ulcers, NPWT accelerates healing by removing excess fluid, increasing blood flow, and promoting granulation tissue. NPWT information.
Coordinate with dietitian for high-protein diet (1.25-1.5g/kg/day), vitamin C supplementation, zinc if deficient. Healing requires adequate calories—wounds won't close without proper nutrition.
Comprehensive 45-60 minute visits include: full wound assessment with staging, measurements, and photography; debridement as indicated; dressing selection and application; pressure relief assessment and recommendations; caregiver education on turning schedules and skin inspection; nutrition review; infection monitoring; supplies for care between visits; coordination with facility staff or family caregivers; and detailed documentation for regulatory compliance.
Emergency signs requiring immediate medical attention: fever with wound, rapid ulcer enlargement, foul-smelling drainage, crepitus (crackling feeling around wound suggesting gas-forming bacteria), exposed bone, severe pain, red streaks extending from ulcer, confusion or altered mental status. These indicate serious infection requiring hospital intervention.
Medicare Part B covers pressure ulcer treatment including mobile visits, debridement, advanced dressings, NPWT, and skin substitutes for Stage 3-4 ulcers. For skilled nursing facility residents, coordinate coverage with facility or bill resident's Medicare. Learn more about Medicare coverage.
Skilled nursing facilities, assisted living, and home patients—we provide comprehensive onsite care.
Request CareExpert mobile care for pressure ulcers—all stages treated at home, nursing facilities, and hospice with advanced wound care.
You did everything right. Repositioning every 2 hours. Special mattress. Skin checks. But pressure ulcers still happened. This isn't about blame—it's about what happens next. Because once that red spot turns into an open wound, standard care isn't enough anymore.
The Reality:
2.5 million Americans develop pressure ulcers annually. Even with perfect prevention protocols, some patients—especially those with paralysis, advanced age, malnutrition, or terminal illness—will develop ulcers despite best efforts. When it happens, specialist intervention becomes essential.
Pressure ulcers are staged by depth of tissue damage. Each stage requires different treatment, different urgency, and different expectations. Here's what each stage actually means for your patient:
Stage 1: The Warning Sign
Non-Blanchable Redness
Skin intact but red area doesn't turn white when you press it. May feel warmer, cooler, firmer, or softer than surrounding skin. This is your last chance to prevent an open wound.
What to Do RIGHT NOW:
Eliminate ALL pressure from that spot immediately. Use foam wedges, pillows, heel boots. If caught here, it's reversible. If pressure continues, it progresses to Stage 2 within hours.
Stage 2: The Open Wound Begins
Partial Thickness Loss
Shallow open ulcer with red/pink wound bed. Looks like a scrape or shallow crater. May have intact or broken blister. Epidermis and part of dermis are lost. It's officially a wound now—not just skin irritation.
Timeline & Treatment:
1-4 weeks to heal with proper care. Requires pressure elimination + moisture-retentive dressings. Can still heal without scarring if treated aggressively. Facility staff can usually handle this stage with guidance.
Stage 3: Deep Tissue Destruction
Full Thickness Tissue Loss
Full thickness tissue loss exposing fat layer. Cannot see bone/tendon/muscle yet. May have yellow slough coating wound. Often has "undermining" (hidden pockets extending under skin edges) making wound larger than it appears. This is where standard care fails.
Timeline:
1-3 months to heal. Requires aggressive debridement + advanced dressings + negative pressure therapy.
SPECIALIST NEEDED: Facility staff cannot manage this stage alone. Requires wound care specialist for debridement and treatment planning.
Stage 4: Catastrophic Wound
Exposed Bone, Tendon, or Muscle
Bone, tendon, or muscle visible in wound bed. Often covered with slough (yellow) or eschar (black dead tissue). Extensive undermining and tunneling common. High risk of osteomyelitis (bone infection). This is a medical emergency situation.
Timeline & Reality:
3-6+ months to heal. May never fully close without surgical flap. 50% mortality rate within 6 months in frail elderly patients with Stage 4 ulcers.
CRITICAL: Requires wound specialist + possible surgical consultation + aggressive treatment. Family should understand prognosis may be poor despite best care.
Unstageable: The Hidden Depth
Obscured by Dead Tissue
Wound bed completely covered with yellow slough or black eschar. Cannot determine true depth until dead tissue removed. Could be Stage 3 or Stage 4 underneath—won't know until debridement performed.
Requires immediate sharp debridement by specialist to remove dead tissue and reveal actual wound. Cannot treat appropriately until staged correctly.
Deep Tissue Injury: The Ticking Time Bomb
Worst Case Scenario
Purple or maroon discolored area of intact skin or blood-filled blister. The damage already happened deep under the surface. Tissue beneath is necrotic (dead) even though skin surface may look only bruised.
WARNING: DTI can "evolve" rapidly over 24-72 hours, suddenly revealing Stage 3-4 ulcer that was hidden beneath skin. Despite perfect treatment, DTI often deteriorates before improving. Document extensively to protect facility.
Changing dressings isn't enough. Pressure ulcers are ischemic wounds—tissue died from lack of blood flow. Even with pressure relief, multiple factors prevent healing:
Perfect Pressure Relief Is Impossible
Even 2-hour repositioning allows 2 hours of continued pressure causing more damage. Patients roll back onto wound. Caregivers miss turns during busy night shifts. Realistically, some pressure continues despite best efforts.
Incontinence Creates Hostile Environment
Urine and feces continuously contaminate wound despite diligent changes. Moisture + bacteria = chronic infection. Sacral ulcers especially challenging when patient incontinent of bowel.
Patients Can't/Won't Eat Enough
Wounds need 1.2-1.5g protein per kg body weight daily. Most elderly/sick patients eat <50% of meals. Without protein, wounds CANNOT heal regardless of dressings used. Malnutrition is #1 barrier.
Dead Tissue Must Be Cut Out
Yellow slough and black eschar cannot "fall off" on their own. Facility nurses cannot perform sharp debridement (legal/liability). Without debridement, wound stays stuck with rotting tissue breeding infection.
These signs mean the ulcer has caused life-threatening complications:
Sepsis (Bloodstream Infection)
40% mortality—needs IV antibiotics NOW
Osteomyelitis (Bone Infection)
Requires 6+ weeks IV antibiotics
Necrotizing Fasciitis
Flesh-eating infection—surgical emergency
Rapid Deterioration
May indicate underlying severe illness
We come to your facility or home 2-3x weekly with everything needed for advanced treatment. This isn't just wound care—it's wound surgery performed bedside.
Sharp Debridement (Surgical Removal of Dead Tissue)
We cut out necrotic tissue with scalpel and curette until healthy bleeding tissue exposed. Performed bedside with local anesthetic. This is THE most important intervention—wounds cannot heal through dead tissue.
Stage 3-4 ulcers typically need debridement every visit initially until wound base clean.
Negative Pressure Wound Therapy (NPWT)
Vacuum device applies continuous suction to wound, pulling edges together and promoting granulation tissue formation. Reduces healing time by 50% for Stage 3-4 ulcers. Device stays on between visits.
Medicare covers NPWT rentals. We set up, train staff, and manage device.
Advanced Biologics When Ready
Once wound bed clean and granulating, we apply cellular tissue products (skin substitutes, amniotic grafts) that provide growth factors accelerating closure. Used for Stage 3-4 ulcers stuck despite optimal care.
Medicare covers these products after conservative treatment attempted.
Staff & Family Education
Train caregivers on proper repositioning techniques, pressure relief devices, dressing changes between visits, and nutrition strategies. Provide written turning schedules and wound care protocols.
Documentation & Coordination
Comprehensive photo documentation, measurements, staging, treatment notes sent same-day to physicians and facility. We handle all Medicare/insurance paperwork and communicate directly with care teams.
Reality check: Without perfect pressure relief + adequate nutrition + infection control, wounds will NOT heal regardless of treatment. Sometimes maintenance/comfort care is most realistic goal for hospice/end-of-life patients.
Medicare pays for mobile wound specialist visits, debridement, NPWT, advanced dressings, biologics, and pressure-relief devices. For nursing facility patients, we bill separately—facility doesn't pay.
Home patients: Medicare pays 80%, Medigap typically covers the 20% (you pay $0). Full coverage details.
Mobile wound specialists treating pressure ulcers at SNFs, assisted living, home, and hospice. We come to you with everything needed.
Find a Provider