My mom is almost 92 and in the final stage of Alz. She is completely bed bound, cannot move on her own, incontinent and non-verbal. She has started developing bedsores, the worst is on her butt, but now has one on her hip and starting to get them on her heels. We try to change her position as much as possible but she is in pain on her side and always falls back to lying on her back. We are using patches, med.ointment, position changing and keeping her clean and dry. She also seems to have trouble breathing on her side as she winds up getting face down on the mattress or pillow - we use props to keep her in place but again she still winds up face down. We are using an air pillow to relieve the stress on her butt, but now she is developing sores on her hips (lying on her side) and on her heels. She cannot move her arms or legs so we do that for but her joints are freezing up. Any ideas of what we can do to help her? Her nutrition is poor as she no longer wants to eat, so we keep her hydrated with home-made smoothies (yogurt, fruit, juice and her meds) as this is something she will take. Does anyone have any ideas of what else we can do for her? She is at home under hospice care.
1. We had medicare cover for a air loss mattress. You can take your mom to the wound care center (I know she is in hospice care and so the point is to make her comfortable, but it is your call. You can take her off hospice to do the wound care visit and then put her back on hospice, we did that all the time for mom so that medicare would pay for services. They wont pay for a wound care visit while on hospice so the bill would go to you if you took mom to wound care while on hospice). Wound care wrote a script of necessity for air loss bed mattress to help lessen bed sores as well as a Roho Cushion with the cut out at the butt area that actually massages the areas for comfort
2. we rotate her every two hours and proper her with pillows
3. we massage her and exercise her (I.E. leg lifts arm lifts, etc.) we had a physical therapist come in and demonstrate. See if hospice can bring in PT to help with this. They may also be able to write a script for air loss mattress for her without you having to go to wound care center.
4. Nutrition. We did protein powders and put them in everything that was water content. So smoothies, yougurts, apple sauce, soups, etc.
5. You can prop pillows on both sides and put pillows between legs and pillow, soft round pillow (I purchased one from walmart while we waited for roho cushion) and elevated her legs with pillows.
By the way, does she have a hospital bed? We had medicare years back order one for her. It is old now they wont allow us to get another one, but it helps in elevation of her torso and her legs.
Lastly, for the sores there was zinc oxide cream we used or barrier ointment with the patches from the local store. Prior to sores, we did 'baby bottom' cream which was cocoa butter and that did wonders!
I hope this helps and God's speed!
Pressure ulcers
are a common problem in palliative care patients. Decreased mobility, increased time spent in bed, and altered nutrition make these patients prime targets for skin breakdown.
Pressure ulcers are painful. As a caregiver, one of the most important things you can do to keep your patient comfortable is to prevent one from developing.
Relieve the Pressure
Turning a patient who is bed bound is the most important thing you can do to prevent pressure ulcers from occurring. Frequent turning alternates areas of pressure on bony areas, such as the lower back, hips, elbows, and heels.
You should plan on turning your loved one every two hours, alternating between the right and left sides and laying him flat on his back. Every two hours is ideal but there is no need to set an alarm clock to wake you up every couple of hours at night. If you and your patient are sleeping comfortably, leave well enough alone. If he does wake you up in the middle of the night, however, take that opportunity to turn him.
It's easy to lose track of which side he should be turned to if he's been on his back for awhile. One family I met had a simple solution for this. They used a soft cotton wrist band to mark the side that their grandmother should be turned to next. The grandmother liked the idea as well because the wrist band was pink -– her favorite color!
When you’re positioning him in bed, pillows are your best friend. Use one under the back to prop him on his side; place one between the knees when he's on his side; use one under the ankles to “float” his heels off the bed. Pillows add comfort and can reduce pressure on bony areas.
See “How to Position a Patient in Bed” for tips on proper turning and positioning.
If your loved one is spending most of the day in a recliner chair, repositioning him is still important. Small adjustments in seating position are often effective enough at relieving pressure. Keeping a folded draw sheet underneath him while he's sitting will make this task easier. When it’s time to reposition him, simply hold the draw sheet (preferably with the help of another able bodied person) and slightly shift his weight. You can also try changing the degree of recline to redistribute body weight.
Special Devices That Can Help You
In addition to turning and repositioning frequently, using a special surface to reduce or relieve pressure can help a great deal. The simplest of these is an egg crate mattress. Many hospice and home health agencies provide these free of charge but they are relatively inexpensive at your local department store. If your loved one is spending a lot of time up in a chair, egg crate chair pads are also available. An egg crate surface helps distribute pressure more evenly, helping minimize the amount of pressure on one area.
A step up from the egg crate mattress is an air mattress overlay. This type of surface is placed on top of a mattress and typically alternates air pressure in various columns. When using an egg crate mattress or an air mattress overlay, it’s still important to maintain the turning schedule. These devices don’t replace frequent repositioning.
The big guns of pressure relieving devices are the fluidized air mattresses. These special mattresses contain silicone-coated glass beads that become fluid when air is pumped through them. These mattresses do a wonderful job of relieving pressure but they have their downside. The frame of the mattress makes transferring to and from bed difficult. And if the person wants to sit up in bed, a foam wedge would probably need to be used to help support their back. This mattress is really best suited for palliative care patients who are fully bed bound, have severe pressure ulcers, and are in a lot of pain.
Reduce Friction and Shear
Friction is the rubbing of skin on an external surface, usually bed sheets. Friction to the most commonly affected areas can be reduced with protective devices. Heel and elbow cradles are typically made of egg-crate material and Velcro on. Skin protecting dressings, such as films (Tegaderm) and thin hydrocolloid bandages (Duoderm) can protect the skin from repeated friction but won’t help reduce pressure.
The most important thing you can do to prevent injury from friction is to make sure you don’t create any yourself when you’re repositioning your loved one. Use a draw sheet to help you lift your loved one off the bed when you lift and reposition.
See “How to Properly Lift a Patient” for more tips on safe lifting, including the use of draw sheets.
Shear is created when the deeper fatty tissues and blood vessels are damaged by a combination of friction and gravity. The best way to avoid this type of injury is to avoid a semi-Fowler and upright position in bed. Semi-Fowler position is where the head is raised less than 30 degrees and upright positions more than 30 degrees. Now, you obviously can’t avoid these positions all of the time. Many patients need to be semi-Fowler to help ease shortness of breath or prevent gastric reflux and all patients need to be in an upright position to eat safely.
To minimize the risk of shear injury in a semi-Fowler or upright position, take precautions to prevent your loved one from sliding down in bed. You can do this by raising the foot of the bed and propping the knees up with pillows.
Shear injury can happen in chairs too. To keep your patient from sliding in his chair, use footstools or ottomans to prop his feet and pillows or special devices to keep his hips at a 90-degree angle.
By Angela Morrow, RN
Prevention is what we did best. When mom became bedridden, the gov't caregivers told us horror stories of how bedsores can go deep down to the bone. That you can see the bone. After that, we did our best to prevent it. We used the electrical air mattress, lifter and waterproof padding. We did turn her on her sides at intervals. Night times, because we both had to sleep, mom spent the whole night in one position. Still no bedsores from this.
We changed her pampers 3 times a day (soiled or not), changed her hospital gown daily. I would pour a capful of a microbial waterless soap into mom's water when cleaning her - using baby wipes and this water to wipe her down. After drying her skin, I would automatically use moisturizing or hydrating body lotion on her back and buttocks. If I see signs of rashes, I either use Creamy Desitin, A&D Ointment or Calmoseptine. It just depends on a case by case basis. It's the rashes that can become pimple-like and then pops. That open sore then can become a real bedsore. With mom, the home care nurses had recommended using DuoDerm.
When dad got his first bedsore, I used DuoDerm. That healed. The 2nd bedsore was the first one I've ever seen in which the blood literally flowed down from it. It kept widening. Fortunately, the new home care nurse saw it. She used to specialize in open wounds. She cleaned his wound up, gently stuffed his wound with gauze. She said that it was very important to keep the bedsore clean and dry. She also said that he needs to take in more Vitamin C and protein (nutrient drink) to help his body heal.
FYI, I've learned from experience that if you ask the same question to the different home care nurses, you will get different advice. It really depends on their medical knowledge plus past experiences with it. So, you may want to ask the different nurses who drops by.
I would recommend you ask your mother's nursing team about it and see if they are prepared to do the research and give it a go. There's not much to lose and anything that helps is worth finding out about. But I concur absolutely about not applying anything at all without explicit medical and/or nursing approval. Your poor mother, I'm so sorry.
I would consider a Hospice referral for care and advice on what they think of her treatment options. It sounds like it might time.
I will pray for you & your mom. Was wondering, can you add a little more boost to your mom's smoothies- Ensure or Instant Breakfast drink- bc that has protein & added vitamins..
Also your air mattress may be sufficient, but I added a memory foam pad & it greatly helped my dad's bedsores. (Bought at Target) For bedsore band aids, we used "hydrocolloid" band aids- can be purchased at CVS (they make them) in large squares or small. The large ones can be cut to size of the sore. We put a little triple antibiotic ointment , cover with small piece of gauze then placed hydrocolloid on top & seal. The hydrocolloid bandaid can keep moisture out and promote healing, even in a diaper. Try elevating moms heels, maybe place soft blanket under her calves, to get her heels off the bed & prevent her from rubbing them.
Blessings to you!! I will pray for you & your mom- that The Lord will give you continued strength & His wisdom & for Him to provide comfort & His peace for you mom.
I use Johnson & Johnson Tough Pads hydrocolloid bandages for the sores. I forgot to say that earlier. I buy them at Walmart or Target, 4 to a box, they are not cheap but effective. You can probably find them elsewhere, too.