Does Hospice Treat Bedsores?

Yes, hospice treats bedsores. Preventing and caring for bedsores (also called pressure ulcers or pressure injuries) is a routine part of hospice nursing, and the dressings, supplies, and pressure-relieving equipment the plan of care calls for are provided by the hospice. What changes on hospice is the goal: the team focuses on keeping the sore clean, controlling pain and odor, and preventing new ones, rather than putting a frail person through aggressive procedures aimed only at closing the wound.

Families often worry that hospice means "letting the sores go," or that a sore means someone failed. Neither is the right way to think about it. Here is what hospice actually does.

Why bedsores happen at the end of life

The National Institute on Aging explains that sitting or lying in one position puts constant pressure on sensitive skin, which can lead to painful bed sores. When a bed sore first forms, the skin gets discolored or darker. The NIA says to watch especially the heels, hips, lower back, and back of the head. A person who spends most of the day in bed, eats little, and is too weak to shift position on their own is at high risk.

What hospice provides for bedsores

Medicare's hospice rules (42 CFR 418.202) cover nursing care, aide services for personal care, and the medical supplies and equipment in the plan of care for the terminal illness or related conditions. For skin and wound care, that usually looks like:

• Nursing assessment and wound care. The hospice nurse checks the skin on visits, cleans and dresses wounds, and adjusts the approach as things change.
• Dressings and skin-care supplies, such as bandages, barrier creams, and underpads, when they are part of the plan of care.
• Pressure-relieving equipment. The NIA suggests asking the health care team whether a special mattress or chair cushion might help; under hospice, equipment related to the terminal illness is provided for use at home. See what equipment hospice covers.
• Hospice aide visits for bathing, skin care, and help with repositioning; see how much aide time hospice provides.
• Pain control around dressing changes and turning, managed as part of the overall symptom plan.
• Caregiver teaching. Federal rules require the hospice to train the primary caregiver for the care in the plan, including how to reposition safely and what to look for.

Prevention: what families can do between visits

Most of the day-to-day work happens between nurse visits. The NIA recommends:

• Turning the person in bed every few hours to help prevent bed sores and stiffness.
• Putting a foam pad under the heel or elbow to lift it off the bed and reduce pressure.
• Keeping skin clean and moisturized, and gently applying alcohol-free lotion to relieve dryness and itching.

Ask the nurse to show you how to turn your loved one without dragging their skin across the sheets, and how often to do it for their situation. Our caregiver's checklist covers skin care alongside the other daily tasks.

Comfort comes first, including about turning

Federal rules require the hospice plan of care to reflect the patient's and family's goals. If turning or dressing changes cause pain, tell the nurse. The team can time pain medication before care and adjust how and how often your loved one is moved to what keeps them most comfortable. These are judgment calls the nurse makes with you, not shortcuts.

The misconception to correct

Many families feel guilty when a sore appears, as though it proves they or the hospice did something wrong. A bedsore is not automatically a sign of neglect. Federal survey guidance for nursing homes, as quoted by the Wisconsin Department of Health Services, recognizes that a pressure ulcer can be "unavoidable": it can develop even when the resident's condition and risks were evaluated and appropriate interventions were put in place, monitored, and revised. A seriously ill person's skin is fragile. What matters is that the team assesses the risk, acts on it, and keeps adjusting.

That said, if you see a sore getting worse with no plan, or no one is checking the skin, raise it right away with the nurse and the hospice's clinical manager. You can also read what to do if you are unhappy with your hospice.

Frequently asked questions

Does hospice pay for wound care supplies?

Yes, when they are part of the plan of care for the terminal illness or related conditions. Dressings and other supplies used for the wound are provided by the hospice; ask how to reorder so you do not run out.

Will hospice send my loved one to a wound clinic or for surgery on a bedsore?

Usually not. Procedures aimed only at closing a deep wound carry their own burdens, and the trip and recovery can be hard on someone near the end of life. The hospice team focuses on keeping the wound clean, comfortable, and free of odor. If a specific procedure would clearly improve comfort, ask the hospice physician whether it can be included in the plan of care.

How do I know if a bedsore is starting?

The NIA says that when a bed sore first forms, the skin gets discolored or darker. Check the heels, hips, lower back, and back of the head when you help with care, and tell the nurse about any spot that does not fade.

Can a bedsore be a reason to start hospice?

Not on its own; a bedsore is not a terminal diagnosis. To qualify, doctors must certify that life expectancy is six months or less if the illness runs its normal course. But Medicare contractors' hospice coverage guidelines do list progressive stage 3 or 4 pressure ulcers that worsen despite good care as one sign of decline, and multiple stage 3 or 4 ulcers as one of the complications that can support eligibility in advanced dementia. See qualifying for hospice with dementia.

Questions to ask the hospice

• How often will the nurse check my loved one's skin?
• Do you provide a pressure-relieving mattress or cushion, and how soon can it arrive?
• How should we reposition, and how often, for my loved one's comfort?
• What signs of infection or worsening should I call about, day or night?

What to do next

If your loved one already has a bedsore or spends most of the day in bed, bring it up at the hospice evaluation so skin care and equipment are in the plan from the start. When you are ready, compare hospices near you by city.