The Skin You’re In: Preventing Pressure Ulcers

Good skin health is important to living a full and active lifestyle

By Corrie Dinwiddie, RN
Oxford HealthCare Wound Coordinator

The skin is the largest organ of the human body. According to the online journal LiveScience.com, the average person’s skin counts for 16 percent of their total weight, and spans a surface area of 22 square feet. It is also one of the most important organs for our general health, helping to:

  • Maintain your body temperature
  • Protect you from germs
  • Gather information for your nervous system
  • Assess and react to your surroundings (e.g. heat, cold, pain, sensory touch)

To function properly, your skin needs adequate attention and proper care. A break-down in your overall skin health can put you at risk for injury and disease.

Possible Skin Problems

Even if you have healthy skin, problems may occur if you are immobile for long periods of time, especially in a lying or sitting position. When this happens, pressure from your body weight on the bed or chair surface cuts off the blood supply to skin. As a result, those skin cells don’t get the oxygen and nutrients they need to survive, and a pressure ulcer may result.

Pressure ulcers occur from prolonged sitting or laying

The condition mainly occurs on skin areas that cover a bone or bulge, such as heels, shoulders, hips, and upper buttocks. Pressure ulcers have many names, including:

  • Bedsore Decubitus (de-KU-bi-tus) ulcers
  • Dermal wounds
  • Pressure sores

Risk Factors for a Pressure Ulcer

You may be at risk for a pressure ulcer if you are experiencing:

  • Limited activity or confined to bed
  • Reduced tactile sensation (sense of touch)
  • Chronic, complicated medical problems such as diabetes, obesity, smoking, poor circulation, and spinal cord injury
  • Increased skin moisture from bladder or bowel control issues
  • Poor diet or nutrition Low protein intake, especially if nutrition is already poor

Older adults are more at risk for a pressure ulcer, as are patients who slide down in the bed. Sliding down can cause friction that may tear delicate or already damaged skin.

Symptoms of a Pressure Ulcer

If you have a pressure ulcer, you may have burning, aching, or itching at the site. The injured skin may be red or bruised, or have a purplish discoloration that continues even after you shift position. People with darker skin tones may not show redness or discoloration, and some may need to compare the injured area with uninjured skin tissue.

A pressure ulcer may feel firm or mushy, and may be warm to the touch. Swelling and tenderness are common, and a blister or shallow sore may develop. Sometimes a clear or blood-tinged fluid may drain from the ulcer area. If un-noticed or un-treated, the wound may deepen and extend into the fat layer or adipose (ADD-ih-pose) tissue, or even down to the bone. Pressure ulcers are sometimes categorized in stages (Stage I, Stage II, etc.), based on how deeply the tissue is injured.

Stages of bedsores and pressure ulcers

What Can You Do to Help Prevent a Pressure Ulcer?

You and your family members are important to the prevention and care of a pressure ulcer. Your skin health can be improved when general steps are taken, including:

  • Not smoking
  • Daily exercise (even bedridden patients need activity)
  • Good nutrition
  • Maintaining a healthy weight
  • Adequate hygiene
  • Moving and turning
  • Asking your family or caregiver to help you move and turn if you are confined to a bed or chair

How Do Hospitals and Nursing Homes Prevent Pressure Ulcers?

Your nurses and doctors will begin a plan of care to help keep your skin healthy. If you are not able to move yourself, the hospital or nursing home staff will help you move and turn. They may use special skin care products to protect your skin, and connect you with a dietitian to help you improve your diet. If your nurse or doctor suspects an ulcer, he or she will work to relieve pressure on the area. In some cases, a special mattress or bed may be used to help redistribute pressure.

Even though your skin is one of the most complex and important organs in your body, caring for it is not complicated. Follow these simple steps, and ask your doctor if you have further concerns about potential pressure ulcers.

How to Protect Yourself from Phishing (pronounced: fishing) Scams

By Bryan Bardwell, Oxford’s Security and Privacy Officer

Don’t get hooked by crooks! Our latest blog post outlines several ways to avoid online scams.

Even in the relative safety of our homes, the world can be a dangerous place. Scammers will attempt to trick you and steal your personal information through various means, such as deceptive phone calls, going through your trash, or with fake emails, just to name a few.

In the digital age, one of the most dubious online scams is known a “Phishing”. Thieves send an email to target victims, often to thousands of people at a time. On the surface, the email appears to be a legitimate contact attempt, but is really a fraudulent message. When links within the e-mail are clicked or an attachment is opened, it triggers computer scripts that automatically download a virus or malware onto your computer. These viruses can capture personal information, such as your User ID and Password logins, bank details, Social Security numbers and credit card account information.

Phishing is a huge threat to homes and businesses because of the vast amount of important information most users store on their computer(s). They may have different messages, but ALL Phishing scams will have some sort of urgency involved in the message, such as: If you do not confirm your User ID and Password by 4pm, we will be forced to lock you out of your computer.

How To Avoid Phishing Scams 

  1. Scan your e-mails carefully and look for grammar mistakes and other inconsistencies.
  2. Verify the email sender’s address to confirm it was sent from a legitimate source. Most phishing scams will try to fool you with similar email addresses, but the email domain name (e.g. Bob@xyzbank.com) should match the web address of a real company.
  3. In addition, secure websites that require a login will all begin with https:// – That “s” indicates the site is Secure. (For example, Gmail’s email server is https://mail.google.com/mail).  Always look for https:// if you’re asked to enter a User ID and Password to access a website.  Legitimate secure sites will include all banks, credit card companies, and other email providers (such as Outlook, Yahoo, and Hotmail), as well as shopping websites like Amazon, Target, Walmart, EBay etc.
  4. Email fraud can be the easiest of all thefts – by simply adding Click Here somewhere in the email text, many victims are enticed to click on the link, and are then directed to a website that is not legitimate. The fake website may have similar graphics or logos to a real company, and will ask for your User ID, Password or to verify personal details. If you comply, it could compromise your computer. But there is an easy way to see through this type of click-through scam: To view the web address behind a “Click Here” link, hover over the link with your mouse without clicking it. A small window will pop up with a URL, such as https://www.xyzbank.com, as shown below.
  5. If you suspect that an email is a phishing attempt, play it safe – DO NOT open any attachments or click any links.

Hover your pointer over a link to see the destination website address.

What to Look For

Here is an example of a Phishing email:

Example of a Phishing email

What are the RED flags in this Phishing email?

  • Look for inconsistencies in the From: – is it a legitimate email address?
  • Check for an attachment. It will appear under the Subject: DO NOT open if you are unsure of who is sending you this information. Be very careful of .zip file attachments in any email.
  • Hover over Click Here to see the website where the link will take you. If you see a number or “http:” instead of “https:”, DO NOT click links or go to the site.
  • Note that there is no personal sender information (name, address, phone, email) signature in the email.

Failure to notice these telltale signs could result in “Phishers” gaining access to your private account information or other personal data.

Other Resources

To help combat Identity Theft, the Internal Revenue Service offers “Seven Steps for Making Identity Protection Part of Your Routine”.

  1. Review your credit card and baking statements carefully and often. Neither your credit card, bank or the IRS will send you emails asking for sensitive personal and financial information, such as asking you for updates to your account.
  2. Review and respond to all notices and correspondence from the Internal Revenue Service.
  3. Review each of your three credit reports at least once a year. Visit annualcreditreport.com to get your free reports.
  4. Review your annual Social Security income statement for excessive income reported. You can sign up for an electronic account at SSA.gov
  5. Shred any documents with personal and financial information.
  6. Review your health insurance statements; look for claims you never filed or care you never received.
  7. If you receive any routine federal deposits such as Social Security of VA benefits, you probably receive those electronically. You can use the same direct deposit for your federal and state tax refund which is safe and secure.

February is American Heart Month!

by Pam Gennings, Executive Director Special Projects

Heart disease prevention is important year-round.

Knowing the causes, symptoms and preventions of Heart Disease is important year-round.

February brings Valentine’s Day and heart-shaped boxes of candy, but it’s also American Heart Month. First declared by President Lyndon Johnson in 1964, it was designed to bring awareness to the symptoms, causes and preventions of Heart Disease, which at that time was responsible for more than half of all deaths in this country.

Awareness and prevention have greatly increased in the half-century since the first Heart Month. As a result, heart disease has steadily declined since 1968, with fewer than 400,000 actual deaths in 2010, according to the National Heart, Lung and Blood Institute (NHLBI). The institute estimates that if 20th-century heart disease trends had continued unchecked, it would have been the cause of nearly five times as many deaths – more than 1.8 million – in 2010.

However, heart disease is still the current leading cause of death in both women and men in this country, responsible for one in four deaths in the United States. Though a heart attack is the most-often associated health risk, other serious types of heart disease include coronary artery disease (the most common), heart arrhythmias (irregular heartbeat), cardiomyopathy (diseased heart muscle), atrial fibrillation (a type of arrhythmia), and congenital heart defects.

Risk Factors for Heart Disease

According to the Centers for Disease Control (CDC), there are numerous hereditary and environmental factors that determine an individual’s risk for heart disease. They include;

  • High Blood Pressure
  • High Cholesterol
  • Diabetes
  • Age/Family History/Race or ethnicity
  • Lifestyle choices such as:

->  Unhealthy Diet
->  Physical Inactivity
->  Obesity
->  Too Much Alcohol
->  Tobacco Use

Symptoms of a Heart Attack

The National Heart Attack Alert Program notes these major signs of a heart attack:

  • Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that lasts for more than a few minutes, or that goes away and returns. It may feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath. This can often accompany chest discomfort, but can also occur before any other signs are noticeable.
  • Other symptoms. This includes breaking out in a cold sweat, nausea, or light-headedness.

If you think that you or someone you know is having a heart attack, you should call 911 immediately.

Preventing Heart Disease

While the effects of heart disease are serious, the good news is there are many common-sense steps that you can take to limit your risk factors, according to the CDC. Some of them include;

1.     Live a healthy lifestyle – Healthy behaviors can lower your risk for heart disease, which include;

  • Eat a healthy diet
  • Maintain a healthy weight
  • Get enough physical activity
  • Limit alcohol use
  • Don’t smoke or use other forms of tobacco

2.     Check your cholesterol – Your health care provider should check your cholesterol at least once every five years. If you have already been diagnosed or have a family history of heart disease, your cholesterol should be checked more frequently. If you have high cholesterol, lifestyle changes or prescribed medication may help reduce your risk of heart disease.

3.     Control your blood pressure – High blood pressure usually has no symptoms, and is important to have yours checked on a regular basis.  If you are diagnosed with high blood pressure, your health care provider might recommend that you lower the sodium in your diet, prescribe medication to lower your blood pressure, and make some lifestyle changes.

4.     Manage diabetes – If your health care provider identifies symptoms of diabetes, they may recommend that you get tested. If diagnosed, it’s important for you to monitor and control your blood sugar levels. Lifestyle changes can help keep your blood sugar under control, and reduce your risk for heart disease or other diabetic complications.

5.     Take your medicine – If you take medication to treat high cholesterol, high blood pressure or diabetes, follow your doctor’s instructions. NEVER stop taking your medication without talking to your doctor, nurse or pharmacist.

6.     Talk with your healthcare provider – Work with your medical team to prevent or treat medical conditions that can potentially lead to heart disease.

How We Can Help

If you or a loved one is diagnosed with heart disease, Oxford Healthcare has numerous Home Care programs that can help. Contact us to find out about our cardiovascular, telemonitoring, and specialty services designed to help more people with heart disease stay healthy, and stay home.


About the Author
Pam Gennings has a Bachelor of Arts and has worked in the field of Geriatric Social Work and Care Coordination for more than 30 years. She started working for Oxford HealthCare in 1993. During the course of her career she has helped thousands of people find resources to remain in their homes, as well as providing guidance to families that were facing difficulties with their aging loved ones.

Good Nutrition Promotes Wound Healing

Healing with nutritionBy Alicia Jenkins BS, RN, CWCN, Oxford Wound Analyst

Good nutrition is essential for wound healing. During the healing process, the body needs increased amounts of calories, protein, vitamins A and C, and sometimes the mineral zinc. Food choices and nutritional status influence wound healing since serious wounds increase the energy, vitamin, mineral and protein requirements necessary to promote healing. Nutrients are lost through wound fluid as well.

Nutrition Tips

  1. Eat sufficient calories from a balanced diet of nutritious foods. Plan healthy, balanced meals and snacks that include a variety of foods, including protein, fruits, vegetables, dairy and grains. If appetite is an issue, eat 5 -6 small meals a day instead of trying to eat 3 large meals in a day.
  2. Include optimum amounts of protein, aiming for 20-30 grams of protein at each meal and 10-15 grams of protein with each snack. A piece of cooked chicken, lean meat or fish the size of a deck of cards (about 3 ounces) contains 20-25 grams of protein. One egg, 1 tablespoon of peanut butter and 1 ounce of cheese each contain 6-7 grams of protein. One cup of low-fat milk or yogurt contains 8 grams of protein.
  3. Stay well hydrated with water and other unsweetened beverages, unless contraindicated and directed otherwise by your physician. It is important to remain within dietary guidelines given by your for other disease processes, for example regarding any limitations of fluid or protein intake.
  4. For people with diabetes, controlling blood sugar levels is one of the best ways to promote wound healing, prevent wound infection and prevent new wounds. Blood sugar levels need to be monitored closely. You may need to visit your doctor and a registered dietician to help control blood sugar through diet and medication.

Power Foods and Food Groups to Help with Wound Healing

  • Protein: Meats, beans, eggs, milk, and yogurt (particularly Greek yogurt), tofu, soy nuts and soy protein products.
  • Vitamin C: Citrus fruits and juices, strawberries, tomatoes, tomato juice, peppers, baked potatoes, spinach, broccoli, cauliflower, brussel sprouts and cabbage.
  • Vitamin A: Dark green leafy vegetables, orange or yellow vegetables, cantaloupe, fortified dairy products, liver and fortified cereals.
  • Zinc: Fortified cereals, red meats and seafood.

If you are unable to ingest all of the recommended food groups with the recommended number of servings daily, you may benefit from oral nutrition supplements. Various types of supplements are available, including milkshake-type beverages, clear beverages, bars, and puddings. If adequate intake is a challenge, consider discussing your situation with a registered dietician.

When Do You Know Loved Ones Need Care?

By Pam Gennings, Executive Director Special Projects*

Over the years I have talked to many family members who come home for the holidays and become concerned because they have noticed “changes” in their loved one or their circumstances.

They are not always sure if home care services are needed or if their concern is unfounded. The following indicators can be used as a guide to help determine if your loved one could benefit from home care services.

Medical Condition

  • New diagnosis
  • New medications or treatments ordered by a physician
  • Terminal illness
  • Recently discharged from a hospital or nursing facility
  • Physician has restricted activity during a period of recuperation—this could be a few days or several weeks
  • Frequent falls or fear of falling
  • Confusion, forgetfulness, depression or other changes in mental status
  • No longer able to/should not drive or driving is very limited
  • Frequent trips to the doctor, urgent care or ER
  • Uses an assistive device (cane, walker, wheelchair or stair climber) to help with balance or walking
  • Is required to take several daily medications

Caregiver Relief

  • The person being cared for should not be left alone and may require 24-hour supervision
  • Spouse/family members work
  • Caregiver appears to be stressed and overwhelmed
  • Spouse/family members in poor health
  • The person being cared for needs more assistance than the caregiver is able or willing to provide

Strong Desire to Remain at Home But is Unsure of How to Manage Because…

  • There is limited support from family or others
  • Spouse is in poor health
  • They worry about emergency situations
  • Family does not want loved one to be alone
  • They need assistance with housekeeping, laundry, meal preparation, shopping, bathing, hair care, medication reminders, transportation, or other essential daily tasks

If your loved one has one or more of the indicators listed above, call Oxford HealthCare and ask to speak with a Care Coordinator.

A qualified home care professional will:

  • Identify needs and available services
  • Evaluate funding sources and community services
  • Coordinate services upon request 

*Pam Gennings has a Bachelor’s of Arts and has worked in the field of Geriatric Social Work and Care Coordination for more than 30 years. She started working for Oxford HealthCare in 1993. During the course of her career she has helped thousands of people find resources to remain in their homes as well as provided guidance to families that were facing difficulties with their aging loved ones.

Managing the Holiday Blues

Holiday Blues

By Pam Gennings, Executive Director Special Projects*

The holidays should be a time of happiness, but for some people it can trigger a range of emotions including the temporary feeling of anxiety or depression also known as the Holiday Blues. The Holiday Blues can be caused by extra stress, unrealistic expectations or even memories that accompany the season.

The Holiday Blues might include:

  • Fatigue
  • Tension
  • Frustration
  • Loneliness or isolation
  • Sadness
  • A sense of loss

How can you avoid the Holiday Blues?

  • Stick to normal routines as much as possible.
  • Get enough sleep.
  • Take time for yourself, but don’t isolate yourself. Spend time with supportive, caring people.
  • Eat and drink in moderation. Don’t drink alcohol if you are feeling down.
  • Get exercise—even if it’s only a short walk.
  • Keep things simple. Make a to-do list.
  • Set reasonable expectations and goals for holiday activities such as shopping, cooking, entertaining, attending parties or sending holiday cards.
  • Set a budget for holiday activities. Don’t overextend yourself financially.
  • Listen to music or find other ways to relax.
  • Perform an act of kindness. It will provide you with a good feeling.

Remember, the Holiday Blues are short-term. Be patient and take the holiday season day by day. You will get through it!

Excerpts from the National Alliance on Mental Illness (NAMI)

*Pam Gennings has a Bachelor’s of Arts and has worked in the field of Geriatric Social Work and Care Coordination for more than 30 years. She started working for Oxford HealthCare in 1993. During the course of her career she has helped thousands of people find resources to remain in their homes as well as provided guidance to families that were facing difficulties with their aging loved ones.