How Senior Living Communities Can Prevent Skin Breakdown

Skin breakdown is more common in nursing homes and senior living communities than you might think. In fact, according to a study published in 2022 in the journal Medical Care, the instances and severity of pressure ulcers (sometimes known as bedsores) are “substantially underreported” in U.S. nursing homes. 

With that in mind, this article is a guide for how senior living communities can prevent skin breakdown and help their residents live their best lives. 

What Does Skin Breakdown Mean?

Everyone’s skin is made up of three layers: the epidermis, dermis, and subcutaneous tissue. “Skin breakdown” is essentially the damage and destruction of those layers of skin, typically from a lack of blood flow to the area. There are four stages of skin breakdown, and the severity of each stage ranges from minor cuts, blisters, and rashes to abrasions, burns, and pressure ulcers (i.e., pressure sores and bedsores).

Skin breakdown is most common among older adults because your skin gets thinner as you age. For the most part, your skin is able to heal itself, but as you age and experience skin breakdown, the self-repair process can become slower. As a result, skin breakdown is a serious concern for many nursing homes and senior living facilities.

Causes of Elderly Skin Breakdown

Because skin breakdown can include rashes, scrapes, and minor cuts, there can be many causes of skin breakdown. However, in a senior living environment, there are often residents with partial or full immobility, which increases the risk. These are generally the four most common causes:

• Friction injuries: Occurs due to the skin rubbing on a surface like a sheet, brace, etc. This type of injury is often referred to as a “rug burn.”

• Shearing injuries: This is a combination of friction and pressure causing an injury. This happens when the skin moves one way and the underlying bone either does not move or moves in the opposite direction. It can happen in any area of the body. Shearing injuries often happen when residents either slide down in a raised bed or use their upper bodies to pull themselves up in a raised bed without also lifting their lower bodies. This can cause skin tears, stretched blood vessels, etc.

• Excessive Moisture: In addition to creating a moist environment for skin breakdown, excessive exposure to urine (often a by-product of cheap, low-absorbency incontinence diapers used in institutional settings) actually alters the microclimate's pH level, which presents a two-fold risk for  Incontinence Associated Dermatitis (IAD).
• Pressure Ulcers: Pressure injuries happen when the blood vessels and soft tissue are squeezed between a bony area (i.e., the tailbone, shoulder blades, and other prominences) and an outside surface. This results in a lack of blood circulation and eventual bedsores. Pressure ulcers are more common among those with little mobility due to injury, age, obesity, etc.

Preventing Skin Breakdown at a Senior Living Community

Checking and changing every three to five hours is the norm in a senior living community. That requires a lot of labor and five to eight diaper changes every day. Only three to four changes per 24 hours are needed for super absorbent products, which also trap moisture and create a pH neutral skin microclimate.

If not managed properly by caregivers, skin breakdown can become a widespread issue in a senior living community. Regardless of the area of skin, there are several interventions, products, and steps that can be taken to prevent skin issues:

Choose Premium Diapers Over Mass-Produced Products 

Switching residents from a generic diaper brand to a premium brand, like Dry Direct, can have a positive effect on their skin health. For instance, Dry Direct diapers offer:

• 3x the absorbency of generic products so urine doesn’t sit on the skin
• Noticeably softer cloth-like fabric with a tailored fit to reduce irritation and potential leaks
• A high-performance top sheet to wick moisture away from the skin

Check and Change 

"Check and change" is a term commonly used in the context of caregiving and nursing, particularly in geriatric care settings, to refer to the practice of regularly checking and changing incontinence products such as adult diapers for individuals who have difficulty controlling their bladder or bowels. The practice involves routinely assessing the individual's diaper or incontinence product and changing it, often on a fixed schedule, to prevent discomfort, skin breakdown, and potential infections.

However, the practice of "check and change" has evolved over time, and as you've mentioned, there are debates and controversies surrounding its effectiveness and necessity, especially in the context of modern incontinence products and caregiving approaches.

Historical Context

The concept of "check and change" originated in a time when incontinence products were less advanced and less effective at managing moisture and preventing leaks. The main goal of this practice was to maintain hygiene and prevent skin issues that could arise from prolonged exposure to moisture.

Advancements in Incontinence Products

Over the past few decades, there have been significant advancements in the design and technology of incontinence products, particularly super absorbent adult diapers and pads. These products are designed to hold larger amounts of liquid, wick moisture away from the skin, and provide better leakage protection. As a result, modern products are often capable of providing extended wear times, including overnight wear, without causing discomfort or skin problems.

Controversy and Debate

The controversy surrounding "check and change" arises from the question of whether the practice is still necessary given the availability of advanced incontinence products. Here are some key points of contention:

• Disruption of Sleep: Waking up residents during the night to perform a diaper change can disrupt their sleep patterns and negatively impact their overall well-being. Sleep disruptions can lead to fatigue, cognitive impairment, and decreased quality of life.
• Dignity and Autonomy: Continuously checking and changing residents' incontinence products can potentially compromise their sense of dignity and autonomy. Individuals may feel embarrassed or uncomfortable with frequent changes, especially if they are capable of managing their own toileting needs to some extent.
• Skin Health: While regular changes were essential in the past to prevent skin breakdown and infection, modern incontinence products are designed to maintain skin health for extended periods. Frequent changing might not be as necessary if the products effectively manage moisture and prevent leakage.
• Workload and Resources: From a caregiver's perspective, frequent "check and change" routines can place a significant workload on nursing staff, taking time away from other important tasks and interactions with residents.

Modern Approaches

In recent years, some caregiving facilities and healthcare professionals have adopted more individualized and flexible approaches to incontinence care. Instead of adhering strictly to fixed "check and change" schedules, they focus on assessing each individual's needs and preferences. This might involve using high-quality, super absorbent products that can provide extended wear times and allowing individuals more control over their own toileting routines.

The practice of "check and change" has evolved alongside advancements in incontinence products and caregiving philosophies. While it's important to prioritize residents' comfort, skin health, and dignity, there is a growing recognition that rigid and frequent changing routines might not always be necessary or beneficial, especially with the availability of modern, high-performance incontinence products. Balancing the benefits of regular changes with the individual needs and preferences of residents is essential to providing effective and respectful care in geriatric settings.

Identify High-Risk Residents

Understanding the risk factors for individuals with skin breakdown can help you prevent them. For example, suppose a resident has a spinal cord injury and deals with incontinence. Because they are at a higher risk, they may need to be repositioned more often and have their incontinence products changed more frequently.

Proper Hygiene, Nutrition, & Hydration 

One of the best ways to prevent skin breakdown and promote wound healing is to eat and drink healthy foods. If the body’s underlying tissue doesn’t get the right amount of fluids, calories, minerals, etc., it can result in more skin tissue breaks than normal. 

Further, it’s essential to maintain proper hygiene and skin care to decrease the likelihood of infections, fungus, etc., that can lead to weaker skin. For example, you can promote preventative skin care by replacing soaps with skin cleaners and barrier creams. 

Frequent Rotations For Those With Limited Mobility

Older adults are much more likely to be sedentary throughout the day. That’s especially true if they are partially or fully immobile. Generally, if you’re a care team member or caregiver working with an elderly person, there are a few steps you can take to prevent bedsores. They include but are not limited to the following: 

• Reposition about once every hour 
• Do “wheelchair pushups” to separate their body from the surface of the wheelchair 
• Use cushions and mattresses that decrease pressure
• Inspect all areas of the skin regularly 

Use Effective Skincare Products

Sometimes, the right practices and preventive steps aren’t enough to prevent skin issues. However, there are effective skincare products available, including moisturizers, barrier creams, and skin cleansers that can help individuals maintain healthier and more resilient skin.

Skin Care Best Practices for Senior Living Communities

With the right routines and practices, aging skin can effectively be maintained and even improved. Here are some tips that can help protect elderly skin:

• Change bathing habits to include warm water (not hot), gentle/fragrance-free soap, patting water off the skin (not rubbing), and using healthy moisturizers.
• Use humidifiers when the air gets too dry. 
• Upgrading residents from a generic diaper brand to a more premium product.
• Protect the skin from the sun using sunscreen and sun-protective clothing. 
• Check all areas of the skin as often as possible. 
• Use the best skincare products. For example, using the right barrier creams, lotions, cleansers, and adult diapers can go a long way to maintaining healthy skin. 

How Parentgiving Can Help

Caring for aging skin requires a plan and constant vigilance. At Parentgiving, we’re dedicated to helping you and your caregivers achieve healthy skin regardless of the situation. 

With the right strategy, the best skincare products, and premium adult diapers that offer better skin protection, you can prevent breakdown and keep your residents comfortable. Contact us to learn more about how Parentgiving can work with your senior living community to find the right products for your residents.