Pressure Injuries and Wound Care: Which Care Settings Can Help

A pressure injury (also called a bedsore or pressure ulcer) can change where a parent is allowed to live. Families are often surprised to learn that California sets firm limits on wound care in assisted living and board and care homes, and that the stage of a wound can decide whether a parent can stay, move in, or needs a nursing home. This guide explains how wound care assisted living rules work in California, what San Diego board and care homes can handle, and how good daily care prevents wounds in the first place.

If your parent is in the hospital or rehab with a wound and the discharge planner is asking “where will they go next,” this is for you.

What Is a Pressure Injury and Why Does Its Stage Matter?

A pressure injury is damage to skin and tissue from staying in one position too long, usually over the tailbone, hips or heels. Wounds are staged from 1 (red, unbroken skin) to 4 (deep wounds exposing muscle or bone). In California care homes, the stage matters because it decides which setting is legally allowed to care for your parent.

A simple way to picture the stages:

• Stage 1: Skin is intact but red, and the redness does not fade when pressed.
• Stage 2: A shallow open sore or blister. Partial skin loss.
• Stage 3: A deeper wound into the fat layer under the skin.
• Stage 4: A deep wound exposing muscle, tendon or bone.

There are also “unstageable” wounds (covered by dead tissue so the depth cannot be seen) and deep tissue injuries (purple or maroon skin over damaged tissue). Ask the wound nurse to tell you in writing how your parent’s wound is classified, because care homes will ask.

Pressure injuries form fast in frail seniors. A parent who stays in bed after a hip fracture, sits in a recliner most of the day, has incontinence, eats poorly or has diabetes is at higher risk. Our guide to life after a hip fracture covers one of the most common situations where wounds start.

What California Allows for Wound Care in Assisted Living and Board and Care

California allows assisted living and board and care homes to care for stage 1 and 2 pressure injuries and healing surgical wounds, but only when a physician or appropriately skilled professional diagnoses and treats the pressure injury. Stage 3 and 4 pressure injuries are prohibited in RCFEs except under hospice. This is set by Title 22.

The key rules, all in Title 22 of the California Code of Regulations:

• Section 87612 lists stage 1 and 2 pressure injuries and wound care as restricted health conditions. RCFEs may care for them under conditions.
• Section 87631 (Healing Wounds) lets a home accept or keep a resident with a healing wound when care is done by, or under the supervision of, an appropriately skilled professional. Surgical wounds must be cared for as the surgeon directs. For a stage 1 or 2 pressure injury, a physician or skilled professional must diagnose it and provide the pressure injury care, and all care must be documented in the resident’s file.
• Skin tears are not considered healing wounds under Section 87631.
• Section 87615 prohibits RCFEs from admitting or keeping residents with stage 3 and 4 pressure injuries, along with gastrostomy tubes, nasogastric tubes, tracheostomies, staph or other serious infections, and residents who depend on others for all activities of daily living.

“Appropriately skilled professional” generally means a licensed professional such as a registered nurse, often from a home health agency. The board and care caregivers support the plan, keep the area clean and dry, reposition your parent and report changes, but the wound care itself is directed by a licensed professional.

This applies to all RCFEs, from small board and care homes in San Diego to large assisted living communities. Our guide to restricted health conditions in California RCFEs covers the full list.

Which Care Setting Fits Each Kind of Wound?

Stage 1 and 2 pressure injuries and healing surgical incisions can usually be managed in a board and care home or assisted living with home health nursing. Stage 3 and 4 wounds, wounds needing daily skilled treatment, and infected wounds usually require a skilled nursing facility, unless your parent is on hospice in a home with a hospice waiver.

Usually manageable in board and care or assisted living (with home health or other skilled professional involvement):

• Stage 1 or 2 pressure injuries diagnosed and treated by a physician or nurse
• Healing surgical incisions after hip, knee or other surgery, cared for as the surgeon directs
• Minor wounds that a home health nurse is treating and expects to heal

Usually needs a skilled nursing facility:

• Stage 3 or 4 pressure injuries
• Wounds with serious infection, including staph infections
• Complex wounds needing daily skilled treatment or IV antibiotics

Ask carefully about: wound vacs (negative pressure wound therapy), unstageable wounds and deep tissue injuries. These often depend on the exact situation, the doctor’s documentation and the home’s willingness, and may require a skilled nursing stay first.

Our overview of nursing homes in San Diego explains skilled nursing, and our post on board and care vs. nursing home helps you decide when a SNF is truly needed.

The Hospice Exception for Advanced Wounds

When a resident is terminally ill and receiving hospice, a home with a California hospice waiver may keep them even with a stage 3 or 4 pressure injury, as long as the hospice care plan specifically addresses it. This lets many families keep a dying parent in a familiar board and care home instead of moving them.

Title 22 Section 87616(c) says that homes with a hospice waiver do not need to request a separate exception for restricted or prohibited conditions when the resident:

• Has been diagnosed as terminally ill
• Is receiving hospice services under a hospice care plan
• Has the treatment of that condition specifically addressed in the hospice care plan

In practice, this is common. Late in life, skin often breaks down despite good care, especially in people who no longer eat much or move on their own. A hospice nurse manages the wound with comfort as the main goal, and the board and care caregivers turn and reposition your parent as the plan directs.

Outside of hospice, a home can request an exception from the licensing agency for a specific resident (Section 87616), but approval is not automatic and many homes will not seek one. Learn more in our guide to hospice in a board and care home.

What Happens If a Wound Gets Worse While Your Parent Lives There

If a stage 2 wound worsens to stage 3 in a board and care or assisted living home, the home generally cannot keep your parent unless hospice applies or the licensing agency approves an exception. Expect a care conference, home health or doctor involvement, and possibly a move to skilled nursing until the wound heals.

What usually happens:

1. The home notifies you and the doctor. A good home calls as soon as caregivers see skin changes, not when the wound is already deep.
2. A professional assesses the wound. Often a home health nurse or wound care nurse visits and stages it.
3. If it is stage 3 or 4, your parent typically moves to a skilled nursing facility for wound treatment. Medicare may cover a skilled stay after a qualifying hospital stay.
4. Once healed or improved, many residents return to their board and care home or move to a new one. Ask the home before the transfer whether they will hold the bed and on what terms.

California licensing can also issue a health condition relocation order (Title 22 Section 87637) if it determines a resident has a condition the home cannot legally care for. Our guide to California’s notice rules when a board and care asks a resident to leave explains your rights.

How Good Care Homes Prevent Pressure Injuries

The best wound care is prevention. Good board and care homes prevent pressure injuries by repositioning residents who cannot move themselves, keeping skin clean and dry after incontinence, using pressure-relieving cushions and mattresses, encouraging food and fluids, getting residents up and moving, and checking skin daily during bathing and dressing.

Prevention practices to ask about:

• Repositioning schedule. For residents who cannot shift on their own, ask how often staff turn them in bed or help them stand from a chair, and whether it is written down.
• Incontinence care. Wet or soiled skin breaks down quickly. Ask how often briefs are checked, including overnight.
• Skin checks. Caregivers should look at heels, hips, tailbone and elbows during bathing and report redness the same day.
• Equipment. Pressure-relieving mattresses, wheelchair cushions and heel protectors. A doctor can often order these through Medicare as medical equipment.
• Nutrition and hydration. Protein and fluids help skin heal and resist injury. Ask how the home encourages residents who eat poorly.
• Movement. Walking to meals, standing to transfer, and therapy exercises all reduce pressure.

This is where small homes have a real edge. In a 6-bed board and care home, the same caregiver who bathes your parent in the morning helps them to lunch and back to bed, so redness on a heel is far less likely to go unnoticed. Residents who need two-person transfers or a Hoyer lift are at higher risk, so see our guide to two-person transfers and Hoyer lifts in care homes.

Who Pays for Wound Care in a Senior Care Home?

Wound treatment by a home health nurse is often covered by Medicare when a doctor orders it and your parent qualifies. The monthly board and care or assisted living rate is separate and usually paid privately. Some homes charge more for residents with wounds because they need more repositioning and personal care.

How the costs usually break down:

• Home health nursing: Medicare can cover intermittent skilled nursing visits for wound care when your parent meets the home health criteria. Our explainer on home health care covers how it works.
• Supplies: Some wound supplies are covered when provided through the home health agency or prescribed. Ask who supplies dressings.
• Equipment: Pressure-relieving mattresses and cushions may be covered by Medicare Part B when ordered by a doctor and medically necessary.
• The care home rate: In 2026, board and care homes in San Diego typically cost $5,500 to $9,500 per month, and assisted living about $5,500 to $12,500. Heavy care such as frequent repositioning, incontinence care and two-person transfers pushes the rate toward the higher end.

Ask each home for a written rate that reflects current needs and what would change it. Our guide to what a board and care monthly rate includes lists questions to ask.

Questions to Ask Before Choosing a Home for a Parent With a Wound

Before choosing a senior care home for a parent with a wound or high wound risk, ask which wound stages the home accepts, which home health agencies it works with, how it repositions residents, how it handles incontinence at night, whether it has a hospice waiver, and what happens if the wound worsens.

Questions to ask the home:

• Have you cared for residents with stage 2 pressure injuries? How did it go?
• Which home health agencies and wound nurses come to your home?
• How often do you reposition residents who cannot move on their own? Can I see how you document it?
• How often are incontinence briefs checked overnight? Is the night caregiver awake?
• What pressure-relieving equipment do you use?
• Do you have a hospice waiver?
• If the wound gets worse, what would you do, and would you hold the bed during a skilled nursing stay?

Paperwork to have ready: the hospital or SNF wound assessment with the stage in writing, the doctor’s wound care orders, the physician’s report, and the home health referral. Our post on the LIC 602A physician’s report explains the form care homes require.

Also look up each home’s licensing history before you commit. Citations for pressure injuries or poor incontinence care are serious red flags. Our guide to RCFE inspection reports shows how to read them.

How Elder Answers Helps

Elder Answers knows which board and care homes in San Diego work closely with home health wound nurses, have strong repositioning routines, hold hospice waivers and have openings now. Our advisors personally visit the homes we recommend and can tell you honestly when a skilled nursing stay is the safer first step.

Our help is free for families because care homes pay us after a move-in, and your rate does not change. We share information only with homes you choose. When a hospital or SNF discharge is close, moves can often happen within a few days. Contact Elder Answers or explore board and care homes in San Diego.

Frequently Asked Questions About Wound Care in Assisted Living

Can assisted living provide wound care in California?

Yes, within limits. California RCFEs, including assisted living and board and care homes, may care for healing wounds and stage 1 and 2 pressure injuries when a physician or appropriately skilled professional is involved, as set out in Title 22 Section 87631. The wound care itself is usually done or supervised by a home health nurse.

Can a board and care home accept someone with a stage 3 bedsore?

Generally no. Stage 3 and 4 pressure injuries are prohibited conditions in California RCFEs under Title 22 Section 87615. The main exception is a terminally ill resident on hospice in a home with a hospice waiver, when the hospice care plan addresses the wound.

Who does the wound care in a board and care home?

A physician or appropriately skilled professional, usually a home health nurse, diagnoses and treats the wound. Board and care caregivers support the plan by repositioning, keeping skin clean and dry, and reporting changes. All care must be documented in the resident’s file.

Does Medicare pay for wound care in assisted living?

Medicare can cover home health nursing for wound care when a doctor orders it and your parent qualifies, even when they live in assisted living or board and care. Medicare does not pay the monthly room, board and personal care rate.

What happens if my parent’s wound gets worse in assisted living?

If a wound worsens to stage 3 or 4, the home generally cannot keep your parent unless hospice applies or an exception is approved. Many residents go to a skilled nursing facility for treatment and then return to board and care once the wound heals.

Are skin tears treated the same as pressure injuries?

No. Title 22 Section 87631 says a skin tear is not considered a healing wound under that section. Skin tears are common in frail seniors and are usually handled with basic first aid and the doctor’s guidance.

How do care homes prevent bedsores?

Good homes reposition residents who cannot move themselves, keep skin clean and dry, use pressure-relieving mattresses and cushions, check skin daily and encourage eating, drinking and movement. Small board and care homes often catch early redness quickly because the same caregivers see residents all day.

Does wound care raise the monthly rate?

It can. The wound treatment is usually billed separately through home health, but the extra repositioning, incontinence care and transfers can move your parent into a higher care level. Board and care homes in San Diego typically cost $5,500 to $9,500 per month in 2026.