Wheelchair Cushions and Pressure Sores: Who Leads Care

What Should You Do If a Pressure Sore Has Already Formed?

Contact a district nurse or medical professional immediately for clinical wound management before purchasing replacement seating equipment. If you think someone already has one, or you notice a patch of skin that stays red, feels different, blisters or breaks, contact the GP surgery or district nurse promptly. Please do not rely on buying a new cushion to sort it out. Searches for wheelchair cushions for pressure sores often lead to product pages promising results, but no cushion can replace proper assessment and care.

This page explains who usually leads care, how cushions and seating fit into it, and what you might ask along the way.

Who Leads the Care

Care for a pressure sore is usually led by the GP and district nursing team for people at home, or by the ward team in hospital. Some areas have a tissue viability nurse, a specialist in wounds and skin, who may be involved for more complex cases. An occupational therapist or the wheelchair service may be asked to review seating and equipment. Care homes have their own nursing arrangements and links to these services.

Roles can overlap, and different areas organise services in different ways, so do not worry if the names above do not match exactly what happens locally. The important thing is that someone with the right training is looking at the skin and the equipment together.

It helps to know who is leading, and who to call out of hours. Ask for a name and a phone number, and keep them somewhere easy to find.

How Are Specialist Seating Decisions Made by Professionals?

Occupational therapists and tissue viability specialists select pressure-relief equipment as part of a comprehensive posture and skin-care plan. The team will think about how long the person sits, how they move, where the sore is, and what equipment they already have. They may provide equipment through an equipment loan service, change the existing wheelchair set-up, or recommend a type of cushion. They may also advise on time spent sitting, which can matter as much as the cushion itself.

If you are thinking of buying something privately, ask first. The team may have a view on which types to use or avoid for this person.

Questions About Cushions and Seating

• Should the person keep using their current cushion, or stop until it has been checked?
• Is a seating review needed, and who arranges it?
• Can equipment be loaned while we wait?
• If we buy privately, what type and size should we look for?
• Are there products we should not use, such as ring cushions or extra padding?
• How should the cushion be checked, and how often?
• Who should we tell if the cushion seems worn or the sore looks worse?

What Happens During an NHS Wheelchair Seating Review?

An occupational therapist evaluates the user’s pelvic alignment, spinal posture, leg positioning and overall chair setup alongside cushion choice. It may cover seat depth and width, footrest and armrest heights, backrest support, and how the person sits over the day. Small changes, such as adjusting footrests, can alter how weight is spread. The reviewer may suggest a different cushion, a new cover, or changes to the chair itself.

Take the cushion and the chair along, or have them ready for a home visit, and mention any other seats the person uses regularly.

Coming Home From Hospital

If someone developed a sore in hospital or is coming home with one, ask about equipment before hospital discharge. Will a cushion or mattress be provided? Who will deliver it and show you how to use it? Will a district nurse visit, and when? Make sure the wheelchair and any cushion at home have been considered, not just the bed. Our guide to wheelchair pressure cushions explains the equipment you may hear about.

Practical Points on Any Cushion

Whatever cushion is used, a few practical points apply. It should fit the chair seat without overhanging or leaving gaps. It should be the right way round; many cushions have a marked front or base. The cover should be clean, smooth and not bunched. Check whether the cover can be washed at the temperature the nurse suggests, and keep a spare. For gel or air cushions, follow the checking routine the professional shows you. Our pages on foam cushions and gel cushions describe those types without making health claims.

Talking to the District Nurse About Daily Life

Visits from the district nurse are often short, so it helps to prepare. Before a visit, jot down what the person does during a typical day: when they get up, how long they sit in the wheelchair, whether they sit elsewhere, how they get in and out of the chair, and whether anything has changed recently, such as illness, less appetite, or a new chair. Mention continence, sweating or anything that keeps the skin damp. These details help the nurse build a picture and give advice that fits real life.

Ask the nurse to explain anything you do not understand, and ask what you should do between visits. If they suggest changes to routines, such as more frequent changes of position or time out of the chair, ask how to fit those around meals, visitors and outings. If the person has a care agency, share the advice with them too, and ask the agency to record what they notice.

If Care Feels Stuck

If a sore does not seem to be improving, or you feel your concerns are not being heard, ask the GP or district nurse whether a referral to tissue viability or a seating specialist would help. You can also ask the practice who to speak to if you want to raise a concern about care. Being clear, calm and specific about what you have noticed usually gets the best response.

Keeping a Simple Log

Some families and carers find it useful to keep a short daily note: when skin was checked, anything noticed, how long the person sat, and whether the cushion looked right. This is not a medical record, but it can help when you speak to the nurse or GP. Ask the professional what they would like you to note, and follow their guidance on what to look for.

Buying Privately While Waiting

Waiting for equipment can be frustrating. If you decide to buy while waiting, ask the team which type they would suggest, check the listing for size, materials, cover and care instructions, and confirm the returns policy, including any hygiene rules. Avoid listings that claim to fix sores. If a free delivery offer is advertised, check whether it applies to your address. Tell the team what you bought, so they can check it at the next visit.

Where to Read More

The NHS page on pressure sores describes the signs, who is more likely to get them, and when to seek help. The NHS social care pages on wheelchairs and mobility equipment are useful if you need to contact the wheelchair service. For cushion types in general, see wheelchair cushion basics.

The Short Version

If there is a sore, contact the GP or district nurse first. Find out who is leading care and ask about a seating review and equipment loan. Use cushions as part of the team’s plan, not instead of it. Check the skin and the cushion as advised, keep a simple log, and report any change quickly.