One thing that was constantly on my mind as a caregiver was the state of my father's skin, particularly on his buttocks, as he sat in a wheelchair almost all day.

I learned to examine his skin closely at every opportunity; if I was not around for a few days I always asked the staff to let me know if they saw a problem. Since my father could not express pain or discomfort, if I saw any redness at all or the beginnings of a sore I looked for the cause immediately. He had a sore on his coccyx; the same day I bought a V cushion to help ease the pressure on his lower back. I tried several cushions over the years — foam, gel and most recently something called a Roho cushion. This cushion — supposedly the best on the market — is filled with air which allows the user to sink as deeply into the cushion as possible without bottoming out or touching the base of the cushion. Proper adjustment of this cushion is crucial. My dad's wheelchair also allowed us to tip him back in various positions; this helped change his weight distribution. Inquire about a possible provincial subsidy to help pay for wheelchairs or cushions; here in Ontario the ADP program assisted with the cost of my dad's equipment.

We also used special cream on dad's skin, watched his posture closely and put him in bed for a few hours every day to ease the pressure on his buttocks. Dad's companion and I massaged his lower back. I knew we were lucky; dad's skin was very thin at the end, but for some reason we escaped pressure sores although a small tear on his elbow ended up becoming terribly infected.

I suspect dad's healthy eating was an influence. When I started seeing some slowing down in his food intake, I became even more vigilant about his skin. The lesson: learn what pressure sores look like and how they progress. Catch the problem early and control the damage immediately. Never let down your guard.