The development of a pressure ulcer is related to the amount and duration of pressure, which in turn decreases transcutaneous oxygen tension. Pressure, friction, sheer forces, and moisture contribute to development of an ulcer. Normally, we are protected against the formation of ulcers by spontaneous movement that occurs during waking and sleeping hours. Conditions that interfere with mental function, commonly seen in the LTCF, impair reflex protective movement; examples include Alzheimer's disease and cerebrovascular accidents. Diabetes mellitus is associated with neuropathy that impairs the reflex sensory arch and is a risk factor for development of pressure ulcers. Ambulation difficulty, Parkinson's disease, fecal incontinence, paralysis, physical restraint, malnutrition, advanced age, presence of a fracture, and bed-bound status are all risk factors in various studies for development of pressure ulcers in the LTCF