What to use to keep the skin from breaking down?

Use a barrier crème. You can buy it over the counter but stuff you get from visiting nurses or a Dr. prescription is much more effective in my opinion.

Zinc oxide is also effective as a barrier crème. But nothing can compare to keeping the skin clean and dry and repositioning the person every 2 hours.

Get rid of the darn Coumadin. It made mom's skin so frail that if she pulled off a bandaid, the skin came with it.

Look at Medline Remedy Skin Repair Lotion. This was recommended to me by a physician at a wound clinic to use for my mom. She was prone to skin tears and became slow to heal for anything. Smells good too. It is now my personal lotion of choice.