Pressure injuries remain one of the most preventable yet costly challenges across home care and long-term care settings. As higher-acuity patients transition home sooner—and staffing limitations reduce the frequency of repositioning—the role of the support surface becomes increasingly critical. Yet surface selection is often inconsistent, based more on availability or habit than on clinical need. This session introduces a practical, evidence-informed framework for support surface selection grounded in current NPIAP principles, microclimate science, and standardized assessment pathways. Participants will learn how immobility drives a cascade of heat, moisture, friction, and shear—and why microclimate management is essential for preventing skin breakdown. The session will also walk through a neutral, category-based support surface algorithm and five essential assessment questions that help ensure the right surface is selected for the first time. Through real-world case scenarios and simplified decision tools, attendees will gain actionable strategies to improve patient outcomes, reduce unnecessary equipment swaps, support healing, and strengthen collaboration with home health and long-term care partners. This session reframes support surfaces not as equipment deliveries, but as essential components of outcome-driven care.