The use of genuine sheepskin was compared to the use of synthetic sheepskin in two long term care institutions. Data for the control group of 44 residents placed on synthetic sheepskin were obtained by retrospecitve chart audit. Sixty-four residents were randomly placed on genuine merino sheepskin (WoolTec USA, Maspeth, NY). The two groups were similar in age, diagnosis, polypharmacy, and risk assessment score. In the control group 41% maintained skin integrity, 38% improved, and 21% deteriorated; in the study group 63% maintained skin integrity, 37% improved, and none deteriorated. The use of genuine sheepskin is recommended to reduce the risk factors of friction and shear.