The purpose of this study was to compare the incidence of pressure ulcers in 40 newly admitted at-risk (Braden Scale score < 18) skilled-nursing-facility residents, randomly assigned to Iris 3000 (Bio Clinic of Sunrise Medical Corp, Ontario, CA) foam mattress overlays (n = 20) or a MAXIFLOAT (BG Industries, Northridge, CA) foam mattress replacements (n = 20). Head-to-toe skin assessments were done 3 times weekly for a maximum of 21 days, using Bergstrom Skin Assessment Tool. Subjects on MAXIFLOAT had fewer pressure ulcers (chi 2[1, N = 40] = 5.013, p = .025) despite heavier body mass (t[35] = 2.60, p = .013) and more days on the surface (t[38] = 2.24, p = .03). MAXIFLOAT proved to be more effective in preventing pressure ulcers in an at-risk skilled-care population and was cost-effective. Research findings on efficacy, adequate feedback from nursing staff, residents, and ancillary staff regarding issues of patient comfort, ease of use, and cost are important factors in decision-making when considering product changes.