Bed Sore Treatment at Home in St. Louis | Pressure Injury Care

What a pressure injury is

A pressure injury is damage to the skin and the tissue beneath it caused by pressure that lasts too long, or by pressure combined with sliding. “Bed sore,” “pressure sore” and “pressure ulcer” are other names for the same thing. Gateway arranges pressure injury and bed sore care in St. Louis and the Metro East for people at home and in care facilities.

Most pressure injuries appear over bone: the tailbone, hips, heels, ankles, elbows, shoulder blades and the back of the head. They can also form under medical devices such as oxygen tubing or a brace. Clinicians describe them by stage, from unbroken skin that stays discolored to deep wounds that reach muscle or bone, as explained in our guide to pressure injury stages.

If you are looking for help with this wound close to home, start with our overview of wound care in St. Louis.

Why pressure injuries can be slow to heal

The wound is injured again each time pressure returns, which is hard to prevent for a person who cannot shift position alone. Common barriers:

Long periods in one position in a bed, recliner or wheelchair
Sliding down in bed or being pulled across sheets, which strains tissue
Moisture from incontinence or sweat, which softens the skin
Too little protein, calories or fluid to rebuild tissue
Poor circulation or reduced feeling, so discomfort never prompts a shift
Damage that begins deep near the bone, so the wound is larger than it looks on the surface

What the treating clinician considers

The treating clinician looks at the wound and at how the person spends the day:

Stage, size and depth, and any tunneling under the skin edges
The tissue in the wound, drainage, odor and signs of infection
The mattress, wheelchair cushion or recliner, and the time spent on each
How the person moves and who helps with repositioning
Continence, appetite and recent weight change
Pain, overall health and the goals of the person and family

The clinician then writes orders for the wound and may recommend changes to surfaces, positioning or nutrition.

Pressure injury care at home and in facilities

At home, most of the daily work falls to family or paid caregivers: turning, checking skin, managing incontinence and keeping heels off the bed. A home visit lets the clinician see the actual bed and chair. Our pressure injury caregiver guide and the page on setting a repositioning schedule at home cover the day-to-day side.

In skilled nursing, assisted living and memory care, partner clinicians see residents on site, often through scheduled facility wound rounds with the nursing team. Findings and orders are shared with staff so the care plan and documentation stay current.

How primary care factors in

Pressure injuries rarely happen to people who are otherwise well. Weight loss, poor appetite, diabetes, incontinence, a recent stroke, advancing dementia and medications that cause drowsiness can all raise the risk and slow recovery. Addressing them is part of caring for the wound.

Gateway can arrange primary care at home or in a facility, including attention to nutrition and healing, and help both clinicians see each other’s findings.

Changes to report and when to call 911

Let the treating clinician or facility nurse know about:

A patch of skin that stays red, purple or darker than the skin around it after pressure is removed
Skin over a bony area that feels unusually warm, firm or mushy
A new blister or open area
A wound that is larger or deeper, or shows black tissue
More drainage, a new odor, or redness and warmth spreading outward
Fever, chills, new confusion or unusual sleepiness
New or increasing pain

Call 911 for trouble breathing, chest pain, bleeding that will not stop, or a person who is suddenly very confused, hard to wake or unresponsive.

How Gateway helps arrange pressure injury care

Families often call when a sore appears after a hospital stay or when a parent now spends most of the day in bed. Facility nurses call to set up visits for one resident or regular rounds. The first call to 314-325-0126 covers where the person is, the care setting and who is already involved.

Gateway then gathers records, confirms visit availability for that location, schedules with a partner clinician, and follows up on orders for dressings, supplies and equipment. Whether a mattress, cushion or other item is a covered benefit depends on the plan, the treating provider and the care needed.

Families can request care with a name and phone number (no medical details, please). Facility and hospital staff can use the referral page.

Bed sore treatment at home: what a visit involves

When a bed sore is treated at home, the visit comes to the bed or chair where the damage happened. Depending on the wound, the clinician may be a physician, a podiatrist (DPM) for heel and foot pressure injuries, or a nurse practitioner.

At the visit, the clinician looks at the wound, measures it and stages it, checks the skin over the other bony areas, and asks how the person spends the day: how long in bed, how long in the chair, how often they are turned, what they sit and lie on, how they are eating and whether they are continent. The wound is cleaned and dressed, and dead tissue may be removed at the bedside when the clinician decides that is appropriate. Before leaving, the clinician writes orders for dressings and, where needed, for a pressure-relieving mattress or cushion, and sets a follow-up schedule. Gateway then coordinates the supplies and lets the family, the home health agency or the facility nurses know the plan.

See a wound care specialist who comes to your home for who visits and what each clinician can do, and wound care for seniors for how bed sores fit with other health problems in older adults.

For caregivers of someone in bed or a wheelchair

Most of what heals a bed sore happens between visits, and most of it is done by the people at home. The treating clinician will give specific instructions, but these are the areas that usually matter most:

Turning and repositioning. Pressure has to come off the wound and stay off. A written schedule that fits the household's real routine works better than an ideal one nobody can keep. See setting up a repositioning schedule at home.
What the person lies and sits on. An ordinary mattress or a donut cushion can make things worse. The clinician may order a pressure-redistributing mattress, overlay or seat cushion. See cushions and mattresses for pressure relief.
Skin checks. Look at the heels, tailbone, hips, shoulder blades and the back of the head every day, especially in someone who cannot say where it hurts.
Moisture. Keep skin clean and dry, change soiled briefs quickly and use the barrier products the clinician recommends.
Food and fluids. Healing skin needs protein and water. Tell the clinician if the person is eating or drinking much less than usual.

Our pressure injury caregiver guide walks through a daily routine in more detail.

Pressure injury stages, explained simply

Clinicians describe pressure injuries in stages so everyone on the care team means the same thing. In plain terms:

Stage 1: skin is intact but stays red or discolored and does not lighten when pressed. This is a warning sign that the area needs pressure relief now.
Stage 2: the top layer of skin is broken, often as a shallow open sore or a blister.
Stage 3: the wound goes through the skin into the fat beneath it.
Stage 4: the wound reaches muscle, tendon or bone.
Unstageable and deep tissue injury: dead tissue hides the base so the depth cannot be seen, or the skin is intact but dark purple or maroon over damaged tissue underneath.

The stage is a description, not a prognosis, and it is decided by the clinician who examines the wound. Our guide to pressure injury stages explained has more detail and pictures described in words.

When a bed sore needs care today

Call the treating clinician's office, or Gateway at 314-325-0126, the same day if a bed sore:

has redness, warmth or swelling spreading into the skin around it
smells bad, or the drainage has become thick, green or much heavier
has new black or dark tissue, or is quickly getting larger or deeper
comes with fever, chills, new confusion or the person seems much weaker

In an older adult, sudden confusion can be the first sign of an infected wound. For a medical emergency, call 911.

Bed sore care by county

Gateway arranges bed sore and pressure injury care at home and in senior living across Greater St. Louis and the Metro East. Choose your county:

Common questions

How often should someone be turned?

There is no single schedule. The right interval depends on the person’s skin, how well they tolerate each position and the mattress or cushion in use. The treating clinician or nursing team sets the plan. A good schedule is written down, realistic for the people doing the turning and adjusted if the skin shows new discoloration.

Does a special mattress or cushion replace turning?

No. Pressure-relieving surfaces spread weight over a larger area, which lowers the load on any one spot, but they do not remove the need to change position. Our page on cushions and mattresses for pressure relief describes the main types.

What should I ask if a family member develops a pressure injury in a facility?

Ask where the wound is, what stage it is, how large it is and when it was first noted. Then ask who is following the wound, how often it is assessed, what the turning schedule is and what surface the person is on. You can also ask to attend the next care plan meeting.

Can a pressure injury improve if the person cannot move on their own?

It can, if caregivers and equipment do the moving for them. Progress depends on the depth of the wound and the person’s overall health. For some people who are very frail or near the end of life, wounds may not close, and the plan may shift to palliative wound care focused on comfort, odor and drainage.

Can a bed sore be treated at home, or does it need a wound clinic?

Many bed sores can be treated at home or in the facility where the person lives, by a visiting physician, podiatrist (DPM) or nurse practitioner. Deep or infected wounds sometimes need a wound clinic or a hospital, and the visiting clinician will say so and help arrange it.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.

Bed sore and pressure injury care at home in St. Louis.