Gateway nurse practitioners visit your home, ALF, or SNF to assess, stage, and treat pressure ulcers — including sacral wounds, heel ulcers, and hip injuries — without transferring patients from their environment.
A pressure ulcer — also called a bed sore, pressure injury, or decubitus ulcer — develops when sustained pressure reduces blood flow to an area of skin, typically over a bony prominence. Shear forces, friction, and moisture (from incontinence or perspiration) accelerate tissue breakdown. Most pressure ulcers develop in the home or care facility where the patient already lives — yet traditional wound care forces families to arrange transportation to clinics, adding cost and disruption.
Gateway Wound Care's model is built around the simple truth that the best place to treat a pressure ulcer is where it formed. Our nurse practitioners visit patients throughout Greater St. Louis — including in Ballwin, Kirkwood, and Town & Country — delivering the same clinical evaluation and treatment available at a wound center, in the patient's own bed or chair.
Whether the pressure ulcer is a Stage 1 area of persistent redness or a deep Stage 4 wound with exposed tissue, Gateway's NPs have the training and tools to manage it — and to educate the surrounding care team so prevention becomes part of daily routine.
The National Pressure Ulcer Advisory Panel (NPUAP) — now the National Pressure Injury Advisory Panel — defines six categories of pressure injury. Understanding the stage guides treatment decisions and helps families communicate with care teams.
| Stage | What You See | Common Locations |
|---|---|---|
| Stage 1 | Non-blanchable redness on intact skin. Area may feel warm, firm, or painful. | Sacrum, heels, hips, elbows |
| Stage 2 | Partial-thickness skin loss — looks like a shallow open wound or blister. No slough or eschar visible. | Sacrum, heels, ischial tuberosities |
| Stage 3 | Full-thickness skin loss. Subcutaneous fat visible. No bone, tendon, or muscle exposed. | Sacrum, heels, lateral malleolus |
| Stage 4 | Full-thickness tissue loss with exposed bone, tendon, or muscle. May have slough or eschar. | Sacrum, heels, occiput |
| Unstageable | Full-thickness loss covered by slough or eschar — depth cannot be determined until debrided. | Any location; heels common |
| Deep Tissue Injury (DTI) | Purple or maroon localized discoloration of intact skin — indicates deep tissue damage before surface breakdown occurs. | Heels, sacrum |
Gateway NPs stage each wound at every visit using the NPUAP classification, document with photographs, and track progression or healing trajectory. Accurate staging is critical for appropriate treatment selection and for insurance documentation.
Transporting a bed-bound or chair-bound patient with a Stage 3 or 4 pressure ulcer to a clinic is painful, logistically difficult, and creates additional pressure and shear during transport. We come to the patient — no disruption, no additional wound stress.
We educate family members and facility staff on the turning schedules, skin protection techniques, moisture management, and nutritional considerations that prevent new ulcers from forming. Education at the bedside — not in a pamphlet — is where behavior actually changes.
Gateway works as a specialist extension of your facility's nursing staff. We document findings, communicate directly with the attending physician, and provide wound care orders — so residents receive expert care without hospital transfers.
Pressure ulcers require the same hands and eyes at every visit — tracking wound dimensions, tissue type percentages, and exudate. Inconsistent wound care produces inconsistent healing. Gateway assigns the same NP to each patient whenever clinically possible.
At the initial visit, our NP performs a full-body skin assessment, stages all active pressure injuries, and reviews the patient's current support surface, positioning routine, nutritional status, and incontinence management. A written care plan is created at that visit and shared with the referring physician and care team.
Every wound is assessed using NPUAP staging, measured (length × width × depth), and photographed. Periwound tissue, exudate characteristics, and wound bed tissue composition are documented in detail to track progress over time.
We select specialty dressings matched to wound stage, exudate level, and infection status. For necrotic tissue, we perform bedside debridement. Stage 3 and 4 wounds that meet criteria receive wound vac (NPWT) therapy at home.
We create an individualized repositioning schedule, recommend or coordinate appropriate support surfaces, and provide hands-on training for caregivers and facility staff on pressure prevention, skin inspection, and moisture management.
Medicare Part B covers medically necessary wound care services — including staging assessment, debridement, and dressing changes — provided by a nurse practitioner in the patient's home or facility. For Stage 3 and 4 wounds that meet clinical criteria, wound vac (NPWT) therapy carries its own Medicare Local Coverage Determination (LCD) and is billed separately through the DME supplier.
Gateway accepts Medicare, Medicaid, most major commercial insurance plans, and Medicare Advantage plans. We verify benefits before the first visit and provide complete documentation — including wound measurements, tissue classification, and photographs — to support ongoing insurance coverage and physician communication.
We treat pressure ulcers throughout Greater St. Louis — including in Chesterfield, Creve Coeur, Des Peres, Town & Country, Kirkwood, Ballwin, and throughout our 50-mile service area. View full service area.