Aides notice first
A nurse or clinician may see a client for part of an hour each week. An aide is there for baths, meals, transfers and the long quiet stretches, and sees how the client really moves, eats and sleeps. When a wound starts to go wrong, the aide is often the first person in a position to notice.
Wound care coordination for home care agencies is about making that noticing count. Gateway Wound Care arranges mobile wound care visits from partner clinicians in private homes across Greater St. Louis and the Metro East, and coordinates scheduling, supplies and communication around those visits. Your aides do not provide wound care. They can be the reason a problem is caught early.
What an aide can observe
Observing means noticing and writing down, not lifting a dressing. Things an aide can see, smell or hear during ordinary care:
- A dressing that is loose, wet, soiled or missing
- Drainage on socks, clothing, bedding or a chair cushion, or a new odor
- Redness, swelling or warmth around the dressing
- The client saying the wound hurts more, or guarding the area during a bath or transfer
- A new red, dark or open area on the heels, tailbone, hips or anywhere skin rests
- The client no longer wearing a prescribed boot, shoe or compression garment
- Eating or drinking much less than usual
- New confusion, unusual sleepiness, chills or a fall
Our patient guide to the signs of wound infection describes several of these changes in plain language.
Where the aide’s role ends
Non-medical home care has limits, and they protect the client and the aide. What an aide may do around a wound depends on state rules, your agency’s policies and the client’s plan of care.
In general, aides do not assess wounds, decide what a change means, choose products or alter the treating clinician’s instructions. When aides are unsure, the answer is to report, not to act.
Who to tell and what to say
A good report is short and factual: the date and time, what was seen, where on the body, and what the client said about it. Photos should be taken only if your agency’s policy and the client’s permission allow it.
- The aide reports to the agency supervisor under your normal change-of-condition process.
- The agency informs the client’s family or responsible party.
- The client, family or agency contacts the office of the clinician treating the wound. If Gateway arranged the visits, call 314-325-0126 and we get the message to the treating clinician.
Gateway is not an emergency service. Call 911 for heavy bleeding, trouble breathing, chest pain, sudden confusion, or a client who cannot be woken.
How Gateway fits, and how to start
Clients and families can call us themselves, with or without a referral. With the client’s permission, your agency can also call on a client’s behalf or send a referral request. The web form takes contact details only, so leave medical details for the phone call. Visit availability is confirmed by location and care setting.
Once a partner clinician is seeing the client, the treating clinician makes every clinical decision. Gateway coordinates the visit schedule, the supplies ordered for the wound and communication among the family and the other teams in the home. That can include home health, a different service from yours (see our comparison of home health and mobile wound care).
If a client has no regular medical follow-up at all, ask about in-home primary care as well.
Helping the plan hold between visits
Much of what makes wound care work at home is ordinary care done consistently, and that is the aide’s territory when the care plan includes it.
- Following the positioning routine in the care plan (families often work from a repositioning schedule at home)
- Offering meals and fluids
- Keeping skin clean and dry during personal care, without disturbing the dressing
- Keeping wound supplies together, dry and easy to find, as in our guide to storing wound supplies at home
- Having the client ready for a scheduled visit, with good light and a clear path to the bed or chair
If your scheduler knows the visit time, an aide shift that overlaps it helps, because the aide can describe how the week has gone.
Common questions
Can a home care aide change a wound dressing?
That depends on state rules, your agency’s policy and the client’s plan of care, not on Gateway. Many non-medical agencies do not allow aides to do wound care. If a dressing comes off or is soiled, the aide should follow agency policy and report to the supervisor, and the family or agency should call the treating clinician’s office for instructions.
Will Gateway share visit information with our agency?
Only with people the client, or the client’s legal decision-maker, has authorized. If the family wants your agency to receive instructions, such as a positioning routine for aides, ask them to raise it with us and with the treating clinician’s office. Our guide to who can receive wound care updates explains how that works.
What should an aide do after finding a new sore?
Leave the area as found, do not rub it or put anything on it unless the care plan says to, and report it to the supervisor that shift. The agency then informs the family. A new sore needs a clinician’s assessment, so the family or agency should call the client’s medical office, or call us about arranging a visit.
What if the client’s family lives out of town?
Then the aide’s reports matter even more, because no relative is seeing the wound week to week. With the client’s permission, we can coordinate by phone with a family member in another city and ask for visit times when an aide is present. Our guide to helping a parent with a wound from far away is written for those families.