Wound care in memory care: what families should know.

Why wounds need extra attention in memory care

Wound care in memory care depends on families and staff noticing what the resident cannot report. A person living with dementia may not mention a sore heel, may not remember bumping a doorframe and may pull off a bandage without knowing why it is there.

The skin problems seen most often are skin tears from bumps or during hands-on help, pressure injuries in residents who sit for long stretches, and moisture-associated skin damage linked to incontinence.

Who does what in memory care

Memory care may be part of an assisted living community or a unit in a skilled nursing facility. Ask which, because it shapes how much nursing care the staff can provide.

• Direct care staff help with bathing, dressing, toileting and moving. They see each resident many times a day and are usually the first to notice a change in the skin.
• The community nurse or wellness director receives orders and passes instructions to each shift.
• The treating wound clinician assesses the wound, writes orders and provides treatment, often in the resident’s own room. See wound care in memory care.
• The primary care clinician looks after overall health, including memory and cognitive health, pain and nutrition.
• Gateway coordinates scheduling, records, supplies and communication among all of them.

What to share with the staff and the clinician

You hold the history. Put it on one page, and ask that a copy go in the chart and to the visiting clinician.

• The name your loved one answers to
• Their best and worst times of day
• What calms them: a song, a topic, a photo, a snack
• What upsets them: being approached from behind, cold hands, having shoes removed
• How they show pain
• Hearing, vision and the language they are most at ease in

Bring a fresh copy every few months.

Questions to ask the memory care team

1. Who checks the skin, how often, and what happens when an aide sees something new?
2. Who changes the dressing, and what is the plan if my loved one removes it at night?
3. Can a familiar staff member be present during wound visits?
4. How do you judge pain in someone who cannot describe it?
5. How are toileting, incontinence care and position changes scheduled?
6. How will I hear about changes, and whom do I call?

Our guide to managing incontinence and skin protection explains why the toileting schedule matters for skin.

Helping wound visits go calmly

A good visit in memory care is short, quiet and familiar. Tell the scheduler your loved one’s best time of day. We work with the community’s staff on timing. Ask that the visit take place in the resident’s own room, with a staff member they know.

If your loved one becomes frightened, the clinician and staff can pause and try again later. Forcing care is not the goal. Many of the approaches in our guide to caring for a loved one with dementia and a wound work in a community as well as at home.

Decisions and permission

Many memory care residents cannot make complex medical decisions. The community and the clinician need to know who decides and how to reach that person quickly.

• Check that the community has current paperwork naming the decision maker, and correct phone numbers
• Return calls promptly, since a clinician may need consent before a treatment
• Tell the clinician what matters most to your loved one, such as comfort or staying out of the hospital

If you are unsure who has authority to decide, ask the community’s director which documents they rely on, and talk with an attorney. This guide is not legal advice.

What you can do when you visit

Each time you visit, check a few things.

• Look at the hands, forearms and shins for new bruises or tears
• Watch for wincing when your loved one sits, stands or has shoes put on
• Notice whether the dressing is in place and looks clean on the outside

Tell the nurse what you saw. Do not remove a dressing, and do not apply creams from home without asking. Report a sudden change in alertness or behavior, spreading redness, more drainage, a new odor or fever. In an emergency, alert staff at once or call 911.

To ask about visits in a memory care community in Greater St. Louis or the Metro East, see our page for families and caregivers or send a request for care.

Common questions

Related pages

• Wound care in memory care
• Dementia and a wound: family guide
• Memory and cognitive health
• For families & caregivers
• When a loved one refuses wound care
• Request care
• Hospital discharge wound checklist
• Caregiver burnout and asking for help