Understanding pressure injuries

Anyone who cannot easily change position is at risk, at any age. That includes people recovering from a hip fracture or major surgery, people with a spinal cord injury or advanced multiple sclerosis who use a wheelchair full time, people weakened by a stroke, and people in the later stages of dementia or another serious illness.

Loss of feeling matters as much as loss of movement. Someone with nerve damage may not notice the ache that tells the rest of us to shift. Very thin people have less padding over bone. People who wear oxygen tubing, splints, braces or casts can develop the same kind of injury wherever a device presses on skin. Several of these risks often appear together in one person.

How the care plan is built

A pressure injury care plan depends on the whole person, so the treating clinician reviews more than the skin. Expect questions about how much the person can move without help, whether they can feel and report discomfort, how often skin is exposed to moisture, and how well they have been eating and drinking.

The clinician also asks what the person and family want from care. For one person the aim is to close the wound. For another, who is very frail, the aim may be to keep the wound stable, clean and comfortable. Being honest about what caregivers can manage each day helps the clinician write a plan that will be followed.

Local context: Alton

For people in Alton, pressure injury care often starts with an Illinois hospital discharge and an Illinois health plan. Illinois Medicaid and its managed care plans work differently from Missouri plans, and rules for wound visits, dressings and support surfaces vary. Before scheduling, Gateway confirms which partner clinician can see the person at an Illinois address and what the plan requires. Doing this first lowers the chance that a mattress or supply order is delayed later.

Alton rises from the Mississippi River in steep hills and bluffs, on the Illinois side upriver from St. Louis. The Clark Bridge connects it to Missouri, and the Great River Road follows the bluffs toward Grafton. It is an old city with brick streets, tall houses and neighborhoods that sit above or below one another. Those hills are part of what people love about Alton, and they are hard on anyone with a leg wound, poor balance or limited strength. Gateway arranges wound care and primary care in the home or facility, so the hills stay outside the door.

When care happens at home

Many people with a pressure injury at home also have a home health agency involved. When that is the case, the wound orders from the treating clinician need to reach the home health nurse, and the nurse’s observations need to reach the clinician. Gateway helps pass that information in both directions so the family is not left carrying messages.

If no home health agency is in place, tell us who is available to help: a spouse, adult children, a paid aide or no one. The treating clinician can decide whether to order home health nursing, and the plan can be shaped around the help that really exists.

For residents of nursing and senior living communities

People often arrive at a rehabilitation center with a pressure injury that began in the hospital, or with fragile skin after surgery and days in bed. Therapy adds a new question: how long can the person sit in a wheelchair or on a mat without harming the wound? The treating clinician, nursing staff and therapists work that out together.

Rehab stays are short, so planning for what comes next begins early. Gateway can help arrange for wound care to continue after discharge, whether the person goes home or to another facility, so that orders, records and supplies follow them and care does not start over.

What to report and when to call 911

Pressure damage can start before the skin opens. Check the tailbone, hips, heels and other bony areas when you help with bathing or dressing, and tell the treating clinician or nurse if you see:

  • A patch that stays red, purple, maroon or darker than nearby skin after the pressure is off
  • Skin that feels warmer, cooler, firmer or softer than the skin around it
  • A blister, a shiny area or a shallow break
  • A spot the person says is sore, burning or itchy

Call 911 if the person has trouble breathing, chest pain, or is suddenly very hard to wake.

Primary care and overall health

Several everyday medical issues affect how much pressure the skin takes. Medications that cause drowsiness can reduce the small movements a person makes while sitting or sleeping. Untreated pain makes people hold still and resist turning. Diarrhea, urinary infections and constipation with leakage keep skin wet. Stiff, contracted joints limit the positions a person can use.

A primary care clinician can review the medication list, pain control, bowel and bladder problems and whether therapy would help with mobility. Do not stop or change a medication on your own. Bring the concern to the clinician, and ask Gateway to share it with the wound care team as well.

Primary care at home in Alton →

Arranging pressure injury care in Alton

To arrange pressure injury care in Alton, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

When you call about care in Alton, mention right away that the address is in Illinois, and have the 62002 ZIP code, a phone number, the regular doctor and the insurance card on hand. Insurance plans and provider participation can differ on each side of the state line, so we check before scheduling. Availability is confirmed by location and care setting. Gateway also arranges care in Godfrey, the rest of the Riverbend, Edwardsville and elsewhere in Madison County.

More wound care in Alton

Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in Alton page.

Common questions

Can a wound care clinician come to a home in Alton to look at a bed sore?

Gateway arranges home visits by partner clinicians for people with pressure injuries, and availability is confirmed by location and care setting. When you call 314-325-0126, we ask for the address, whether the person is at home or in a facility, and who is already involved in their care. We then tell you what can be arranged for that address.

What do the stages of a pressure injury mean?

Stages describe depth. Stage 1 is unbroken skin with a color change that does not fade. Stage 2 is a shallow open area or blister. Stage 3 extends into the fat layer under the skin. Stage 4 reaches muscle, tendon or bone. A wound is called unstageable when its base is hidden, and a deep tissue injury is a dark purple or maroon area where the damage lies below the surface.

What is debridement, and will my family member need it?

Debridement means removing dead tissue from a wound so healthy tissue can grow and infection is less likely. There are several methods, some using dressings or ointments and some done by a clinician with instruments. Not every pressure injury needs it, and in some situations it is avoided. The treating clinician decides whether, when and how, and will explain the reasons.

My doctors are in Missouri but I live in Alton. Can care at home still be coordinated?

Yes. Give us the names of your Missouri doctors when you call. The partner clinician who visits you in Alton makes the clinical decisions for those visits, and we send notes to your other doctors with your permission so they stay informed. Tell us about upcoming appointments across the river so visits can be planned around them.

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.