What to know about non-healing wounds

Non-healing wound is a description, not a diagnosis. It means a break in the skin that is no longer moving toward closure with the care it has been getting. Clinicians also say chronic wound, stalled wound or hard-to-heal wound, and they mean roughly the same thing.

The label covers many kinds of wounds. A surgical incision that opened along part of its length, a shin scraped on a car door, a sore over the tailbone, an ulcer near the ankle or under the foot can all end up here. What they share is the pattern: nearly the same measurements visit after visit, or a wound that seals over and then breaks down again. Working out which kind of wound it really is comes first, because the right care depends on it.

What the treating clinician looks at

At the visit, the treating clinician documents the wound in detail so that later visits have a baseline for comparison. That typically includes:

  • Length, width and depth, plus any tunnels or pockets under the skin edge
  • The kind of tissue in the base and how much of it looks healthy
  • The amount, color and odor of drainage
  • The condition of the edges and the surrounding skin
  • Pulses, skin temperature, swelling and sensation nearby

These findings point toward the type of wound and what is slowing it. The clinician then writes orders for dressings and any supporting measures, and sets a schedule for rechecking.

Local context: Arnold

In many households in Arnold, the person helping with wound care leaves early for work and gets home late. A dressing plan that needs midday attention will not hold up. Tell us the real schedule, and the treating clinician can consider dressings with longer wear times, home health nursing or a different routine. We can set up visits so a family member joins by phone, and we send a plain summary afterward. Newer senior living communities in the area can be visited too, and we ask their staff what they are able to assist with.

Cross the Meramec River on Interstate 55 and the first city you reach is Arnold, the largest in Jefferson County. Subdivisions spread over the hills on both sides of the interstate, and Jeffco Boulevard carries much of the local traffic. For daily errands Arnold is self-contained, but a good deal of specialty care sits north of the river in St. Louis County. For someone with a wound that needs frequent attention, or for a caregiver who works, that bridge crossing adds up. Care that comes to the home or facility takes the trip out of the week.

Care at home

Many people with a long-standing wound already have a home health agency involved. When that is the case, the partner clinician and the agency nurses work from the same orders. The nurses carry out dressing changes and report measurements, and the clinician adjusts the plan at each visit. Gateway shares visit notes with the agency so both sides see the same picture.

Supplies are the other piece. Running out of the ordered dressing and substituting whatever is in the cabinet is a common way for wounds to slip backward. We help route supply orders through the proper channel and ask about quantities before they run low.

For residents of nursing and senior living communities

For a resident in memory care, a wound that will not heal often has a behavioral side. The person may pull off dressings, scratch at the area, pace for hours on swollen legs, or be unable to say that something hurts. Staff who know the resident usually know these patterns well.

The treating clinician takes that knowledge into account when choosing dressings and how they are secured, and may suggest timing care for the calmest part of the resident’s day. A familiar staff member or relative at the visit helps. Gateway arranges those details ahead of time and updates the family or legal decision-maker afterward.

Changes to report

Because these wounds are judged by their trend, small shifts matter. Report any of the following between visits instead of waiting for the next one:

  • The wound looks wider or deeper, or a new opening appears nearby
  • Black, gray or yellow tissue that was not there before
  • Bone, tendon or surgical hardware visible in the base
  • Bleeding at a light touch
  • Fever, chills, nausea or unusual tiredness
  • A dressing that will not stay in place or cannot be done as ordered

Call 911 if a foot or leg suddenly becomes cold, pale or blue, or if the person is hard to wake, breathing fast or suddenly not making sense.

Primary care and overall health

The legs and feet show what the heart, kidneys and blood vessels are doing. Fluid that builds up with heart failure or kidney disease stretches the skin and floods a leg wound with drainage. Narrowed arteries starve it of oxygen. Anemia means the blood carries less of what new tissue needs.

These conditions are followed in primary care and by specialists, with monitoring that changes over time. When the wound clinician and the primary care clinician share notes, a swollen week or a new lab result gets connected to what is happening at the wound, and referrals for circulation problems are less likely to sit unanswered.

Primary care at home in Arnold →

Arranging non-healing wound care in Arnold

If you have been managing a wound mostly on your own and are looking for non-healing wound care in Arnold, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

Arnold residents commonly use three hospitals: Mercy Hospital South just north of the Meramec, Mercy Hospital Jefferson in Festus down Interstate 55, and SSM Health St. Clare Hospital in Fenton, reached by Route 141. Gateway has no affiliation with them. If you are a family member, tell us which hospital and the expected discharge date, and we will request records. If you are a discharge planner, fax the referral with the face sheet and wound orders. We then check availability in 63010 and arrange the first follow-up visit with a treating clinician.

  • County: Jefferson County, Missouri
  • ZIP codes: 63010
  • Nearby hospitals: Mercy Hospital South; Mercy Hospital Jefferson in Festus; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
  • Nearby communities: Jefferson County, Oakville, Imperial, Fenton, Mehlville
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Arnold

Read the full guide to non-healing wounds, or see everything Gateway arranges on the mobile wound care in Arnold page.

Common questions

Is there someone in Arnold who can check a relative’s wound at an assisted living or nursing facility?

Gateway arranges visits in skilled nursing, assisted living, memory care and rehabilitation settings as well as private homes. If your relative lives in a facility in Arnold, call us with the facility name. We confirm availability for that location, coordinate with the nursing staff and attending physician, and keep you updated if you are the resident’s contact or decision-maker.

Does insurance cover care for a non-healing wound?

You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a visit, a dressing or a therapy is a covered benefit depends on your plan, the treating provider and the care that is needed, so we cannot answer in general terms. Gateway helps confirm these points before the visit where possible. Have your insurance card nearby when you call.

What are advanced wound treatments, and will my wound need one?

Advanced therapies include options such as negative pressure devices, skin substitutes and specialized dressings. They are usually considered only after the basics are in place: the cause identified, pressure and swelling controlled, unhealthy tissue cleared and infection addressed. A stalled wound may begin to improve once those basics are corrected. The treating clinician decides whether an advanced option is appropriate, and health plans often have their own requirements.

Does Gateway arrange visits south of the Meramec River in Arnold?

Yes. Gateway’s region includes Jefferson County, and Arnold sits at the county’s northeast corner on Interstate 55. You can ask about care in a private home, an apartment or a care facility anywhere in the 63010 ZIP code. When you call, we check whether a visit is available for the specific address and care setting, since availability depends on location.

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.