What to know about pressure injuries

Pressure injuries change slowly, and the early changes can be confusing. Damage that started deep may take days to show on the surface, so a wound can look worse at first even while care is going well. Dead tissue has to clear before new tissue can grow.

Healing happens from the base upward as the wound fills in and the edges draw together. The treating clinician tracks this with measurements at each visit, because week-to-week change is hard to judge by eye. Once closed, scar tissue forms over the area, and it is weaker than the original skin, so the same spot can break down again. Protecting that area continues long after the wound has closed.

What an assessment covers

Where a pressure injury sits says a lot about what caused it, and the treating clinician reads the location as a clue:

  • Tailbone or buttocks: long hours sitting, or lying with the head of the bed raised
  • Heels: lying on the back with the feet resting on the mattress
  • Hip or outer ankle: time spent on one side
  • Ears, nose or cheeks: pressure from tubing or a mask
  • Back of the head or shoulder blades: lying flat for long stretches

The clinician then looks at the bed, chair or device involved and asks about the daily routine. A care plan that leaves the source of pressure unchanged is unlikely to succeed, whatever dressing is chosen.

Arranging this care in Ballwin

Across Ballwin, the main family caregiver often works a full day and has a commute on top of it. That can leave a person with a pressure injury in one position for many hours. Tell the treating clinician exactly when help is and is not in the house. The plan can then lean more on the support surface, on paid caregivers or home health, and on positions the person can manage alone, instead of a turning schedule no one is home to follow.

Manchester Road is the spine of Ballwin. North and south of it, this West County city is mostly quiet subdivisions of ranch and two-story homes on curving streets, with Clayton Road along the north side and Big Bend Road to the south. Ballwin has long been a place where families settle and stay, so plenty of residents are now in their seventies, eighties and beyond. For them, a wound that needs frequent visits or a chronic illness that needs steady follow-up is easier to manage when the clinician comes to the house or the care community.

When care happens at home

Dressings are only part of what a pressure injury needs at home. The treating clinician may also order a pressure-redistributing mattress or overlay, a wheelchair cushion, heel protection or a hospital bed. Gateway follows up on those orders with suppliers and lets you know what to expect about delivery.

Dressings usually arrive in quantities meant to last until the next order. Check the box against what the clinician ordered, store it somewhere clean and dry, and tell us before the last few are used. Once equipment arrives, keep the instructions and the supplier’s phone number handy. Tell the clinician if a mattress feels flat, a cushion has shifted or the person will not tolerate it.

For residents of nursing and senior living communities

Assisted living communities are not staffed like nursing homes, and that shapes pressure injury care. Aides may help with bathing and transfers, but skilled dressing changes are often done by a visiting home health nurse or, where the community’s license allows, by its own nurse.

When Gateway arranges a wound visit in assisted living, we ask early who handles each part: dressing changes, repositioning, incontinence care and equipment. The treating clinician’s orders are shared with the community’s nurse or director, the home health agency if one is involved, and the family. A resident who now needs far more hands-on help may prompt a wider talk about the level of care.

What to report and when to call 911

Once a pressure injury is being cared for, the treating clinician needs to hear about changes in the wound between visits. Report any of these:

  • The wound looks wider or deeper than it did at the last visit
  • Black, brown, gray or thick yellow tissue appears
  • Drainage increases, soaks through the dressing or changes color
  • A new or stronger odor that remains after the wound is cleaned
  • The edges lift or a pocket seems to open under the skin

Call 911 for bleeding from the wound that will not stop, or if the person collapses or cannot be roused.

Why primary care matters here

A new pressure injury is often a sign that a person’s overall health has changed. Perhaps they have become weaker, are sleeping most of the day, or a long illness such as dementia or cancer has advanced. Caring for the wound without asking why it appeared now misses part of the picture.

That is the reason Gateway arranges wound care and primary care side by side. The primary care clinician can reassess the person’s conditions, talk with the family about goals and bring in palliative or hospice care if that fits. The wound clinician can then match the wound plan to those goals, whether that means working toward closure or keeping the person comfortable.

Primary care at home in Ballwin →

Arranging pressure injury care in Ballwin

Setting up pressure injury care for someone in Ballwin usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

A few details speed up a request for care in Ballwin. Tell us whether the address is in 63011 or 63021, since the city spans both, and give the subdivision name if there is one. Have the patient’s date of birth, doctor’s name and a list of current medications within reach when we call back. Visits in Ballwin can be planned on the same route as Manchester, Ellisville, Wildwood, Des Peres, Valley Park and Chesterfield, so flexibility on the day of the week helps us find a time.

  • County: St. Louis County, Missouri
  • ZIP codes: 63011, 63021
  • Nearby hospitals: St. Luke's Hospital in Chesterfield; Missouri Baptist Medical Center in Town and Country; St. Luke's Des Peres Hospital; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
  • Nearby communities: Chesterfield, Manchester, Ellisville, Chesterfield and West County, Wildwood, Des Peres
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Ballwin

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

Common questions

Will insurance pay for pressure injury care or a special mattress in Ballwin?

It depends on the plan, the treating provider and the care that is needed. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans, and we will help you find out what applies before a visit. Equipment such as a support surface usually requires a clinician’s order and supporting documentation, and each plan sets its own rules.

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.

Can a wound care clinician come to a home in Ballwin 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.

My dad lives in assisted living off Manchester Road in Ballwin. Can a wound care clinician see him there?

A visit can be requested by you, by him or by the community’s nursing staff. Gateway works with the facility to find a visit time that fits its routines, and the treating clinician leaves orders the staff can follow between visits. Check with the community about its own policies for outside clinicians. We will ask who on staff should receive notes and supply information.

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.