About non-healing wounds

Healthy skin repair follows a rough order. Bleeding stops, the area becomes inflamed and cleans itself, new tissue fills in, and skin grows across the top. A stalled wound is usually stuck in the inflamed, cleaning-up step and cannot move on.

Something keeps it there. Often the reason is mechanical, such as weight or friction on the same spot every day. Often it is a supply problem, meaning too little blood reaching the area or fluid pooling in the limb. Sometimes it is a heavy load of bacteria, leftover dead tissue, or a body that is short on the raw materials for repair. Most long-standing wounds have two or three of these at once, which is why switching to a different dressing, and changing nothing else, so often disappoints.

How the care plan is built

Part of building the plan is agreeing on the goal. For most people the goal is full closure, and the plan is aimed at removing whatever stands in the way. For some, especially people who are very frail or whose circulation cannot be improved, the treating clinician may talk with the patient and family about a different aim: keeping the wound stable, clean, comfortable and free of infection.

Either way, the clinician explains what they found, what they think is holding the wound back and what they recommend. You should come away knowing what the plan is, who does what, and how you will be able to tell whether it is working.

Non-healing wound care in Clayton and Central County

People in Clayton and Central County often move between home, a nearby rehabilitation unit and a senior living community as their health changes, and a chronic wound travels with them. Each move risks a different dressing, a lost measurement history and a new set of nurses starting from zero. Gateway keeps the wound’s history together across those settings and arranges for a treating clinician to follow it where the person is staying, when availability allows. If an adult child nearby helps with dressings, we include them in scheduling and updates when the patient agrees.

Clayton is where St. Louis County does its business. The county seat has courthouses and office towers downtown, condominium buildings a few blocks away and tree-lined residential streets beyond. Around it sit the Mid County communities of Richmond Heights, Brentwood, Maplewood, University City and Ladue, tied together by Clayton Road, Hanley Road, Big Bend Boulevard and Interstates 64 and 170. Everything in Clayton and Central County is close, but close is not the same as easy. Traffic, parking garages and stairs make outings hard for someone with a wound or limited mobility.

Care at home

A home visit lets the treating clinician see things an exam room hides. The recliner where someone sleeps every night, the slippers worn all day, the step into the shower, the bandage supplies in a kitchen drawer: each can explain why a wound keeps stalling. The clinician assesses the wound at the bedside or in a favorite chair and writes orders based on what is realistic in that house.

Gateway schedules the visit, confirms who will be there and passes along records beforehand. Afterward we follow up on the orders so the plan does not sit on paper.

Care in skilled nursing and assisted living

Assisted living communities are not set up like nursing homes. Staff may help with medications and bathing but are often limited in the wound care they can provide, so a resident with a stalled wound can fall between services. Dressing changes may depend on a visiting home health nurse, a family member or the resident.

Gateway helps sort out who is doing what. We arrange the partner clinician’s visit to the resident’s apartment, find out what the community’s staff can assist with, and coordinate with any home health agency involved. The resulting plan is written for the help that is really available.

What to report and when to call 911

Not every change is an emergency, but these deserve a prompt call to the treating clinician’s office:

  • Red streaks running up the arm or leg from the wound
  • Pus, or drainage that turns green, tan or cloudy
  • Home blood sugar readings well above your usual range
  • Numbness, tingling or new swelling below the wound
  • A wound that had closed and has opened again

If you cannot reach the office and you are worried, go to urgent care or an emergency department. Call 911 right away for spurting or uncontrolled bleeding, chest pain or pressure, difficulty breathing, or a limb that suddenly turns cold and discolored.

How primary care fits in

Blood sugar is one of the strongest links between general health and a wound that will not close. When sugar runs high, the cells that fight infection and build new tissue work poorly, and small blood vessels deliver less. A wound clinician can choose the right dressing at every visit and still see little progress if diabetes control has slipped.

That is primary care territory: reviewing readings, lab results and the overall diabetes plan. When Gateway arranges both kinds of care, the wound findings reach the clinician managing the diabetes, and changes on that side are known to the wound care team.

Primary care at home in Clayton and Central County →

Getting care arranged in Clayton and Central County

Setting up non-healing wound care for someone in Clayton and Central County 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.

For people in Clayton and Central County, the nearest hospital is usually SSM Health St. Mary’s Hospital in Richmond Heights. Many also go east to Barnes-Jewish Hospital or west to Missouri Baptist Medical Center in Town and Country. Gateway has no affiliation with these hospitals. A discharge planner can refer by fax, and a family member can call us while the patient is still admitted. We ask for the discharge summary and wound orders, verify the address the patient is returning to, and arrange follow-up with a treating clinician who directs wound care from that point.

  • County: St. Louis County, Missouri
  • ZIP codes: 63105, 63117, 63124
  • Nearby hospitals: SSM Health St. Mary's Hospital in Richmond Heights; Barnes-Jewish Hospital; Missouri Baptist Medical Center in Town and Country (not affiliated with Gateway)
  • Nearby communities: Richmond Heights, University City, Ladue, Brentwood, Maplewood, Central West End
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Clayton and Central County

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

Common questions

Can a clinician come to a home in Clayton and Central County to look at a wound that will not heal?

In many cases, yes. Gateway arranges home visits with partner clinicians across Greater St. Louis and the Metro East, and we confirm availability for your exact address and care setting before scheduling. Call 314-325-0126 or send a request with a name and phone number. You do not need a referral to ask, and a family member can call for you.

What if my wound closes and then opens again?

A wound that reopens in the same place usually means the original cause is still present. New skin over a healed wound is weaker than the skin around it, so returning pressure, swelling or friction can break it down. Tell the treating clinician how long it stayed closed and what changed beforehand. Ongoing protection of the area is often part of the plan after closure.

Is there someone in Clayton and Central County 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 Clayton and Central County, 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.

Which communities count as Central County when I ask about care in Clayton and Central County?

We use the term for Clayton and the Mid County suburbs around it, including Richmond Heights, Brentwood, Maplewood, Ladue and University City. Boundaries between them can be hard to spot from the street. You do not need to sort that out before calling. Give us the address and ZIP code, and we will check which partner clinicians are available for that location and care setting.

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.