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 the treating clinician looks at
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.
Local context: Clayton and Central County
In the older single-family homes common across Clayton and Central County, the bedrooms are often upstairs, and a person with a pressure injury may have started sleeping in a living room recliner. Recliners put steady weight on the tailbone and heels, and a spouse of the same age may not be able to help with turning. A home visit lets the treating clinician see that setup directly and write orders that fit it, including whether a different sleeping surface should be considered.
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.
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.
Care in skilled nursing and assisted living
Pressure injuries in memory care come with particular challenges. A resident with advanced dementia may not be able to say that a spot hurts, may resist being turned, may sit in one favorite chair for hours, or may pull at a dressing. Staff who know the resident are usually the first to notice a change in mood, sleep or willingness to sit.
Partner clinicians see residents in the memory care setting, which spares the resident a trip to an unfamiliar clinic. The treating clinician takes behavior into account when writing orders, and Gateway shares the plan with nursing staff and the family member or representative who makes decisions.
Changes to report
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.
How primary care fits in
Tissue under pressure survives on blood flow, so anything that reduces circulation or the oxygen carried in the blood makes a pressure injury more likely and harder to close. Diabetes, peripheral artery disease, heart failure, chronic lung disease and anemia are common examples. Heels are especially sensitive to poor circulation in the legs.
These conditions are managed in primary care. When the wound clinician and the primary care clinician can see each other’s notes, a wound that has stalled can prompt a fresh look at blood sugar, circulation or blood counts. Gateway arranges both kinds of visits and helps keep records moving between them.
Getting care arranged in Clayton and Central County
Before anything is scheduled, Gateway checks two things for every request for pressure injury care in Clayton and Central County: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.
Here is what helps when arranging care in Clayton and Central County. Know the municipality and ZIP code, such as 63105 in Clayton, 63117 in Richmond Heights or 63124 in Ladue, because several main roads run through more than one town. Tell us about building access and where a visitor can park. Name one family contact for scheduling calls. Weekday traffic and parking around downtown Clayton can shape the visit window. Gateway also arranges care in Brentwood, Maplewood, University City and the Central West End.
- 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
More wound care in Clayton and Central County
Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in Clayton and Central County page.
- Diabetic foot ulcers
- Venous leg ulcers
- Arterial and mixed wounds
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Pressure injury and bed sore care in University City
- Pressure injury and bed sore care in Ladue
- Pressure injury and bed sore care in the Central West End
Common questions
Can a wound care clinician come to a home in Clayton and Central County 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.
How quickly can a pressure injury develop?
Faster than most families expect. In a person who is very frail or cannot move, damage can begin within hours of unrelieved pressure, for example during a long wait on a hard stretcher, a lengthy surgery or a day spent in one chair. That is why any new discoloration over a bone after a hospital visit, a procedure or an illness deserves a prompt call to the treating clinician.
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.
I work in downtown Clayton and my father lives nearby. Can I be the contact for his care in Clayton and Central County?
Yes, with his permission. Tell us you are the main contact and give the phone number you answer during the workday. Gateway will call you about scheduling, supplies and follow-up, and can tell you when a visit is set so you can be there if you wish. Clinical questions go to the treating clinician, who can speak with you if your father agrees.
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.