About 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.

What an assessment covers

After the assessment, the treating clinician writes orders and explains them to the people who will carry them out. A pressure injury plan usually has several parts:

  • Wound orders: how the wound is cleaned and covered, and how often the dressing is changed
  • Pressure relief: the mattress, cushion or heel protection to use
  • Positioning: which positions to use, which to avoid and how often to change
  • Skin care: keeping the area clean and dry after incontinence
  • Follow-up: when the wound will be checked again

Gateway follows up on the supply and equipment orders and shares the plan with the caregivers, home health nurses or facility staff involved.

Local context: Florissant

In the older single-family homes common across Florissant, 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.

Florissant is one of the largest cities in North County, with a historic Old Town at its heart and decades of subdivisions spreading out from it. Lindbergh Boulevard cuts across the city, and New Halls Ferry Road links it to its neighbors. A great many of its homes are single-story ranches, bought by young families years ago and still occupied by the same owners. That makes Florissant a natural place for aging at home, and it makes home-based wound care and primary care especially useful as those owners need more medical attention.

When care happens at home

A home visit shows the treating clinician things an office visit cannot: the mattress the person actually sleeps on, the chair they sit in most of the day, and how transfers happen in that room. For a pressure injury, those details are often the cause of the wound.

Gateway schedules the visit with a partner clinician once availability is confirmed for your address. Leave the bed and chair set up as they normally are. If the person uses a cushion, pillows or a lift, keep them in place. The clinician decides how often to return based on how the wound is doing.

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

Some of the most useful reports are not about the wound at all. They are about changes that put more pressure or moisture on the skin. Let the treating clinician know when:

  • A new area of discolored skin appears somewhere else on the body
  • The person can no longer shift, turn or tolerate a position they used before
  • Incontinence starts or gets worse, or dressings keep getting soiled
  • An air mattress, cushion or heel protector stops working or is not being used
  • Eating or drinking drops off, or weight is falling

These are not emergencies. Call 911 for chest pain, trouble breathing, heavy bleeding or sudden unresponsiveness.

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 Florissant →

How to get started in Florissant

Setting up pressure injury care for someone in Florissant 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.

Florissant is big enough that location within the city matters. Tell us the ZIP code, the nearest major road and whether the home is north toward the Missouri River or south near Interstate 270. Have the patient’s phone number, the doctor’s name and the name of a second contact. Ask us about timing if a caregiver is only there at certain hours. Gateway also arranges care in Hazelwood, Ferguson, Bridgeton and the rest of North County, and visits in Florissant are planned with those areas.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Hazelwood, Ferguson, North County, Bridgeton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

Common questions

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

Should a bed sore be left uncovered so it can dry out?

In general, no. Clinicians usually keep pressure injuries covered with a dressing chosen to hold the right amount of moisture, protect the wound from stool and urine, and cushion it from rubbing. A wound left open to dry tends to form a hard crust that slows new tissue. Follow the treating clinician’s dressing orders and ask before changing anything.

How do you spot early pressure damage on darker skin?

Redness can be hard to see on dark skin, so color alone is not a reliable guide. Look for a patch that appears darker, purplish or ashen compared with the skin around it, and use touch as well. An area that feels warmer, cooler, firmer or puffier than nearby skin, or that the person says is tender, should be reported to the treating clinician.

How are wound care supplies handled for a patient at home in Florissant?

The treating clinician decides which dressings and supplies are needed and writes the orders. Gateway coordinates getting those orders to a supplier and tracks the follow-up, so the family is not left making calls. What a plan pays for depends on the plan and the order. Let us know if a delivery to your Florissant address is late or something in the box looks different from before.

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.