What to know about pressure injuries

Several common beliefs about bed sores are mistaken. One is that a small opening means a small wound. Pressure damage is often wider beneath the skin than at the surface, which is why clinicians measure depth and check under the edges.

Another is that rubbing a reddened area helps. Current guidance is to avoid massaging skin that already shows pressure damage. Ring or donut-shaped cushions are also a frequent mistake, because they can concentrate pressure around the edge of the ring. And a sore that does not hurt is not a mild one. Lack of pain may simply mean the person has lost feeling there. When in doubt, ask the treating clinician before trying a home remedy or a new cushion.

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 Kirkwood

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

Kirkwood is an established St. Louis County suburb that grew up along Kirkwood Road (the local name for Lindbergh Boulevard) south of Manchester Road. Interstate 44 crosses the south side and Interstate 270 is a short drive west. The city has a walkable downtown near the train station and block after block of older homes under mature trees. Many people here have lived in the same house for decades and intend to stay. When a wound or a long-term health problem makes trips out harder, care arranged at home or in a nearby facility helps them do that.

At home between visits

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.

For residents of nursing and senior living communities

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.

Primary care and overall health

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 Kirkwood →

Arranging pressure injury care in Kirkwood

Setting up pressure injury care for someone in Kirkwood 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.

Before you call 314-325-0126, it helps to have the patient’s name, the Kirkwood address or facility name, a phone number and the name of the regular doctor. If there was a recent hospital or rehab stay, tell us where it was and when it ended. Gateway also arranges care in nearby Webster Groves, Des Peres, Crestwood, Sunset Hills, Manchester and Valley Park, so relatives in two nearby towns can be discussed in one call. Visit days are confirmed for each address once a partner clinician is identified.

  • County: St. Louis County, Missouri
  • ZIP codes: 63122
  • Nearby hospitals: St. Luke's Des Peres Hospital; Missouri Baptist Medical Center in Town and Country; Mercy Hospital South; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
  • Nearby communities: Webster Groves, Des Peres, Crestwood, Sunset Hills, Manchester, Valley Park
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Kirkwood

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

Common questions

Does Gateway work with nursing homes and assisted living communities in Kirkwood?

Yes. Gateway arranges for partner clinicians to see residents with pressure injuries in skilled nursing, assisted living, memory care and rehabilitation settings, either one resident at a time or through regular wound rounds. Facility staff can refer a resident, and families can ask the facility to contact us. Availability for a specific building is confirmed when the request comes in.

Does a bed sore mean someone was neglected?

Not necessarily. Many pressure injuries can be prevented with good positioning, skin care and equipment, and it is reasonable to ask how one developed. But they can also occur despite attentive care, especially in people who are very ill, very thin or near the end of life. The useful questions are what the plan is now and who is carrying out each part.

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.

Can Gateway arrange visits for a resident of an assisted living community in Kirkwood?

Yes, you can ask. Gateway arranges wound care and primary care visits by partner clinicians in assisted living, memory care and skilled nursing settings in Kirkwood. The resident, a family member or the facility’s nurse can make the request. We coordinate with facility staff so that the treating clinician’s orders and visit notes reach the people who help with daily care.

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.