What to know about pressure injuries

Skin and muscle need a steady supply of blood. When body weight presses tissue between a bone and a mattress or seat, the small vessels in that tissue are squeezed shut. If the pressure is not relieved, the cells run short of oxygen and begin to die.

Pressure is rarely the only force at work. Shear happens when the skin stays put while the skeleton slides, as it does when a person slumps down in a raised bed. Friction rubs the surface raw. Dampness from urine, stool or sweat weakens the outer layer so it breaks more easily. A healthy person shifts without thinking, even in sleep. A pressure injury forms when illness, weakness or numbness takes that automatic movement away.

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.

Pressure injury and bed sore care in Ladue

People in Ladue with a pressure injury often move between settings: home, a hospital stay, a few weeks of rehabilitation, then perhaps assisted living or skilled nursing close by. Each move brings a new bed, new caregivers and a risk that the turning plan and wound orders get lost. Gateway arranges wound care in private homes and in senior living and nursing facilities across Ladue, and helps the latest measurements and orders travel with the person.

Clayton Road and Ladue Road carry most of the traffic through Ladue, a residential city in Mid County just west of Clayton. Away from those two roads, the streets turn into quiet lanes with large wooded lots and houses set well back from the curb. Interstate 64 and Interstate 170 are both close. There is little commercial development inside the city limits, so most medical appointments mean a drive to a neighboring city. For someone with a wound or limited mobility, care arranged at home removes that trip.

At home between visits

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.

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.

Signs to tell the clinician about

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.

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.

Primary care at home in Ladue →

Getting care arranged in Ladue

Before anything is scheduled, Gateway checks two things for every request for pressure injury care in Ladue: 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.

A few details make the first call go faster: the street address in Ladue with any gate or entry instructions, a daytime phone number, the regular doctor’s name and whether a private caregiver or home health agency is already involved. Gateway also arranges care in Clayton and Central County, Creve Coeur, Richmond Heights, Brentwood and University City. Ladue is in Mid County, close to the other cities on that list, though each visit is still confirmed by address and care setting.

  • County: St. Louis County, Missouri
  • ZIP codes: 63124
  • Nearby hospitals: Missouri Baptist Medical Center in Town and Country; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
  • Nearby communities: Clayton and Central County, Creve Coeur, Richmond Heights, Brentwood, University City
  • 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 Ladue page.

Common questions

How do we start pressure injury care for a family member in Ladue?

Call Gateway or send the request form with a name and phone number only. You do not need a referral to call. On the phone we will ask where the person lives, how long the sore has been there, which hospital or doctor has seen it and what insurance they have. From there we gather records and work on scheduling with a partner 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.

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.

Is wound care at home in Ladue covered by Medicare?

It depends. You can ask about Medicare, Medicare Advantage, Medicaid and commercial plans when you call. Whether a visit or supply is a covered benefit depends on the treating provider, the specific plan and the care that is needed, so we cannot tell you in advance that something is a covered benefit. Have the insurance cards handy, and we can suggest questions to ask the plan and the treating practice.

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.