Understanding 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

A pressure injury care plan depends on the whole person, so the treating clinician reviews more than the skin. Expect questions about how much the person can move without help, whether they can feel and report discomfort, how often skin is exposed to moisture, and how well they have been eating and drinking.

The clinician also asks what the person and family want from care. For one person the aim is to close the wound. For another, who is very frail, the aim may be to keep the wound stable, clean and comfortable. Being honest about what caregivers can manage each day helps the clinician write a plan that will be followed.

Local context: Lake St. Louis

From Lake St. Louis, a specialist appointment can mean a long car ride each way. For someone with a pressure injury on the tailbone or hip, that ride is extra time sitting on the wound, followed by a waiting room chair. Having a partner clinician come to the home or senior living community takes that sitting out of the picture. Gateway confirms visit availability for the address first, then schedules and follows up on dressing and equipment orders.

Two lakes shape daily life in Lake St. Louis. The city was planned around them in western St. Charles County, in the stretch between Interstate 70 on the north and Interstate 64 on the south, with Wentzville to the west and O’Fallon to the east. It started as a lake community and still draws people who want to retire near the water. Many residents are older adults, and some live alone. Wound care and primary care that come to the home help them stay where they are.

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.

In a facility

People often arrive at a rehabilitation center with a pressure injury that began in the hospital, or with fragile skin after surgery and days in bed. Therapy adds a new question: how long can the person sit in a wheelchair or on a mat without harming the wound? The treating clinician, nursing staff and therapists work that out together.

Rehab stays are short, so planning for what comes next begins early. Gateway can help arrange for wound care to continue after discharge, whether the person goes home or to another facility, so that orders, records and supplies follow them and care does not start over.

Changes to report

Once a pressure injury is being cared for, the treating clinician needs to hear about changes in the wound between visits. Report any of these:

  • The wound looks wider or deeper than it did at the last visit
  • Black, brown, gray or thick yellow tissue appears
  • Drainage increases, soaks through the dressing or changes color
  • A new or stronger odor that remains after the wound is cleaned
  • The edges lift or a pocket seems to open under the skin

Call 911 for bleeding from the wound that will not stop, or if the person collapses or cannot be roused.

How primary care fits in

Several everyday medical issues affect how much pressure the skin takes. Medications that cause drowsiness can reduce the small movements a person makes while sitting or sleeping. Untreated pain makes people hold still and resist turning. Diarrhea, urinary infections and constipation with leakage keep skin wet. Stiff, contracted joints limit the positions a person can use.

A primary care clinician can review the medication list, pain control, bowel and bladder problems and whether therapy would help with mobility. Do not stop or change a medication on your own. Bring the concern to the clinician, and ask Gateway to share it with the wound care team as well.

Primary care at home in Lake St. Louis →

How to get started in Lake St. Louis

Setting up pressure injury care for someone in Lake St. Louis 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.

When you call about someone in Lake St. Louis, have the street address and subdivision or building name, a phone number and the names of the doctors already involved. Mention it if the patient spends part of the year elsewhere or stays with family some weeks. Gateway also arranges care in Wentzville, O’Fallon, Dardenne Prairie and the rest of St. Charles County. Lake St. Louis is toward the western end of the region we cover, so visit days are confirmed by location, and it helps to call early.

  • County: St. Charles County, Missouri
  • ZIP codes: 63367
  • Nearby hospitals: SSM Health St. Joseph Hospital in Lake Saint Louis; Progress West Hospital in O'Fallon (not affiliated with Gateway)
  • Nearby communities: Wentzville, O'Fallon, Missouri, Dardenne Prairie, St. Charles County
  • 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 Lake St. Louis page.

Common questions

Will insurance pay for pressure injury care or a special mattress in Lake St. Louis?

It depends on the plan, the treating provider and the care that is needed. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans, and we will help you find out what applies before a visit. Equipment such as a support surface usually requires a clinician’s order and supporting documentation, and each plan sets its own rules.

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.

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.

Does Gateway work with SSM Health St. Joseph Hospital in Lake Saint Louis?

Gateway is an independent company and is not affiliated with SSM Health St. Joseph Hospital in Lake Saint Louis or any other hospital. Patients discharged from that hospital, and its discharge planners, are welcome to contact us about follow-up wound care or primary care at home. We ask for the discharge summary and current orders so the treating clinician can review them before the first visit.

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.