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 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.

Arranging this care in North County

In the older single-family homes common across North 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.

North County is the name St. Louisans give to the northern part of St. Louis County, roughly the area north of Interstate 70. It takes in Florissant, Hazelwood, Ferguson, Bridgeton, Berkeley, Jennings, Black Jack, Bellefontaine Neighbors and unincorporated Spanish Lake, and it runs north and east to the Missouri and Mississippi rivers. Interstate 270 and Interstate 170 tie these communities together. Many families have lived here for generations, and many longtime homeowners are now older adults. Care arranged at home or in a nearby facility helps them stay close to family, church and neighbors.

Care 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

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.

Signs to tell the clinician about

An infected pressure injury can make the whole body sick, and in frail older adults the first sign is often a change in behavior, not a change in the wound. Contact the treating clinician promptly about:

  • Fever or shaking chills
  • Redness, warmth or swelling spreading out from the wound
  • Pus or cloudy drainage
  • Pain that is new or clearly worse
  • New confusion, unusual sleepiness or refusing food and drink

Call 911 if the person is very confused or unresponsive, is breathing fast or with difficulty, or looks suddenly and seriously ill.

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 North County →

Getting care arranged in North County

For a resident of a nursing home, assisted living or memory care community in North County, a request for pressure injury care can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

North County covers many towns and ZIP codes, so start with the exact address and the municipality. Have the patient’s phone number, insurance cards and doctor’s name ready. If a relative on another street or in another town helps with care, give us that number too. Gateway arranges care in Florissant, Hazelwood, Ferguson and Bridgeton, and across the city line in North St. Louis. Because the region is spread out, each visit is confirmed by location and care setting.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034, 63042, 63135, 63136, 63137, 63138, 63134
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Florissant, Hazelwood, Ferguson, Bridgeton, North St. Louis
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in North County

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

Common questions

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

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.

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.

Will insurance pay for pressure injury care or a special mattress in North County?

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.

Can someone discharged from Christian Hospital to a North County nursing facility be seen there?

Yes, that can be requested. Gateway arranges partner clinician visits in skilled nursing and rehabilitation facilities in North County. The facility’s nurse or social worker, the hospital case manager or a family member can contact us. Gateway is not affiliated with Christian Hospital, so we ask for the discharge summary and wound orders to give the treating clinician a clear starting point.

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.