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.
How the care plan is built
Part of every assessment is deciding whether the wound needs more than dressings and pressure relief. The treating clinician checks for signs of infection in the wound and the tissue around it, and looks for dead tissue that may be slowing progress. In a deep wound, the clinician considers whether bone could be involved.
Depending on what is found, the clinician may order lab work or imaging, or refer the person to a surgeon or another specialist. None of this is automatic. Each step is the clinician’s decision, based on the wound, the person’s health and the goals of care. Gateway helps arrange any orders or referrals that follow.
Arranging this care in South County
In the older single-family homes common across South 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.
South County is shorthand for the southern part of St. Louis County, a band of communities roughly south of Interstate 44 that reaches from the River des Peres at the city line down to the Meramec River. It includes Affton, Lemay, Mehlville, Oakville, Concord, Sappington, Green Park, Crestwood and Sunset Hills. Gravois Road, Tesson Ferry Road, Lemay Ferry Road, Telegraph Road and Lindbergh Boulevard are the roads everyone uses. People here tend to stay for life, and many are retirees. Bringing wound care and primary care to them fits the way South County lives.
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.
Care in skilled nursing and assisted living
In a skilled nursing facility, pressure injury care is a shared job. Facility nurses do the daily dressing changes and repositioning, the attending physician oversees the resident’s overall care, and a partner wound clinician can see the resident on site, often during scheduled wound rounds.
After each visit, measurements, staging and updated orders go to the nursing team so the chart and care plan match what the clinician found. Gateway coordinates the rounding schedule, the list of residents to be seen and the supply follow-up. Staff can also call Gateway between rounds when a resident’s wound changes.
What to report and when to call 911
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.
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.
Arranging pressure injury care in South County
Before anything is scheduled, Gateway checks two things for every request for pressure injury care in South County: 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.
South County is a patchwork of small cities and unincorporated neighborhoods, and nearly all of them use St. Louis as the mailing city. When you call, give the ZIP code and a nearby main road so we place the address correctly. Have the patient’s phone number, doctor’s name and insurance cards with you. Gateway arranges care in Affton, Mehlville, Oakville, Crestwood, Sunset Hills and Fenton, among others. If you are helping two relatives in different parts of South County, tell us, and we will take both requests together.
- County: St. Louis County, Missouri
- ZIP codes: 63123, 63125, 63126, 63127, 63128, 63129
- Nearby hospitals: Mercy Hospital South; SSM Health St. Clare Hospital in Fenton; St. Luke's Des Peres Hospital (not affiliated with Gateway)
- Nearby communities: Affton, Mehlville, Oakville, Crestwood, Sunset Hills, Fenton
- 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 South County page.
- Diabetic foot ulcers
- Venous leg ulcers
- Arterial and mixed wounds
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Pressure injury and bed sore care in Affton
- Pressure injury and bed sore care in Mehlville
- Pressure injury and bed sore care in Oakville
Common questions
Will insurance pay for pressure injury care or a special mattress in South 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.
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 do we start pressure injury care for a family member in South County?
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.
Do patients in South County have to use Mercy Hospital South to work with Gateway?
No. Gateway is not affiliated with Mercy Hospital South or any hospital, and it does not matter where you were treated. You can ask for care after a stay at any hospital, after rehabilitation, at your doctor’s suggestion or on your own with no referral at all. We ask only for the records and orders that help the treating clinician understand your situation.
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.