What to know 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

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.

Arranging this care in St. Charles County

From St. Charles County, 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.

St. Charles County lies between the Missouri River on the south and east and the Mississippi River on the north, a broad stretch of suburbs, small towns and farmland. Interstate 70 and Interstate 64 run through it, linking St. Charles, St. Peters, O’Fallon, Lake St. Louis and Wentzville, with Cottleville, Dardenne Prairie and Weldon Spring in between. The county has grown quickly, and it now has both young subdivisions and many retirees. Distances are long here. A patient in Wentzville and a specialist in St. Louis County can be a long highway drive apart, which makes care at home valuable.

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.

In a facility

Assisted living communities are not staffed like nursing homes, and that shapes pressure injury care. Aides may help with bathing and transfers, but skilled dressing changes are often done by a visiting home health nurse or, where the community’s license allows, by its own nurse.

When Gateway arranges a wound visit in assisted living, we ask early who handles each part: dressing changes, repositioning, incontinence care and equipment. The treating clinician’s orders are shared with the community’s nurse or director, the home health agency if one is involved, and the family. A resident who now needs far more hands-on help may prompt a wider talk about the level of care.

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.

Why primary care matters here

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 St. Charles County →

How to get started in St. Charles County

If you have been managing a wound mostly on your own and are looking for pressure injury care in St. Charles County, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

Start with the town and ZIP code, since St. Charles County includes everything from 63301 in St. Charles to 63385 in Wentzville. If the home is outside city limits, describe the nearest highway or crossroads. Keep the patient’s phone number, doctors’ names and insurance cards nearby. Gateway arranges care in St. Charles, St. Peters, O’Fallon, Wentzville, Lake St. Louis and Cottleville. In the outlying parts of the county, visit days depend more on location, so calling early gives us more room to plan.

  • County: St. Charles County, Missouri
  • ZIP codes: 63301, 63303, 63304, 63376, 63366, 63368, 63385, 63367
  • Nearby hospitals: SSM Health St. Joseph Hospital in St. Charles; SSM Health St. Joseph Hospital in Lake Saint Louis; Barnes-Jewish St. Peters Hospital; Progress West Hospital in O'Fallon (not affiliated with Gateway)
  • Nearby communities: St. Charles, St. Peters, O'Fallon, Missouri, Wentzville, Lake St. Louis, Cottleville
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in St. Charles County

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

Common questions

Will insurance pay for pressure injury care or a special mattress in St. Charles 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 sitting in a wheelchair or recliner cause a pressure injury?

Yes. Sitting puts much of the body’s weight on a small area under the sitting bones and tailbone, so pressure injuries can form in a chair as readily as in a bed. People who sit most of the day need a suitable cushion and regular changes of position. The treating clinician can advise on the cushion and on how long the person should sit at a stretch.

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.

We live on a rural road in St. Charles County. Can a clinician still come to us?

It is worth asking. Gateway arranges visits in rural parts of St. Charles County when a partner clinician is available for that location. Give us the full address, the nearest highway and any directions a first-time visitor would need. We confirm availability first, and if a home visit cannot be arranged, we will tell you so and talk through other options.

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.