Understanding pressure injuries
A pressure injury is an area of damaged skin, and often damaged tissue underneath, that forms where the body rests against a surface for too long. Bed sore, pressure sore, pressure ulcer and decubitus ulcer all mean the same thing. These wounds nearly always sit over a bone that lies close to the skin, such as the tailbone, the hip, the heel, the ankle or the back of the head.
A pressure injury is not always an open sore. It can begin as a patch of unbroken skin that looks or feels different, and it can also be a deep crater. Clinicians describe that range with a staging system based on how many layers of tissue are involved. Staging gives everyone caring for the person a shared language for the wound.
What the treating clinician looks at
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.
Local context: St. Charles
From St. Charles, 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 is the historic county seat of St. Charles County, set on the bank of the Missouri River across from St. Louis County. The brick-paved Main Street district and the old neighborhoods near the riverfront are the oldest part of town, and newer subdivisions extend west and south from there. Interstate 70 and Routes 364 and 370 cross the river on separate bridges. For an older adult in St. Charles, a medical appointment on the other side of one of those bridges can take up half a day. Care at home changes that.
Care at home
Dressings are only part of what a pressure injury needs at home. The treating clinician may also order a pressure-redistributing mattress or overlay, a wheelchair cushion, heel protection or a hospital bed. Gateway follows up on those orders with suppliers and lets you know what to expect about delivery.
Dressings usually arrive in quantities meant to last until the next order. Check the box against what the clinician ordered, store it somewhere clean and dry, and tell us before the last few are used. Once equipment arrives, keep the instructions and the supplier’s phone number handy. Tell the clinician if a mattress feels flat, a cushion has shifted or the person will not tolerate it.
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.
Changes to report
Pressure damage can start before the skin opens. Check the tailbone, hips, heels and other bony areas when you help with bathing or dressing, and tell the treating clinician or nurse if you see:
- A patch that stays red, purple, maroon or darker than nearby skin after the pressure is off
- Skin that feels warmer, cooler, firmer or softer than the skin around it
- A blister, a shiny area or a shallow break
- A spot the person says is sore, burning or itchy
Call 911 if the person has trouble breathing, chest pain, or is suddenly very hard to wake.
How primary care fits in
The body builds new tissue from what a person eats and drinks, and a pressure injury raises the demand. Someone who has lost weight, eats only a few bites at meals, has trouble swallowing or has poorly fitting dentures may not be taking in enough protein, calories or fluid to keep up.
A primary care clinician can look for the reason appetite has fallen, review weight over time and decide whether a dietitian or a swallowing evaluation would help. Gateway can arrange primary care in the same home or facility where wound visits take place, so the clinician who orders the dressing and the clinician who looks at nutrition are working from the same information.
Getting care arranged in St. Charles
Setting up pressure injury care for someone in St. Charles usually goes in this order:
- You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
- Gateway talks with you about the wound, the address and the insurance.
- We confirm availability for that location and gather records for the treating clinician.
- The clinician visits, assesses the wound and writes the orders.
- We follow up on supplies, the next visit and communication with your other clinicians.
You do not need a confirmed diagnosis to start.
A little preparation helps. Write down the patient’s full address in St. Charles with the ZIP code (63301, 63303 or 63304), a phone number, the regular doctor and pharmacy, and any recent hospital or rehab stay. Gateway also arranges care in St. Peters, Cottleville, Weldon Spring and the rest of St. Charles County, and across the river in Bridgeton. Some addresses with a St. Charles ZIP code are outside the city limits, so a few words about how to find the house are useful when visit days are confirmed.
- County: St. Charles County, Missouri
- ZIP codes: 63301, 63303, 63304
- Nearby hospitals: SSM Health St. Joseph Hospital in St. Charles; Barnes-Jewish St. Peters Hospital (not affiliated with Gateway)
- Nearby communities: St. Peters, St. Charles County, Bridgeton, Cottleville, Weldon Spring
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
More wound care in St. Charles
Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in St. Charles 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 St. Peters
- Pressure injury and bed sore care in St. Charles County
Common questions
How do we start pressure injury care for a family member in St. Charles?
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.
Will insurance pay for pressure injury care or a special mattress in St. Charles?
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.
Does Gateway work with nursing homes and assisted living communities in St. Charles?
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.
Can a home health nurse and a Gateway partner clinician both be involved for a patient in St. Charles?
Often, yes. Some patients in St. Charles have a home health agency providing nursing visits after a hospital stay. Tell us which agency is involved. With permission, Gateway shares the treating clinician’s orders and visit notes with the agency so the nurses and the clinician work from the same plan. How the services fit together under a given health plan depends on the plan and the care needed.
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.