About non-healing wounds
Anyone can have a wound that stalls, but some people are more likely to. Older adults are seen most often, because skin thins with age and repair slows. People living with diabetes, vein disease, narrowed leg arteries, heart failure or kidney disease are also common, since each condition affects blood flow, swelling or the body’s ability to rebuild tissue.
Limited mobility raises the odds too. Someone who spends most of the day in a wheelchair, recliner or bed puts steady pressure on the same areas. People who have lost feeling in their feet may not notice a shoe rubbing until the skin has broken. People who smoke, people recovering from a long hospital stay and people who are eating very little also turn up often with wounds that will not close.
What the treating clinician looks at
Part of building the plan is agreeing on the goal. For most people the goal is full closure, and the plan is aimed at removing whatever stands in the way. For some, especially people who are very frail or whose circulation cannot be improved, the treating clinician may talk with the patient and family about a different aim: keeping the wound stable, clean, comfortable and free of infection.
Either way, the clinician explains what they found, what they think is holding the wound back and what they recommend. You should come away knowing what the plan is, who does what, and how you will be able to tell whether it is working.
Arranging this care in the City of St. Louis
In the City of St. Louis, many people with a slow wound live in upper-floor apartments or tall older houses with steep stairs. Each trip down for an appointment puts weight on a foot ulcer or leaves a swollen leg hanging, and some people simply stop going. A reassessment at home removes that trip. Before the visit, Gateway asks about building entry, buzzer codes, elevators, parking and where supply deliveries can be left safely. The large medical centers nearby remain the place for vascular testing or specialty procedures when the treating clinician orders them.
The City of St. Louis is its own jurisdiction, separate from St. Louis County, and stretches from the Mississippi riverfront west to Forest Park and the county line. Inside it are dozens of distinct neighborhoods, from Downtown and Soulard to the Central West End, The Hill and the north side. The city is dense, old and largely built of brick, and many households do not have a car. For someone managing a wound or several chronic conditions, getting to appointments by bus or by borrowed ride is a recurring struggle that care at home can ease.
When care happens at home
Most of the work on a slow wound happens between visits. Dressings are changed on the schedule the clinician ordered, by the patient, a family member or a visiting nurse. Someone keeps an eye on the drainage and the skin around the wound. Leg elevation, pressure relief or wraps are kept up day after day.
Gateway helps keep that routine from breaking down. We ask whether the dressing is manageable, relay questions to the treating clinician and schedule the next visit. If something changes, such as a hospital stay or a new caregiver, tell us so the plan and the visit schedule can be revisited.
For residents of nursing and senior living communities
In a skilled nursing facility, a wound that has not improved is a shared concern for the nurses, the attending physician, the family and often the facility’s own wound nurse. A partner clinician arranged through Gateway sees the resident at the bedside, reviews the treatment record and weekly measurements, and talks with the nurse who knows the wound.
Recommendations and orders go through the facility’s normal process, with the attending physician kept informed. Floor staff continue the daily dressing changes and turning schedule. Gateway coordinates visit days with the facility and sends documentation back for the chart.
Changes to report
Not every change is an emergency, but these deserve a prompt call to the treating clinician’s office:
- Red streaks running up the arm or leg from the wound
- Pus, or drainage that turns green, tan or cloudy
- Home blood sugar readings well above your usual range
- Numbness, tingling or new swelling below the wound
- A wound that had closed and has opened again
If you cannot reach the office and you are worried, go to urgent care or an emergency department. Call 911 right away for spurting or uncontrolled bleeding, chest pain or pressure, difficulty breathing, or a limb that suddenly turns cold and discolored.
Why primary care matters here
Some people with a long-standing wound have not seen a primary care clinician in a long while. Getting to an office may be the obstacle: stairs, a wheelchair, no ride, or a wound that leaks through its dressing on the way. Meanwhile blood pressure, weight, mood, sleep, tobacco use and mobility go unreviewed, and each has a hand in how skin repairs.
Gateway can arrange primary care in the same settings as wound care, including at home. One coordinated plan means fewer conflicting instructions and one place to call with questions. Each clinician still makes the decisions in their own area.
Arranging non-healing wound care in the City of St. Louis
You may already have a surgeon, a wound clinic or a home health nurse and still want help with non-healing wound care closer to home in the City of St. Louis. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.
Barnes-Jewish Hospital, beside Forest Park, and SSM Health Saint Louis University Hospital, on Grand Boulevard, are the two major hospitals in the City of St. Louis. Gateway is not affiliated with either. Both discharge patients to every part of the city, and some go home with wounds that need regular attention. Case managers and social workers can refer by phone at 314-325-0126 or by fax at 314-786-7966. Families can call directly. Once we have the discharge summary and orders, we look for a partner clinician for the patient’s neighborhood and report back.
- County: City of St. Louis, Missouri (an independent city)
- ZIP codes: 63101, 63103, 63104, 63106, 63108, 63109, 63110, 63111, 63112, 63113, 63115, 63116, 63118, 63139, 63147
- Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital (not affiliated with Gateway)
- Nearby communities: Downtown St. Louis, Central West End, North St. Louis, South St. Louis, Clayton and Central County
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
More wound care in the City of St. Louis
Read the full guide to non-healing wounds, or see everything Gateway arranges on the mobile wound care in the City of St. Louis page.
- Diabetic foot ulcers
- Venous leg ulcers
- Pressure injuries and bed sores
- Arterial and mixed 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
- Non-healing wound care in Downtown St. Louis
- Non-healing wound care in the Central West End
- Non-healing wound care in North St. Louis
- Non-healing wound care in South St. Louis
Common questions
How often will someone visit for a wound that is not healing in the City of St. Louis?
The treating clinician sets the visit schedule based on the wound, the plan and who is changing dressings between visits. Chronic wounds are usually rechecked on a regular cycle so measurements can be compared, and the interval may change as the wound does. Gateway confirms what is available for your location and care setting and lets you know the schedule ahead of time.
Who changes the dressing between visits?
It depends on the plan and the help available. Some people manage their own dressings, some rely on a spouse or adult child, and some have a home health nurse or facility nurse. The treating clinician writes the orders with that person in mind. If nobody is able to do the changes as ordered, say so, and the clinician can look at other options.
What are advanced wound treatments, and will my wound need one?
Advanced therapies include options such as negative pressure devices, skin substitutes and specialized dressings. They are usually considered only after the basics are in place: the cause identified, pressure and swelling controlled, unhealthy tissue cleared and infection addressed. A stalled wound may begin to improve once those basics are corrected. The treating clinician decides whether an advanced option is appropriate, and health plans often have their own requirements.
My father in the City of St. Louis has both Medicare and Medicaid. Can we still ask about home visits?
Yes. You can ask about Medicare, Medicare Advantage, Medicaid and commercial plans, alone or in combination. Whether a visit is a covered benefit depends on the treating provider, the plan and the care your father needs, so Gateway cannot tell you ahead of time that something is a covered benefit. Have both cards with you when you call 314-325-0126, and we will explain what the treating practice needs to check.
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.