About pressure injuries
Several common beliefs about bed sores are mistaken. One is that a small opening means a small wound. Pressure damage is often wider beneath the skin than at the surface, which is why clinicians measure depth and check under the edges.
Another is that rubbing a reddened area helps. Current guidance is to avoid massaging skin that already shows pressure damage. Ring or donut-shaped cushions are also a frequent mistake, because they can concentrate pressure around the edge of the ring. And a sore that does not hurt is not a mild one. Lack of pain may simply mean the person has lost feeling there. When in doubt, ask the treating clinician before trying a home remedy or a new cushion.
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.
Local context: St. Louis County
People in St. Louis County with a pressure injury often move between settings: home, a hospital stay, a few weeks of rehabilitation, then perhaps assisted living or skilled nursing close by. Each move brings a new bed, new caregivers and a risk that the turning plan and wound orders get lost. Gateway arranges wound care in private homes and in senior living and nursing facilities across St. Louis County, and helps the latest measurements and orders travel with the person.
St. Louis County wraps around the City of St. Louis on three sides, reaching from the Missouri River in North County to the Meramec River in the south and west past Chesterfield toward Franklin County. It is made up of dozens of municipalities plus large unincorporated areas, linked by Interstates 270, 64, 44, 55, 70 and 170. Distances add up here. For someone with a wound, a walker or a wheelchair, a drive across the county to an appointment can take most of a day, which is why care at home or in a facility matters.
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.
For residents of nursing and senior living communities
Pressure injuries in memory care come with particular challenges. A resident with advanced dementia may not be able to say that a spot hurts, may resist being turned, may sit in one favorite chair for hours, or may pull at a dressing. Staff who know the resident are usually the first to notice a change in mood, sleep or willingness to sit.
Partner clinicians see residents in the memory care setting, which spares the resident a trip to an unfamiliar clinic. The treating clinician takes behavior into account when writing orders, and Gateway shares the plan with nursing staff and the family member or representative who makes decisions.
Signs to tell the clinician about
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
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.
How to get started in St. Louis County
If you have been managing a wound mostly on your own and are looking for pressure injury care in St. Louis 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 municipality or ZIP code when you call 314-325-0126, because the same street name can appear in more than one St. Louis County town. Have the patient’s name, a phone number, the regular doctor’s name and any discharge papers within reach. Gateway also coordinates care in North County, South County, Chesterfield and West County, Clayton and Central County, Kirkwood and Florissant. Visit availability is confirmed by address and care setting, so the exact location helps us answer accurately.
- County: St. Louis County, Missouri
- Nearby hospitals: Mercy Hospital St. Louis in Creve Coeur; Missouri Baptist Medical Center in Town and Country; St. Luke's Hospital in Chesterfield; Mercy Hospital South; Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton; SSM Health St. Mary's Hospital in Richmond Heights; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
- Nearby communities: North County, South County, Chesterfield and West County, Clayton and Central County, Kirkwood, Florissant
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
Related care in St. Louis County
Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in St. Louis 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 North County
- Pressure injury and bed sore care in South County
- Pressure injury and bed sore care in Chesterfield and West County
- Pressure injury and bed sore care in Clayton and Central County
Common questions
How do we start pressure injury care for a family member in St. Louis 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.
Does a bed sore mean someone was neglected?
Not necessarily. Many pressure injuries can be prevented with good positioning, skin care and equipment, and it is reasonable to ask how one developed. But they can also occur despite attentive care, especially in people who are very ill, very thin or near the end of life. The useful questions are what the plan is now and who is carrying out each part.
Does Gateway work with nursing homes and assisted living communities in St. Louis 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.
Can a nursing facility in St. Louis County refer a resident for wound care?
Yes. Skilled nursing facilities, assisted living, memory care and rehabilitation centers in St. Louis County can refer residents by phone at 314-325-0126 or by fax at 314-786-7966. Gateway works with the facility staff on scheduling, records and orders. The treating clinician assesses the wound and writes the orders, and the facility team stays informed about the plan.
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.