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

A care plan for a stalled wound usually has several parts working together, because one change alone is seldom enough. The treating clinician may decide on some combination of:

  • Clearing unhealthy tissue so the wound bed can rebuild
  • A dressing matched to how much the wound drains
  • Taking weight or friction off the area
  • Controlling swelling in the limb
  • Referral to a vascular, surgical, dermatology or infectious disease specialist

Each part is assigned to someone: the clinician, a nurse, a caregiver or the patient. The plan also sets a point at which progress will be judged and the approach reconsidered if the wound has not responded.

Local context: Washington, Missouri

Running out of dressings is a bigger problem in Washington than it is closer to St. Louis, because a replacement may be days away. Gateway plans supply orders with extra lead time and asks about quantities before each visit. If the treating clinician orders a blood flow study, imaging or a specialist consult, we help line up the appointment, records and ride so one trip covers as much as possible. Clear written instructions and a list of changes to report matter more when help is far away, so we check that you have both.

Washington sits on the south bank of the Missouri River in Franklin County, well west of the St. Louis suburbs. It is the largest city in the county and the place surrounding farm communities come to for shopping, work and medical care. Highway 100 leads east toward St. Louis County and Highway 47 crosses the river to the north. Outside the city limits the roads turn rural fast. For a person with a wound who lives miles out, or who no longer drives, care arranged at home or in a local facility can replace a long round trip.

At home between visits

A home visit lets the treating clinician see things an exam room hides. The recliner where someone sleeps every night, the slippers worn all day, the step into the shower, the bandage supplies in a kitchen drawer: each can explain why a wound keeps stalling. The clinician assesses the wound at the bedside or in a favorite chair and writes orders based on what is realistic in that house.

Gateway schedules the visit, confirms who will be there and passes along records beforehand. Afterward we follow up on the orders so the plan does not sit on paper.

In a facility

For a resident in memory care, a wound that will not heal often has a behavioral side. The person may pull off dressings, scratch at the area, pace for hours on swollen legs, or be unable to say that something hurts. Staff who know the resident usually know these patterns well.

The treating clinician takes that knowledge into account when choosing dressings and how they are secured, and may suggest timing care for the calmest part of the resident’s day. A familiar staff member or relative at the visit helps. Gateway arranges those details ahead of time and updates the family or legal decision-maker afterward.

Changes to report

Because these wounds are judged by their trend, small shifts matter. Report any of the following between visits instead of waiting for the next one:

  • The wound looks wider or deeper, or a new opening appears nearby
  • Black, gray or yellow tissue that was not there before
  • Bone, tendon or surgical hardware visible in the base
  • Bleeding at a light touch
  • Fever, chills, nausea or unusual tiredness
  • A dressing that will not stay in place or cannot be done as ordered

Call 911 if a foot or leg suddenly becomes cold, pale or blue, or if the person is hard to wake, breathing fast or suddenly not making sense.

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.

Primary care at home in Washington →

Arranging non-healing wound care in Washington

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 Washington. 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.

Mercy Hospital Washington is the hospital most local families know, and it is where many people in Washington are admitted or have surgery before coming home. Gateway is not affiliated with the hospital. When a discharge is planned, a relative or a discharge planner can call or fax us with the basics. We request the records, coordinate the treating clinician’s orders and arrange follow-up at the home or facility. Patients sent to a St. Louis hospital for specialty care and then returned to Washington can be referred the same way.

  • County: Franklin County, Missouri
  • ZIP codes: 63090
  • Nearby hospitals: Mercy Hospital Washington (not affiliated with Gateway)
  • Nearby communities: Franklin County, Eureka, Wildwood
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

Read the full guide to non-healing wounds, or see everything Gateway arranges on the mobile wound care in Washington page.

Common questions

Can a clinician come to a home in Washington to look at a wound that will not heal?

In many cases, yes. Gateway arranges home visits with partner clinicians across Greater St. Louis and the Metro East, and we confirm availability for your exact address and care setting before scheduling. Call 314-325-0126 or send a request with a name and phone number. You do not need a referral to ask, and a family member can call for you.

Does insurance cover care for a non-healing wound?

You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a visit, a dressing or a therapy is a covered benefit depends on your plan, the treating provider and the care that is needed, so we cannot answer in general terms. Gateway helps confirm these points before the visit where possible. Have your insurance card nearby when you call.

Can a wound that has been open for years still heal?

Sometimes, and it is worth asking. The length of time alone does not rule out improvement. What matters is whether the things holding the wound back can be found and changed. Some long-standing wounds do close after the cause is addressed. Others cannot fully heal, and the aim becomes comfort and preventing infection. The treating clinician can give you an honest view after an assessment.

Is Washington too far from St. Louis for Gateway to arrange a visit?

Washington is within the area Gateway coordinates, along with other parts of Franklin County. It is farther out than most communities we work in, so availability depends on the exact location and the care setting. Call 314-325-0126 with the address. We will tell you plainly what can be arranged and will not leave you guessing.

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.