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.

Pressure injury and bed sore care in Webster Groves

People in Webster Groves 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 Webster Groves, and helps the latest measurements and orders travel with the person.

Tall trees, deep front porches and houses that have stood for a century give Webster Groves its look. The city lies along Interstate 44 in St. Louis County, with Lockwood Avenue running through its center and Kirkwood, Shrewsbury and Crestwood nearby. Many residents have been here for decades and have no plans to leave. Those same older homes can be hard on someone with a leg wound or a recent surgery, since many have steps at every door. Arranging care at home, or in a nearby facility, spares the patient that climb.

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

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

Once a pressure injury is being cared for, the treating clinician needs to hear about changes in the wound between visits. Report any of these:

  • The wound looks wider or deeper than it did at the last visit
  • Black, brown, gray or thick yellow tissue appears
  • Drainage increases, soaks through the dressing or changes color
  • A new or stronger odor that remains after the wound is cleaned
  • The edges lift or a pocket seems to open under the skin

Call 911 for bleeding from the wound that will not stop, or if the person collapses or cannot be roused.

Why primary care matters here

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.

Primary care at home in Webster Groves →

Getting care arranged in Webster Groves

Setting up pressure injury care for someone in Webster Groves usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

Families arranging care in Webster Groves should have the address, a phone number, the patient’s regular doctor and a list of current medications on hand when they call 314-325-0126. Mention which entrance has the fewest steps. We coordinate care in nearby Kirkwood, Shrewsbury, Maplewood, Brentwood, Crestwood and Affton as well, so a move to a relative’s home or a facility close by need not mean starting over. Availability is confirmed by location and care setting.

  • County: St. Louis County, Missouri
  • ZIP codes: 63119
  • Nearby hospitals: SSM Health St. Mary's Hospital in Richmond Heights; St. Luke's Des Peres Hospital; Mercy Hospital South (not affiliated with Gateway)
  • Nearby communities: Kirkwood, Shrewsbury, Maplewood, Brentwood, Crestwood, Affton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

Common questions

Will insurance pay for pressure injury care or a special mattress in Webster Groves?

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.

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 Medicare pay for wound care at home in Webster Groves?

You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. What a plan pays for depends on the plan itself, the treating provider and the care that is needed, so we cannot answer for every case in advance. Have the insurance card nearby when you call and we will explain what to check before a visit is arranged.

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.