Wound care that comes to the resident
Sending a resident out to a wound clinic takes staff time, a transport booking and often a missed therapy session or meal. Mobile wound care for skilled nursing and assisted living works the other way around: a partner clinician sees the resident in the building, with a nurse who knows the resident present.
Gateway arranges those visits across Greater St. Louis and the Metro East and handles the request, scheduling, records, supply follow-up and communication around them. The treating clinician makes the clinical decisions.
Residents who benefit from on-site visits
- New admissions from the hospital with surgical wounds, pressure injuries or negative pressure therapy
- Residents with pressure injuries, including heel and sacral wounds, that need staging and a treatment plan
- Chronic leg and foot ulcers related to venous disease, arterial disease or diabetes
- Wounds that have stalled or worsened under current orders
- Residents for whom transport is a burden because of advanced dementia, pain with transfers, frailty or comfort-focused goals
What the treating clinician may do on site
At a visit, the partner clinician may:
- Assess, measure and document each wound, with cause and staging where they apply
- Write or update treatment orders for the nursing team to carry out
- Perform bedside procedures such as debridement when clinically appropriate and the setting allows
- Order or recommend pressure redistribution, offloading, compression or a nutrition review
- Identify wounds that need vascular, surgical or infectious disease input
The visit note comes back to the facility for the chart. Daily dressing changes, turning schedules and routine skin checks stay with facility staff under your own policies.
How Gateway arranges facility visits
- First contact. A director of nursing, wound nurse or administrator contacts Gateway. We confirm the building’s location, level of care and how many residents have wounds.
- Resident information. The facility sends a face sheet, current wound orders, recent notes and relevant history for each resident. Consent and coverage are confirmed per resident with the treating provider.
- Scheduling. Visits are set up as individual appointments or as recurring facility wound rounds. We confirm availability for your location and level of care.
- Visit day. A nurse who knows the residents goes with the clinician. Our wound rounds preparation checklist covers what to have ready.
- Afterward. Gateway routes notes and orders, follows up on supply requests and tracks any specialist referral the clinician made.
How skilled nursing and assisted living differ
In a skilled nursing facility, licensed nurses carry out wound orders on every shift, an attending physician oversees medical care, and wounds are tracked for the care plan and required assessments. Visits usually run as rounds, with the wound nurse working through a list, as our page on wound care for skilled nursing facilities describes.
In assisted living, nursing coverage and what staff are permitted to do vary by community and license. Dressing changes between visits may fall to a home health agency, a family member or the resident. Before the first visit we ask who will carry out the orders, so the clinician can write a plan that fits. See wound care for assisted living communities.
Memory care adds residents who cannot describe pain or who remove dressings. Our page on wound care in memory care covers how visits are adapted.
Working with the attending physician and primary care
The attending physician or the resident’s primary care clinician remains in charge of overall medical care. Wound visit notes go to that clinician, along with anything the wound clinician flags beyond the wound, such as swelling, blood sugar, weight loss or a medication question.
Some assisted living residents have no primary care clinician who can come to them. Gateway can arrange primary care in assisted living with a partner clinician.
When a wound changes between visits
If a wound gets larger or deeper, drains more, smells or shows spreading redness, report it to the attending physician under your facility’s policy and tell Gateway so an earlier review can be requested. For an emergency, follow your emergency procedures and call 911. Gateway is not an emergency service.
When a resident goes to the hospital, returns or discharges home, Gateway helps the wound history and current orders go with them.
How to start
Facility teams can refer a resident or ask about on-site visits, call 314-325-0126 or fax to 314-786-7966. Families of residents can also call us directly.
Common questions
Does a visiting wound clinician replace our wound nurse or attending physician?
No. The wound clinician adds assessment and treatment orders for the wound. Your wound nurse still leads daily care, monitoring and documentation, and the attending physician still directs overall medical care. Visit notes go to the chart and to the attending so all three work from the same information.
Can a visit be arranged for one resident, or only for a group?
A request can be for one resident or for many. Whether visits are set up as single appointments or recurring rounds depends on how many residents have wounds, where the building is and the partner clinician’s availability. Tell us what you have, and we will confirm what can be arranged.
Who supplies the dressings the clinician orders?
It depends on the setting and the resident’s coverage. In skilled nursing, dressings usually come through the facility’s own supply process. In assisted living, supplies are more often ordered for the individual resident through a supplier, based on the clinician’s order and the resident’s plan. Our supply ordering tips for facilities cover common snags.
How do families find out what happened at a visit?
The facility remains the family’s main point of contact, and updates follow the resident’s wishes and privacy rules. A family member or legal representative can ask to be present for a visit or to get a call afterward. With the right permission in place, Gateway can pass a family’s questions to the treating clinician and help set up that conversation.
Related pages
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.