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The doctor was willing to discharge my dad back home and without any nurse support nor instructions which was shocking to me. He simply said "He is an old guy"....meaning ? Let his wounds become infected?

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Superhawk, to me this is unacceptable treatment and behavior on behalf of the doctor. Was he a primary care doctor?

I would call him back and ask for a script for home care, for a nurse to assess and provide in home wound care. Start researching and contacting home care agencies to decide on one to choose, as it is your choice, not the doctor's.

If he won't do that, try to find a wound care specialist or wound care clinic. In my area, large hospitals sometimes have special wound care clinics.

To infer that he's old and not provide care is to me irresponsible. Even if he's old, wound care would make his life safer.
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Keep him off his back or butt area as much as possible, wherever the sore is. I can't imagine that it is infected and they would turn him loose like that. I'm talking about a pressure sore. Many years ago in the hospital we would dab it with Maalox with a sterile piece of gauze. It would help heal the pressure sore by drying it out. Good luck.
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SuperHawk May 2020
Very shocking advice indeed when doctor asks me to take him home without home health nurse! Almost sadistic.
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Are you and your dad in the US?

Discharged from a US hospital? Call the patient advocate tomorrow and report this.


AFTER you get the doc to prescribe home care services, of course.
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SuperHawk May 2020
I am being careful not to be incendiary before getting help for My father. I was able to suspend his discharge. We are in California. The other disturbing fact is that any moment doctor can call for same day discharge. So no time to look for alternatives ....they do this on purpose. To catch the vulnerable caregiver by surprise.
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I would call the hospital and find out how you can get wound care at home and how you report the derelict doctor.

I would write a report stating specifically what happened and send it to the hospital, the AMA and the states governing body for doctors, this doctor needs to go mop floors.
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SuperHawk May 2020
You have perceived perfectly this doctor's mindset. But THIS doctor at least "suggested" immediate discharge.....not ordered it last Monday he tried again..... if it were one of the other 2 doctors that I know work at this hospital under that medical group......they WOULD have hung up the phone on me after telling me TODAY IS DISCHARGE. TAKE HIM HOME. Probably without a good bye.
You say I ought to call the hospital but for me the hospital belongs to this medical group. I don't think there is a hospital manager.
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Make sure you rotate dad so he is not on the same spot. clean area. Calmosepetin I think helps. A & D ointment. air.. It. Bedsores come on quickly, usually due to some poor handling of your dad.. It took my MIL 2 days to get one in hospital, and months to get rid of it.
Make sure your dad gets extra protein.. Ensure, lots of protein, for some reason someone told me that it helps because the body needs protein to heal...??

If dad got it in hospital,,the doctor knew it and knew you didn't know how fast and bad these things get..
rotate every 3 hours. keep him off that spot.. clean bandages.
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SuperHawk May 2020
Thanks Mayday. Someone should have alerted me a long time ago about this danger with my dad. To avoid at all cost any pressure sore. Suggested buying a matress after the Rehab or during his post rehab at home. Every day counts .....so I hope someone is making my dad's days count.
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My sister has had a couple of pressure wounds. Some actually start below the surface, so by the time it breaks through and is visible, the underlying tissue has suffered damage. It is not something you want to ignore, or adopt a "let's wait and see how it goes" attitude, especially with an elderly person. There are many treatments, some more invasive than others. I do not know where you live, but I highly recommend finding a wound care specialist.

If you can find it, there is a protein drink called Juven. It is supposed to help with healing after surgery; my sister drank it while recovering from her most recent pressure wound.
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SuperHawk May 2020
Referral to wound care specialist would imply doctor feels there is a chance of treatment. This doctor does not believe it. For him there is no point. He literally wants to leave his wounds alone. Which if it weren't for the fact he has been pressuring me since day 3, I would assume doctor is now looking at someone too far off to help. But since day 3 this doctor has been asking me to give up and make dad comfortable for.....world discharge.
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I’m confused. How does anyone know it’s unstageable without performing an assessment?
Diagnosing this would mean they’ve done some sort of evaluation.

Is it unstageable because it is not an open wound? Usually unstageable pressure ulcers are open wounds or can’t be measured for depth/width/length. Stage 1 is redness around an area With no open areas (yet). In order to be classified as unstageable the wound needs to be evaluated by a MD as they measure depth/length/width. When I was a HC RN we measured the wound weekly to assess for healing.

Did a wound specialist see the pressure ulcer while dad was in the hospital?
If it’s unstageable and no one has seen it, how could someone write woundcare orders?

Now dad will have to see a woundcare specialist to determine treatment. Then homecare will get ordered for woundcare if needed.

A physician needs to write homecare orders & specify woundcare to be completed and homecare orders the supplies designated by the doctor. Nurses can assess the wound but not write woundcare orders (unless they are PA’s or NP’s).

I can’t believe that doctor just discharged him with no instructions. Usually a nurse will come and explain discharge orders to a patient, not the doctor. Did anyone discuss this with nursing on dad’s discharge?

Change his position every two hours. Get an order for an alternating air mattress for his bed while he is sleeping.
Make sure he gets protein in him to promote tissue healing.

What does his wound look like now? As a nurse I am curious.
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SuperHawk May 2020
Thanks for taking the time, your concern and knowledge. Sorry if I repeat myself or fail to be more coherent I am new at forums. We are in California. Dad is still hospitalized. Just yesterday found out sacral wound is 10 to 15 cms. And there are 9 pressure areas of concern. Sacral an thigh being highest and the others just surface redness. No mention of stage. Is a wound care specialist a nurse? I was told he has been seen. I am really in the dark. I don't think he is being repositioned every 2 nor 4 hours. They do check dressings in two different shifts I think.
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Superhawk, thank you for responding and clarifying some issues.

I'm shocked that there are 9 areas of concern, not to mention the size of the sacral wound. Could you provide some background how these occurred? Is your father primarily sedentary, limited in mobility, and spent a lot of time sitting or laying down?

What was the cause that prompted hospitalization?

I am definitely not criticizing, just inquiring. His conditions at home could provide insight into how the ulcers developed and contribute to an appropriate curative plan. I'm also wondering if he's diabetic?

You are aware I hope that you can ask for a different doctor? I did that when a hospitalist and two young things with little people experience outstepped their bounds. I don't recall if I approached the Charge Nurse, or called the hospital Administrator, but I got rid of the insensitive ones and got a doctor who focused on elderly care.

He was much more sensitive; although he was also frank, he was professional in addressing the issues, unlike the "baby doctor" who still needed to learn how to deal with older people.

Shane is very insightful and I anticipate will have more questions and advice.
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SuperHawk May 2020
Hello GardenArtist. Thanks for your insightful input. Since I am living this at the present moment sometimes it aches me to recount my ordeal. Yet I am reaching out to see if I can get help for My dad with people with experience or simply well meaning advice. My Dad had only been back home for 8 days from a 2 week stay at a SNF after a hemiarthroplasty. Rehab did not work he was still bed bound. Now with a sacral wound from that stay. Following home nurse advise: Keep him off his back. He spent time between both hips. But more on the right. So after one night of tossing and turning on a plastic matress courtesy of his insurance benefits became reddened. Home nurse started dressing it as well. So when he arrived at the hospital he had a sacral wound and right hip under observation. Barely a week back home. I was not enough for him nor the matress.
It has been 3 weeks since admission and yesterday nurse informed there are now 9 pressure points plus sacral is 10-15 cms.
Is it normal to be in hospital with 3 nurse shifts and have that many and sacral expanding? I read wound care is very expensive. Is that why they are expecting me to accept there is nothing more to do?
Not even rotating him??
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Superhawk, on the second issue of discharging...this was in part why I suggested considering getting a different doctor.

The size of the largest ulcer is to me indicative of need for medical treatment in a hospital, or perhaps even a rehab center. I think this doctor may be thinking of his "quick discharge" score in wanting to send your father home.
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SuperHawk May 2020
Quick discharge is what has my father in this state. But this time I have been able to hold it off. But just barely. He is still in hospital. Father has HMO and hospital doctor is assigned weekly by his medical group. So we are stuck. I also believe this wound or wounds need specialized well targeted TREATMENT and to think he wanted me to take over ALONE. Is it not almost like a crime ? You said either hospital treatment or a rehab center? Are you referring to skilled nursing? I do not think he would get the care he needs at this point at a skilled. I was told they do not furnish patients with low air loss matress nor any special alternating pressure relieving gadget. But also I am doubting he is even getting aggressive curetage treatment at the hospital. But better than SNF.
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Ulcers can be life threatening, and are very painful and difficult to heal. I would call Quality Assurance at the hospital and report this, and follow-up with a letter. So sorry your dad is going through all this, it is really a shame. Shane offered great advice about wound care and treatment. I would also talk to Social Service so they can set up home care for wound treatment. As Barb advised report only after doctor sets up treatment, and I would definitely search for a another doctor with more compassion and intelligence!
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I would want to see if there were pressure points upon admission. If yes, an air mattress should have been ordered. If not, then its the Hospitals fault and they need to give you the tools to deal with it. A layman should not do woundcare. My Dad got heal blisters from rehab. When my daughter looked at them there was dead tissue, not good. She is an RN. But none of the other nurses took note and they put on the bandages.

I think the Hospital doesn't want to admit its their fault. It can be considered abuse. Get someone to order an in home wound care nurse.
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SuperHawk May 2020
Hello JoAnn when dad came back from SNF he was sent home with nurse visits. Except just in general like a follow up no mention of having a sacral open wound or risk. When a nurse came I believe was just a general nurse or an assistant. Is a wound care nurse the same as a RN or an assistant nurse?
When my father makes it back home I need to make sure someone VERY specific oversees his decubiti. Or are all rn's knowledgeable and trained enough?
I shiver thinking of dad's actual wound state. No one can answer anything. Almost as if they were under a gag order. I am so afraid for him.
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FYI re: wound care treatment -- When my sister had her most recent sacral pressure wound, she saw two different doctors and tried multiple treatments, including a low-loss air mattress and a wound vac. Medicinal honey, medicinal silver, etc.

What turned the corner for her was Procellera. It is gauze with tiny metal dots on it that, when exposed to moisture (like sterile water or saline), creates a small electrical charge. This stimulates the blood supply and promotes healing. My sister was the first patient in our city to use it, with the approval of her wound care doctor. We bought it directly from the company because it was a new product that had recently been approved by the FDA. I believe it is more readily available now and may be covered by insurance. (I don't work for them, but the product worked for my sister and I have told many people about her success using it.)
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SuperHawk May 2020
Hello Texas, thanks so much for sharing hope with me. I have made a notation of that dressing.
Sounds incredible. A charged dressing.
I hope your sister will continue well. Were these private consults or through insurance? Access to consult with 2 different doctors sounds luxurious.
With an HMO once you select medical group you can only have doctors under that umbrella for coverage. Asking for second opinion among them will certainly have conflict of interests. Second guessing colleagues is something not covered so it is never brought up I suppose.
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Superhawk, thanks for the additional explanations.

You wrote the magic words: HMO, rotating doctors assigned by the HMO.

It might be costly to get Medicare now, but please do consider it.

And even though the HMO assigns the doctors, you still have a right to criticize, or call an Ombudsperson. And I would do that.
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SuperHawk May 2020
Hello GardenArtist. Right now any change would be impossible. I would need to change medical group. The HMO works with several medical groups and they are the ones handling the medical portion alongside medicare. I hope dad survives all this medical incompetence.
I am looking into getting an ombdusperson if they try to discharge him to an unsafe skilled nursing facility without consulting me. I hope the SNF know better and tell them not until his sacral sore is not addressed medically. I do not think dad is getting antibiotic therapy to avoid sepsis. They are with the wait and see approach. Very mean system.
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Keep the pressure sore clean with salt water and then fill with gauze and natural honey (yes honey) and get thick spongy dressings as these cushion the wound best. Use gloves every time you cuange the dressing and do so once or twice a week. Also shift his weight off any bony areas every 2hours when possible 🌻🖤
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Isthisrealyreal May 2020
I want to add a caution, not all honey is actually honey.

Go to a health oriented store, ie Trader Joe's, Natural Grocers, even a farmer's market and buy RAW honey. It will be a bit cloudy because it is not processed and it is expensive, but a little bit goes a long way. Be prepared to pay around 10.00 a cup.

I discovered that not everything labeled as honey really is when treating a skin rash on holiday. I ran out and picked some up, needless to say that all healing came to a screeching halt, that is how I discovered the fraud.
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Complain about dad's care.

He needs proper wound care Doctor, treatment nurse, and nursing assistants. He needs a team.
Take pictures, take pictures.
As a Medicare patient your dad has rights. As a patient he has rights. Complain to Medicare.
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This is all new to me- my dad a diabetic got a lumbar infection- had to put him in ER, then rehab 3 weeks total very stressful during Covid -now home a week he needs an IV infusion daily for 30 minutes and has a bedsore that probably started at home but 3 weeks on his back added to the problem and should have been taken care of better at the hospital- he was sent home and I was excepted to do both the IV and the would care with limited instruction by the nurses. A little much for me to handle, I am already under incredible stress- he's 87 and mom 84, I have no siblings and single. Fortunately I found amazing help and very slowly he is improving, moving and sitting up - I don't know how they expect people to handle this. I mean I wouldn't throw people into my job with 10 minutes training under stress and my job does not involve lives. The whole thing is shocking and that there are not better systems in place.
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SuperHawk May 2020
Hello Cascia. I was told by hospital wound care nurse my dad needed 24 hour care and I should not even consider taking care of his wounds alone. Not possible she said. Today in conversation with dad's medical group social worker I was convinced dad would be better at home with daily wound care visits plus a good mattress. This was planned for Monday.
Then within 1 hour a case manager called and said they had found a placement in a SNF. So they could discharge him tomorrow. I said I was already in conversation to have him back home on Monday. She said once there's a placement available and discharge in place patient needs to go. Or you could be hit with some fees for the extra days. So I had to rush decision and move dad's return home for tomorrow!
No time for mattress negotiating....I was assured by social worker he would get what he needed. Rest assured. So now I just realized that I will be 99% responsible for all his care. When I asked if nurse could also help with dad's stoma bag I was told if that day needed change. But that nurse was mostly wound support. Now I just realized that if mattress is not alternating pressure.....I will need even more to be on top of repositioning.
24 hours a day. Just not physically possible. Yet that is what they are leaving me with. So I will have wound, stoma and condom Cath care verification all day and night.
When will I sleep? May have to get a relative to caregive moonlight shift for some compensation.
I was so fixated on dad's wound care I had forgotten the package was much larger. This was a savvy entrapment. Feels very coordinated ....impossible to out maneuver the system. This will be my last good night sleep until I get plan B set in motion. Rotational mattress and/or shout out to a cousin to help during night time repositioning. Somehow they still manage to slide in the word team (working with me).
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You can ask the family doctor to prescribe Home Health Care. My daughter is a nurse with Bayada and this is one of the things she does-wound care. It has to come from a doctor, but you can check out the home health care providers in your area and then ask the doctor to send a request to the one you want to choose. We had home health care for my Mama when she came home from rehab and one of the things they helped me with was the bedsore on her back. I still had to do the changes in between their visits, but the fact that someone knowledgeable was available and could show me what to do as it changed was so relieving. I had enough stress in just trying to take care of everything else, so I highly recommend home health care.
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Look into oxygen treatment. It is not covered. Not sure if it is possible for all parts of the body or not. We paid $500. It healed my mother in laws pressure wound up in a week. It was amazing to see how fast it healed. They told us they would bill Medicare, and knew Medicare would not pay as it was still considered experimental. Therefore the one time upfront payment. Her geriatric doctor suggested the treatment.
My mom never has pressure sores except when in the hospital or rehab. At home we use Desodine to prevent them.
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Isthisrealyreal May 2020
It is amazing how well that works for healing.
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My mom had pressure sores from sitting for long periods of time.She had a stroke so her mobility wasn't the best ,but she did use a cane with assistance. I had to get a special gel cushion as well as apply ointments and sometimes a dressing if the sore ruptured.
Getting up moving around and changing positions is also key.
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Call the physician and request that home care is ordered. Your dad needs to have the wound care provided by a registered nurse. The physician needs to write an order and if he doesn't, he needs to be reported. Saying your dad is an old guy is unacceptable. The nurse will evaluate, treat, and monitor the wound. I would tell the hospital social worker as well. The social worker is responsible for safe discharges.
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A pressure sore needs to medically monitored and treated. If your dad has been hospitalized long .enough to qualify for home health follow up visits, set those up right away. Learn all you can from nurses and online about how to care for wounds yourself for when you are left on your own. You can do it, but you need to know what to do.
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I would definitely get some home health care. This doctor sounds like he should not be working in his field. I treated my mom's stage 4 wound which she got during rehab in a Medicare 5 star rated nursing home, and I didn't find out about the wound until she was hospitalized from there and the hospital intake nurse told me about it. I took her home never to return to that NH. A wound nurse at the hospital did train me to clean and bandage the wound. I used a coloidal silver spray on the dressing, and upped my mom's protein intake for healing,(not too much as too much protein is bad for the kidneys. Gave her peanut butter toast for breakfast daily. The wound began to shrink. She also saw a wound doctor every week or couple of weeks, and they were helpful with instructions. I wish you all the best, and keep after those hospital social workers, etc. to help you.
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SuperHawk May 2020
Hello Katie. You said you nurtured back to health your mom's stage 4 pressure ulcer? Did it look very deep and open? My father's expanded during hospital stay and professional....wound care consult once a week.
He is 90 so that number alerts hospice in preparation for the end. Currently he is bedridden. I almost lose hope upon looking at his wound for the first time today. Almost but I have a little left.
How could you muster courage to undertake stage 4 curettage? I will start on peanut butter breads tomorrow. And smile with my slice of hope left.
Thanks much for your success story. You did everything right.
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Superhawk,

Answering your question here.

I have worked with RNs (as their secretary) and my daughter is one. They all know what a pressure sore is and how to treat it. Just some, like my daughter, are better trained. She runs a Woundcare unit and was a wound care nurse at a facility she worked for.

Someone mentioned they had been shown by a Nurse how to dress the wound. Thats OK but a nurse should be checking it regularly.
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Medicare will pay for a wound care nurse to visit your dad and help you learn how to treat the wounds, as well as, recommend products to alleviate the wound.

it also sounds like you need a different doctor.
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Pressure sores kill. I am an RN and know how easily and quickly they do so. I am quite shocked at the advice from this doctor, and am wondering just how old a guy he is. This should be "wound care management" which is now a specialty and very precise. These are impossible to handle and become necrotic, and down to the bone. I am so sorry you had such bad advise and recommend you call and raise some "Hades" with this doctor. This is negligent treatment.
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I am an RN. Here are the general principles of pressure wounds:

Healthy skin needs all these components:
good oxygenation = good circulatory and good respiratory system functions
good nutrition = balanced diet and if there are wounds, a little more protein and probably vitamin pill
good hygiene = mild soap and water and mild rubbing on healthy skin to remove bacterial load
good mobility = moving self or help repositioning every 2 hours , if there are wounds, keep bodyweight off that area
good hydration = enough water so person urinates every 3-4 hours and pee is clear to straw in color

As for wound care. The adage is, "If it is dry, make it wet. If it is wet, make it dry."

Wet/Oozing wounds - clean with liquid soap like Hibiclens in water, rinse with clear water, place non-stick pads over all of wound, pad with gauze to absorb fluids, and wrap with rolled gauze or elastic bandage(ACE) and secure in place.

Dry wounds - clean with liquid soap like Hibiclens in water, rinse with clear water, allow to air dry, coat with triple antibiotic ointment, place nonstick pad over wound, wrap in rolled gauze or elastic bandage (ACE), and secure in place.

Change dressings daily and keep a record of the size, depth (use a Qtip), drainage, colors. Let doctor know if wound is getting bigger, deeper, or changing colors or drainage. Doctors can prescribe antibiotic ointments or oral medications. Doctors can also prescribe visits from a wound care specialist.

In some older folks, wounds do not heal well or easily since they usually have problems with circulation, nutrition, mobility and/or oxygenation. So, do not get discouraged if your efforts do not yield speedy results.
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renoir May 2020
Thank you! This will be helpful for many.
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Oh boy, you have opened a can of worms for yourself. You might have to get a Dolphin air mattress. There is also a blue bottle you buy at a pharmacy that is specifically for wounds care/cleaning. You need to get that bottle. I am sorry I don't remember it offhand.
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I would call your dad's doctor and INSIST upon few weeks of home visit of Wound Care Nurse as you are not qualified to manage such a thing. You can also call his Insurance company to see if he qualifies for at-home RN visit. "He's an old guy" IS NOT ACCEPTABLE RESPONSE. smdh.
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SuperHawk May 2020
Thanks Renoir. Dad's wound is an embarrassment to all those who dressed it at the hospital.
Dressing it only hid it from view. This hospital has an outpatient wound care clinic and they boast they are among the best. Their specialty is non healing wounds.

So....if money could buy you better dressings....why doesn't anyone put that on the table? Then one decides what or how to gather the money.

I am wondering WHY they allowed dad's pressure injury to go "day by day" denying it was actually getting worse !
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Imho, his doctor was very wrong in brushing the pressure sore off as due to being elderly. Good heavens - the doctor needs to be corrected. I have seen this happen before where they tell the patient to tend to the wound themselves. Not so much. My DH got cellulitis from a cat bite, wherein he was at the hospital and was sent home. Bad medical treatment as his wounds became infected and ended up for a lengthy hospital stay.
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Sorry to not answer sooner, yes, my sister's wound care docs were covered under a Medicare Advantage PPO plan (not HMO) -- I myself have an HMO and know how frustrating it is to be locked in to a certain group of doctors. My best wishes to you and your dad!

Re: gel mattresses -- in addition to turning the patient, don't forget to turn the mattress (or rotate, whichever the instructions recommend). My sister had one that Medicare provided and after a couple of years, it developed a sunken place right where my sister needed the most support. (She has since purchased a Purple mattress, with her wound care doc's approval. Not cheap or covered by insurance, but it is holding up well.)
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