Any practical advice for a total novice on wound care for unstageable pressure sore management?

I’m on my own at home so I couldn’t read through to see if you got any help yet.
i came home with the air mattress and I did pay a fee (but stage 4 would have qualified for it). I also learned you can buy the same one that DME rent you on amazon for like $200. Beat investment is an air mattress.
I also use daily a foam dressing (from amazon in her sacral area with a bandage over it) as added protection. U can cut these foam price to size - box of 10 for like $11.00 they last me a long time as I cut them up. Dynarex Foam dressing.
Home health can be set up with any drs orders. They will also set you up with supplies and wound care bandages (delivered to you).
I will try to look at more of this to see where else I could offer any help. About to set up for in home Skype therapy ;)! Best wishes and keep reaching out here.

SuperHawk, how are things going with your dad? Hope all is well!

No nurse to teach you wound care? THAT is unheard of. Sounds like the Dr. knows it wont work for you as you may not be a "caregiver". If you do out of a sense of duty it will not last. The job gets old real fast and it is not good for you or the patient. Frustration and being tired of it will result in emotional abuse for you and the one you are doing things for. Plus, may result in negect. As a A.P.S and past Deputy Public Guardian it most often results in physical abuse as well.

My father is in much the same place - one week hospital, 2 in rehab, 2 at home back in hospital- am afraid where he will be with the wound when he comes home which may be tomorrow. No one has said he is dying and I still have a lot of hope for him but fear him coming home and the state he will be in. Since I can't see him I can only go by what I hear on the phone and it's rather scary and he is much more confused, who wouldn't be. He developed a wound during the last stay and am hoping it at least hasn't become worse. The whole thing has been exhausting and the medical people coming to the house have not been all that helpful both times they should have noticed something was off earlier and told me to put him in ER- it became my decision and I am just a lay person sorting through all this without any experience. I do hope there is some light at the end and that he can heal, I know he will never be back to where he was in march but this very quick decline because we couldn't get him help due to covid has been really difficult to take.

also I was told that Prostat - AWC protein drink is really great for wound healing- my dad was doing better but I had to once again put him in the hospital and am afraid of the state he will been when he gets home again

Thank you surprise. You are so right.

SuperHawk, Being wiser usually comes from experience. If your dad said something about his regrets, you can learn from those experiences and lead a "happier, more targeted life." "A Purpose Driven Life," I believe a certain book calls it, one that I have not read yet.

I know that growing up under a filthy rock as I did and absorbing the world view of a mentally ill person put me at great disadvantage as far as "emotional quotients" and knowing how to get along with people (not to mention not knowing how to do laundry or eat right). I've searched for answers and found that great book of ancient wisdom, the Bible, to apply to more situations that I could have imagined when I started reading it (I'm sure there are other ancient books of wisdom but I have not read others). I think everyone has regrets and our efforts to pass those down to the next generations are very valuable.

I'm glad you all has this existential conversation. Perhaps that is the budding of new growth on the rosebush. <3

SuperHawk, Mthr was in kidney failure and her skin was fragile, all from malnutrition from the Alzheimers. She would not eat and batted food away the last 3 months. I don't know how she survived for so long. She'd had a stage 1 sore for about 2 months and the hospice aide was aggressively treating it, but when CV hit, outside staff was banned and it developed into an open sore quickly. We did not treat it with antibiotics since she was at the end of her story. Mthr was ready to go years ago. I did not ask the stage of the sore as I really did not want to know. I do know that I am thankful for opioids.

Superhawk, I am so sorry you are going through this. Mthr was at the end stage of her dementia which is far different from how you describe your dad. She was a medical professional and when signing her Advanced Directive, knew what she could be in for when she said "no antibiotics." Her wound appeared and she died within a month even though hospice and our nurses treated her wound marvelously - we chose to honor her choice on the AD. Hospice put her on methadone and dosed her before her dressing changes to minimize her pain. She was as comfortable as she could be in these trying circumstances. I heard her talk about dementia long ago; she would have preferred to die of pneumonia long ago and refused the shot so pneumonia would take her out. The methadone made her last weeks bearable.

“Do you think doctors looking ahead, due to his age decided to let his own body fend for itself, since the expected outcome regardless of treatment is shut down? “

No I do not at all. But they can’t wave a magic wand and make the tissue heal, or restore dad to optimal nutrition, or make his bones create red blood cells. His body is in a state of inflammation which makes his other organs/body systems not work as they should. Please try to accept that It is very unlikely the wound will heal quickly IF AT ALL. I say this to you respectfully, your father is on hospice. That means no heroic efforts will be done if he should take a turn for the worse. The decubiti dressing changes are no doubt painful for him and stressful for you. He’s home but they want him to sit up....why? He’ll be sitting on the wound.
Consider your father’s quality of life going through all this as well.

Please Superhawk listen to his providers. It is very difficult when you know you are losing your dad. He is 91. He’s lived a long time. Reevaluate your expectations for his recovery. You are caught up in the blame game as well. Maybe you are not hearing what his doctors are saying.

My advice? Keep him as comfortable as possible and let nature take its course. Medicate him for pain before dressing changes so they are less painful.

You’ve never told us what your father wants nor if he has Advanced Directives for EOL planning. What does HE want?

I also want to say one more thing and hope you don’t take it the wrong way but throughout my career I have seen many families who continue to insist on every possible treatment to keep their loved one alive when in fact those treatments are futile. Keep this in mind going forward. He may be ready to go but you are not ready to let him go.

I don’t mean to hurt your feelings with not knowing exactly what ails him, my advice may be wrong.

Just know you are doing the best that you can.

And this has happened In the middle of a pandemic, which makes it worse! Every hospital has been effected by Covid 19 and doctors & their availability of the providers is stretched.

Hydrogel and medihoney is an appropriate dressing for that wound.

I'm a little late to the discussion, but for anyone in addition to the OP looking for practical advice:

https://www.coloplast.us/Global/US/Wound%20Care/Pressure%20Ulcers%20-%20Prevention%20and%20Treatment%20Quick%20Guide_M4006N.pdf

Coloplast is a manufacturer of products so I must declare their commercial interest but this link is to a very good, useful manual. It is also an extremely graphic manual, be warned.

Superhawk sorry it has come to this but his age DOES matter as far as looking ahead. Can his aged body systems fight this off? He may not survive this. He’s anemic, malnourished and tired. It will takes months to heal that wound. Is he in pain? Nutrition wise what will he eat at home now that he’s there. Is he on Hospice now? If something happens at home would you allow him to be re-admitted? The probability of re-admission is high with his compromised state. Is he a DNR? Have Advanced Directives?

Take a breath You can deal with the “why’s & “if only’s” later. Again, at 90 age does matter. We all get old. The staff there were providing realism and perhaps told you this to help you understand the challenges here.

What does dad want? I don’t think you’ve told us that.

SNF now have specified Covid 19 units & keep patients separated. The virus is out there so chances of anyone getting it is equal - doctors & nurses have become positive. 11 weeks into this pandemic management of cases in SNF’s have improved after what was learned the hard way in NY state.


Heartbreaking I know.

They found him placement in skilled nursing and you turned it down?

Why?

Make him an appointment with a “wound doctor”. My mother had one for her ankle. She was bedridden and that is why it developed in the first place. We learned a lot from the specialist. Her immune system was compromised due to rheumatoid arthritis and it will take a month or two months or more to get that under control for your parent but that is the best way to go. Look up wound doctors and make the appointment or get a referral from family physician.

Please arrange for your family member to be evaluated by a Woundcare specialist. I would not take random advice from the internet.
I was a homecare RN and performed a lot of Woundcare. First a doctor must evaluate the wound and they order the Woundcare. If an agency has a certified Woundcare nurse they will be sent out to evaluate it and make recommendations to the doctor who may then agree or disagree with the nurses’ recommendations.
Woundcare supplies have come a long way and the materials used depend on the wound itself.
Usually my patients were seen by the MD every two weeks if not sooner depending on the severity of the wound. Often wounds need debridement to cut away the dead tissue to promote healing.

I believe the OP’s dad’s wound is not open, just reddened. An “egg crate” and frequent repositioning is the treatment and then daily observation to address any changes. If he needs an Alternating pressure mattress (recommended) Medicare may pay for that with proper medical necessity documented. Usually Medicare pays when a wound is open and requires frequent dressing changes.

Even if your dad is in a HMO they have resources outside of network they can refer you to but I am not sure about how and at what rate you will be charged.

Please don’t listen to suggestions about what to use to care for the wound. Dad needs evaluation and orders specific to his wound.

Again, if there is no open areas only redness it sounds like a Stage 1 PU. Make sure you turn him every two hours and add protein to his diet.

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.)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.