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

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.

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.

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

Why?

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.

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.

“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.

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.

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, 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

Thank you surprise. You are so right.

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

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.

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.

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

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.