Guide to Long-Term Care For Wounds
A wound is defined as any injury that breaks or injures skin or other body tissues. Wounds may occur accidentally or purposely such as during surgery and include scratches, abrasions, cuts, incisions, punctures, and burns. Living with wounds in your elder years can be challenging, and understanding the long-term care requirements can be equally complex. By the end of this article, you’ll have a much better understanding of the long-term care options for those with wounds.
Four Phases Of Wound Healing
There are 4 main phases of wound healing:
- Hemostasis phase: The wound begins to bleed and is closed by clotting.
- Inflammatory phase: The body begins to repair itself but the wound may continue to bleed or produce drainage.
- Proliferative phase: New skin grows underneath the wound (this typically lasts a few weeks) and new blood vessels form in the new tissue.
- Maturation phase: The scab falls off the wound revealing new skin and scar tissue.
A wound becomes a chronic wound when it is unable to heal past the inflammatory phase noted above.
Types Of Wounds
There are 2 main types of wounds: acute wounds and chronic wounds.
Acute wounds are injuries that occur suddenly rather than over a period of time. They heal in a predictable way within an expected timeframe. Acute wounds are defined as either traumatic wounds or surgical wounds.
- Traumatic wounds - occur suddenly such as from the impact of a fall or an accidental cut and are classified by the object that caused the injury (e.g. abrasion, puncture, laceration, incision).
- Surgical wounds - occur when a deliberate incision is made in the skin which is then closed with material such as sutures or staples or left to heal naturally. They are classified according to their potential for infection (e.g. clean, contaminated, dirty).
A chronic wound is an acute wound that has failed to heal within the expected timeframe for that type of wound. Proper treatment of wounds in the early phase coupled with ongoing care and attention may prevent wounds from becoming chronic.
Chronic wounds require longer-term management and they may be susceptible to recurring. Some common types of chronic wounds include:
- Ischemic wounds: These wounds are often found in the lower body. The periwound skin near these wounds may feel colder because of decreased blood flow which affects normal skin functioning and hair growth. Ulcers are the most common type of chronic wound that results from inadequate blood flow and include arterial ulcers, venous ulcers, diabetic ulcers, and pressure ulcers. It’s important to speak with your doctor about ulcer prevention measures.
- Infectious wounds: These wounds may be very painful, swollen or inflamed. They may have a strong odor and/or create pus.
- Radiation poisoning wounds: This wound is caused by skin that is “burned” by radiation usually during radiation therapy for cancer. The periwound skin may be irritated and inflamed with itching or blistering skin.
- Surgical wounds: These are wounds caused by surgical incisions that do not heal due to poor blood flow to a wound or because of a wound infection. As a result, these wounds may become chronic wounds.
Other less common wounds include pressure sores, pressure injury, devitalized tissue in the wound area, granulation tissue in the wound area, moisture-associated skin damage, decubitus ulcers, and fungating wounds.
There are a number of factors that predispose seniors to chronic wounds. Aging skin loses its natural ability to repair resulting in slower healing and rejuvenation following an injury. In addition, accidents leading to wounds are more likely to occur in older adults due to a loss of mobility and more issues with core strength and balance.
Decreased skin elasticity and other underlying conditions such as diabetes all contribute to a slower recovery time in seniors. Since skin becomes thinner as one ages, cuts that heal quickly in younger people may take much longer to heal in the elderly.
Effects Of Wounds On Older Adults And Caregivers
Effects On Older Adults
Individuals suffering from chronic wounds such as ulcers report a lower quality of life. Wounds can make many daily activities such as climbing stairs or taking a shower much more challenging. Due to the complex care needs associated with managing chronic wounds, older adults may find themselves forced to spend extended periods of time resting at home or in a nursing facility. Limited mobility due to chronic wounds not only impacts an individual’s emotional well-being but increases the risk of further health care complications such as pressure ulcers.
A wound may dramatically reduce the mobility of an individual living in their own home. Fear of making the wound worse may also be a restrictive factor on mobility. This may lead to a negative effect on overall health as an individual is less inclined to exercise and potentially less motivated to eat well and take care of themselves as they did before the wound occurred. Individuals may also suffer from fatigue due to wound pain which prevents quality sleep.
A wound may also be a socially isolating experience, especially if the wound has a foul odor. Individuals may feel ashamed and seek solitude to avoid embarrassment. Low self-esteem is not uncommon among individuals with chronic wounds. In addition, being dependent on outside support for care can leave wound sufferers feeling depressed, helpless, and isolated.
Chronic conditions such as diabetes also cause slower wound healing in individuals resulting in another potential source of stress for the wound sufferer. Negative emotions such as stress and frustration have also been shown to delay wound healing as well.
Effects On Caregivers
For caregivers who are helping a family member who needs skin and wound care, the impact on their time and mental well-being may cause stress and frustration as well. An individual with a wound may require regular trips to the hospital, daily skin and wound care products, and support in completing activities of daily living (ADLs). The time-consuming nature of such care can feel like a heavy burden for a caregiver to bear.
Caregivers may feel overwhelmed when faced with the complexity of their role, especially if wounds are to be dressed and cared for at home. Increased responsibility for the welfare of their family member can put undue pressure on the caregiver providing care.
Caring for a family member without the ability to relieve their pain can be an emotionally stressful experience for caregivers who want to ease their family member’s suffering. Helping treat a wound that an individual finds embarrassing or shameful can also put considerable strain on the relationship between caregiver and their family member. The caregiver, especially if they are the child of the sufferer, may feel uncomfortable in their new role and struggle to adapt to their parent’s dependency.
Wounds And Long-Term Care Support
There are a number of organizations that offer support and information to individuals with wounds and their families including:
- The Wound Healing Foundation: An online community and support group for those with wounds and their families.
- Wound Care Centers: A tool for locating wound care products and specialists in your area.
- Wound Source: An informative site containing wound care guides and suggested products to treat them.
Short-Term Care Needs
Wounds do not always require round-the-clock care. Considering how your family member’s care condition can be managed independently, with family assistance or through home care may help to preserve their autonomy for as long as possible. The more your family member feels like they are able to lead a normal life, the greater their well-being is likely to be which puts less strain on family members in the caregiving role.
If an individual with a wound does not have a family member who can help them with their personal care needs, home care services may be employed to provide this care. Home care services can range from daily scheduled drop-ins to one’s home to round-the-clock assistance if needed which makes it a good option for individuals and their families needing flexible care services.
You can support a family member with a wound by helping them follow the advice of their physician, encouraging them to take any prescribed medication, and helping them to keep the wound clean and dressed. Most wounds will need to be assessed regularly to ensure they are healing properly. Helping your family member keep medical appointments concerning the wound can be a key part of their recovery.
Physical activity has been shown to improve wound recovery time in seniors by up to 25% so encouraging your family member to engage in some physical activity may speed wound healing. Similarly, proper nutrition including a diet high in protein has a beneficial effect on how quickly a wound heals.
If you cook for your family member or are able to support with grocery shopping, highlighting the importance of this in regards to wound care may be valuable. If you are concerned about the diet of your family member who has a wound, it may be worth consulting a nutritionist who can help establish a diet specific to wound healing to support their recovery.
In order to help your family member adapt to life at home with a wound, it may be worth exploring rehabilitation services available in your area. Dieticians, therapists and nursing professionals can help to ease the transition home after initial wound care in a hospital setting.
Long-Term Care Needs
There are many considerations when planning long-term care for a family member with a chronic wound. Individuals tend to find higher levels of satisfaction living in their own home since this permits greater autonomy and independence in one’s daily life. However, this needs to be balanced against the financial and emotional strain that this may place on caregivers and the risk that this may damage the relationship between the caregiver and their family member.
Caring for a family member can be a generous, life-affirming decision. As a caregiver, it is important to maintain and monitor one’s own well-being as well. Use of respite care from time to time can help prevent caregiver fatigue and burnout and ensure a caregiver is emotionally and physically able to provide ongoing care.
Another care option for wounds is palliative care. The focus of palliative care for wounds is on preventing infection, relieving pain, and controlling odor. These measures may potentially promote wound healing while taking the pressure of caring for a family member with a wound off family members.
In some cases, living independently may become unmanageable for individuals with wounds. Requiring mobility assistance, not wanting to be a burden on family members, and the desire to make social connections are examples of when it may be time to consider moving out of one’s home into another form of accommodation.
Assisted living provides individuals and their families with the peace of mind that help will always be available while enabling individuals to continue living with as much autonomy as possible. Individuals live in communities with access to care staff without being restricted to a nursing home lifestyle or timetable.
If your family member requires minimal assistance but you foresee that their needs may change over time, continuing care retirement communities (CCRCs) have the flexibility to accommodate residents without requiring individuals to move to a new location if their needs change. This can be a good option for individuals with wounds who have other health conditions as well such as diabetes or dementia.
In the event that your family member requires constant care and monitoring, a nursing home may be the best option. Nursing homes provide 24-hour care and support as well as assistance with ADLs.
Identifying The Right Care Provider
In some cases, however, long-term care will be the right option. If this is the right decision for your family member, it is essential that your family member be at the forefront of the decision making process.
Before visiting any care providers, discuss with your family member what their needs are and what they would like from long-term care. How often will they need help? What do they need help with? What aspects of life can they not live without? Equipped with this information, it will be easier to begin researching and shortlisting long-term care options in your area.
A nursing home that is well-equipped to manage the needs of your family member will have a chronic wound care plan in place. Be sure to ask about wound care with all potential care providers to ensure they are able to meet the specific the needs of your family member.
While it is essential that a care provider has an established wound care plan, they should also be able to reassure you that they can provide for the emotional and social needs of your family member.
How do they combat the possible feelings of isolation experienced by individuals with chronic wounds? Are there accessible social activities that your family member will be able to attend? How will they support them in living as fulfilling a life as possible?
Because nutrition and exercise are also key to promoting wound recovery as noted earlier, explore what potential care providers offer in these areas as well.
When patients are actively involved in caring for their wound, their sense of wellbeing increases. Seeking out a provider willing to work with your family member will therefore likely result in an enhanced sense of self-control and well-being. Ultimately, choosing the right provider for your family member comes down to which fits best with their needs and preferences. Be sure to take enough time to explore the different care options available before committing to one.
Be sure to check that the care providers you are considering have been recognized by the state or other regulatory body for the quality of care they provide. You might find it useful to begin your search with the Eldercare Locator online search.
Caring for a family member in their own home or through long-term care providers can be costly. Knowing what financial options are available to assist with expenses can help reduce the stress associated with caregiving and help you plan for your family member’s future. There are a number of different ways to pay for long-term care, both through insurance and private pay.
Individuals who have a Medicare policy have coverage for initial treatment in hospitals and a limited period of rehabilitation. If a wound requires a patient to have a wheelchair or other mobility aid, this is usually covered within Medicare.
While Medicare does not cover long-term care costs, those eligible for Medicaid will be able to use this to pay home care or residential care providers. If an individual or their spouse is eligible for the veterans aid and attendance benefit, this may also be used to fund rehabilitation services or long-term care. For additional expenses, such as respite care, family savings or short-term loans could be used to cover the cost.
If your family member has long-term care insurance, this is an effective method to pay for home care or long-term care expenses. In these plans, a pre-agreed amount can be taken out on a regular basis to finance home care, assisted living or nursing home care.
Outside of traditional insurance routes, there are other options to finance long-term care. For example, it is possible to convert an existing life insurance policy into a long-term care coverage plan. By doing so, an individual receives monthly benefit payments that they may then use to pay for their long-term care needs. This type of plan may be used to fund home care, assisted living, community living services and nursing homes.
Home equity loans are another potential source of funding for long-term care. When accessing funds through a home equity loan, an individual is told upfront the maximum dollar amount they may borrow which is usually no more than 85% of the equity in their home (or a percentage of the amount that has been paid on the mortgage). This is followed by a ‘repayment period’ of typically 5-15 years.
The borrowed amount may be paid back in a lump sum by selling the house or over a given period of time. This method allows an individual to retain ownership of their home even if they choose to move into a long-term care facility. Home equity loans can be effective in helping individuals access some of the equity in their property to pay for their long-term care needs.
Reverse mortgages allow individuals to access funds in monthly installments or as a lump sum and these funds are secured against the value of their home. Unlike home equity loans, a reverse mortgage does not have to be repaid until the remaining owners have moved out of the home making this a more flexible option to cope with the unpredictability of long-term care.
Reverse mortgages can also be used to pay family members for care which may enable the family to assume the role of full-time caregiver and rather than paying for outside assistance.
If an individual is considering ways to use a property to maximize their care options, it may be worth exploring the possibilities of trusts or a “Lady Bird deed”. When a grantor (an individual with property) places property into a trust, it is then managed by a trustee (which can be the grantor or another trusted individual). Funds can then be leveraged for the benefit of the grantor and are more easily accessible than through a traditional Last Will.
Many of these methods allow families to take control of their assets at an earlier stage and manage their affairs with greater privacy. It may also provide peace of mind knowing that in the event that the trust holder should become incapacitated for any reason, there is a legal structure in place to allow a family member to take over the management of the trust in their name.
Long-Term Care For Wounds FAQs
1. Why isn’t my wound healing?
Wounds may have difficulty healing for a number of reasons, particularly in the elderly. A lowered immune system and more fragile skin can slow down the body’s natural healing capacity. Poor circulation and restricted blood flow to the affected periwound area can also inhibit normal healing times. A lack of nutrients and poor diet can reduce the body’s ability to create the proteins it needs to heal a wound. Infection and inflammation are also common causes of non-healing wounds.
2. What’s the best thing I can do to take care of a wound?
Ideally, an individual who wants to heal their wound as quickly as possible may want to consider a number of lifestyle changes. Stopping smoking, eating a healthy diet of plenty of protein, green vegetables, and some fruit, and managing one’s weight all play a role in helping chronic wounds heal faster.
3. What happens at a wound care appointment?
Chronic wounds typically need to be cared for over a long period of time so any meetings with health care professionals will be geared towards putting plans in place to help your family member take care of their wound. Blood tests and a medical history may need to be completed to establish the best course of care.
4. When is it time to look for long-term acute care for my family member?
Only you and your family member will know when long-term acute care is the right decision. It could be that your family member requires assistance many times throughout the day or they may require a level of care that a family member is unable to provide. If your family member feels unsafe in their own home or unable to care for their wound alone, outside assistance may be necessary to ensure they are getting the care they need. If a periwound area is preventing your family member from performing ADLs, it is time to consider other care options.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.