Dealing With Pressure Ulcers at End of Life by Home Care and Hospice Clinicians

Usually it is seen in end-of-life patients that they suffer from pressure ulcers.In such a situation it is required to provide home care to the patients typically focusing on the comfort measures. Making an informed choice about home care will enable hiring skilled clinicians who can deal with the significant challenges in such medical conditions to heal and even prevent these wounds.

However, there are multiple comorbidities to consider as well as different other factors such as:

  • The age of the patient
  • Malnutrition if any
  • Compromised mobility which is very common in aged patients and even
  • The rights of the patient and their family.

In the medical field it is often said that prevention is the best strategy for a cure and therefore whenever possible you should try and prevent such issues from occurring. However, in some cases, it may be impossible to avoid pressure ulcers from developing no matter how hard you may try.

Need to hire a home care agency

In such circumstances it is therefore important to hire and introduce home care clinicians. This will help in many different ways such as:

  • Proper assessment of the condition of the patient
  • Proper and timely care
  • Use of proper tools and medication as and when required
  • Assisting patients and
  • Identifying and assessing the degree of risk of the patients.

This will enable you to know about the wounds that are likely to heal and those that will not.

Choosing the right home care agency

Easier said than done, choosing a reliable and reputable home care agency will need you to find one that has carefully designed and developed agency policy and procedures.

  • This should reflect a more holistic and well-integrated approach to ensure palliative wound management for the aging population.
  • This policy should also be centered around the patient requirements that may vary from one to the other as well as the family goals.

Ideally, the home care agency and their policy both should promote quality of treatment, care as well as life for the patient and at the same time they must ensure that they maintain wound bed stabilization.

Therefore, take your time and research well about the home care agencies before you make any final decision. Better even, look for reliable sites like and others only so that you do not put the life and health of your loved ones in the hands of an inexperienced, irresponsible and uncaring clinician. A little effort now will provide you with a lot of value for your money, trust as well as the life of the older and ailing member of your family.

Overview of pressure ulcers

An overview of the matter will make things as well as the need for a reliable home care agency clearer to you.

The pressure ulcers are defined and characterized by The National Pressure Ulcer Advisory Panel as:

  • A localized injury to the skin
  • It can also be a result of an injury to the underlying tissue normally over a bony prominence
  • It is a result of pressure or a combination of pressure and shear and friction.

They further explain that these pressure ulcers are developed due to the sustained pressure on the specific areas that support the body. This pressure eventually results in restricted blood flow. That means these areas will experience a lack of oxygen and eventually lead to different medical conditions such as:

  • Cell death
  • Ischemia and
  • Tissue necrosis of the skin in these areas as well as the underlying structures.

There are different stages in which pressure ulcers are classified according to the visible layers of the damaged tissue from the surface of the skin toward the bone. Other stages are unstageable stage and deep tissue injury stage.

The incidence, as well as the prevalence rates of pressure ulcers, may vary due to different factors such as:

  • The patient population and
  • The clinical setting.

Though the exact figures are unknown, a survey found that the prevalence of pressure ulcers are found most among the hospice population which ranges from 14% to 28%.

When the wounds are severe it becomes really hard to manage which is when you will need a skilled home care clinician as well as more frequent skilled nursing visits. They will relieve you, the patient and your family from the significant burden of providing substantial caregiver time. Add to that, the human cost in pain and suffering, as well as the reduced quality of life, makes the situation even grimmer and grave warranting for such skilled services.

Change in the conception

Until recently, most people carried this common misconception that pressure ulcers can be prevented with the simple application of cautious staff interventions. However, now people have started to recognize that it is the circumstances in which the patient lives or creates that leads to the development of these unavoidable pressure ulcers.

It is for this reason that according to a statement released by the NPUAP in 2010 it is required to follow these specific steps in order to avoid these so-called ‘unavoidable’ pressure ulcers. These are:

  • Develop a care strategy after evaluating the clinical condition of the individual patient
  • Consider the risk factors of the pressure ulcers
  • Define, identify and implement interventions that are consistent
  • Consider the needs and goals of the individual patient
  • Recognize and follow the set home care standards of practice
  • Monitor and evaluate the condition of the patient on a regular basis in order to adjudge the impact of the interventions and
  • Revised the approaches as and when required and considered as appropriate.

It is for this reason that the Centers for Medicare and Medicaid Services has interestingly issued special directives that has now become the foundation and norm of the majority of state healthcare regulations.

According to the directives that contains new and more detailed terminologies, it is now very easy to find out whether or not a pressure ulcer was avoidable or unavoidable especially in long-term health care facilities.

Therefore, home care facilities now have to follow this detailed guidelineto abide by theFederal Regulations for pressure ulcer prevention and treatment in home.

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