Interestingly, in the 12+
years of working on Assisted Living Directory, I've rarely heard
or seen the the words 'wound care' in articles, facility marketing
materials, or spoken by professionals in the industry.
Most often, you'll hear about the big ones, such as Alzheimer's or memory care.
What I think might be often overlooked
is with many of these seniors and care home residents, there is
a significant percentage of
them who are bedridden most, or all of every day. This can, without
proper preventative measures, lead to wounds, pressure ulcers
and other issues.
Our interview with Renee Cordrey,
a member of the Board of Directors of the AAWC explains what their
association does, and a little bit about it's history and mission.
Our interview also sheds some light on the importance of wound
care awareness with seniors, and what caregivers and the senior
care industry can do to prevent wounds, and how to handle them
should they occur.
with Renee Cordrey, Board Member for the AAWC:
tell me about the Association for the Advancement of Wound Care
(AAWC), how long it has been in service, and a little bit about
it's history, growth and mission.
A: The Association
for the Advancement of Wound Care was conceived in 1995. It is
the preeminent, multidisciplinary organization dedicated to the
research and clinical application of evidence – based wound
care. As a not-for-profit association, AAWC gives numerous benefits
to build a collaborative wound care community for optimal care
of those who suffer with chronic non-healing wounds. The Association
for the Advancement of Wound Care (AAWC) exists to be the leader
in interdisciplinary wound healing and tissue preservation.
We now offer free memberships for
people living with wounds and their caregivers, though our WIN
(Wounds in Need) program. (http://aawconline.org/benefits-of-patientcaregiver-membership/)
my interest in what you do revolves around seniors, and senior
care. We all know that bedridden seniors are more prone to tissue
deterioration, and pressure ulcers. Interestingly, in all of my
time working with our site Assisted Living Directory, wound care
is rarely mentioned on facility listings, or in conversation.
Most families don't think to ask about this either when they are
researching facilities. Why do you think this is?
A: There is a
significant lack of awareness about wounds, even
though more people have wounds than have cancer.
Therefore, families don’t even think about the risk of skin
issues such as pressure ulcers (bed sores) and skin tears. It’s
not in the “top 10” concerns they may have about needs
their loved one may have.
Facilities might chose to not admit
people with existing wounds because the wounds may be complex
or require a lot of nursing time to manage, and the ALF may not
have the expertise in-house. Because people in assisted living,
in general, are more active than those in long-term care, they
are less likely to develop skin problems such as pressure ulcers,
but they are not unheard of.
Do you think that the senior care industry, at this time, is adequately
knowledgeable about wound care, and issues, and do you think that
most senior care homes and facilities, in general, are adequately
trained and prepared to handle these issues?
A: Overall, across
all areas of health care and senior care, there is a general lack
of awareness of the problem of wounds, how to prevent them, and
how to manage them. Many assisted
living facilities do not have wound specialists on staff,
and may not have the resources available to treat chronic wounds.
However, home health agencies, in-house rehabilitation departments,
or outpatient wound clinics might be utilized to provide the care
needed for residents who have wounds.
What are some steps that families, caregivers and the general
population can do to prevent wounds (with themselves, or perhaps
an aging loved-one) from occurring in the first place? Is prevention
is indeed key to preventing many of the skin problems facing older
adults. The AAWC has resources to help people and their caregivers
learn more about wounds, how to prevent them, and how to manage
them. They can be found on the AAWC’s Patient/Caregiver
Resources page. http://aawconline.org/wound-patientcaregiver-resources/.
Of particular interest may be the pamphlets of the ABC's of Wound
Care, Take the Pressure Off, and The Skin You’re In.
As mentioned above, people who
are bedbound are at higher risk for pressure ulcers (bed sores).
Moving around in bed and changing position often is important
to change where the pressure is concentrated. This might take
the form of a caregiver helping with the repositioning, but the
person might become better able to do it himself with the help
of physical therapy to gain the skills, strength, and knowledge
necessary. For those at even higher risk, special mattresses or
overlays might be appropriate. Consulting with a wound specialist
can help determine when that is necessary, and what type of surface
would be appropriate, as there are many different categories of
common in ALFs are people who sit in wheelchairs, or other chairs,
much of the day. People sitting should take the
weight off of their “sit bones” in their buttocks
and their tailbone frequently. This might be achieved by a chair
push-up, a lean to the side, or a forward lean several times an
hour. Those with less physical ability may benefit from a chair
that will change the position when a switch is activated. A physical
therapist or occupational therapist can help make sure a wheelchair
is the correct size (which should be done before the chair is
ordered), that the person has an effective strategy to shift their
body weight, and that an appropriate cushion is chosen for the
chair. For those who use the wheelchair for longer distances but
can walk short distances, encouraging continued activity instead
of sitting will help not only the pressure ulcer risk but overall
health. Additionally, physical therapy may help improve overall
mobility, so that a person may be able to walk more and use the
Other types of wounds may be present
in ALFs. People with circulation problems in the legs can get
ulcers (venous or arterial ulcers). These should be managed by
a wound care specialist (physician, nurse, PT, or podiatrist,
for example). Avoiding trauma to the legs can reduce the risk
of a new sore forming if a circulation problem exists.
People with diabetes are at greater
risk for foot problems, including wounds. Anyone with diabetes
should see a podiatrist regularly for foot and nail care. Foot
hygiene, daily foot exams, and the choice of shoes all help prevent
these wounds from happening. The US Department of Health and Human
Services has educational materials on diabetic foot care available.
Do you believe there could be more awareness about wound care,
and what do you believe is the best way to spread awareness about
wound care, pressure ulcers, and the like to families with aging
loved ones, and throughout the senior care industry?
A: There is definitely
a need to increase awareness among the public and the media, and
the AAWC is working on this challenge.
Sometimes pressure ulcers are the
focus of attention because they are seen as an indicator of the
quality of care, are closely monitored by many states, and influence
Medicare payment to facilities. However, other types of wounds,
such as diabetic foot ulcers, venous ulcers (leg wounds caused
by poor circulation out of the leg), and arterial ulcers (wounds
caused by poor circulation going into a leg), also occur in older
adults, even those who are active. They are sometimes overlooked,
but must be considered as well.
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- Interview by David