Long-term care residents are generally elderly, frail individuals who are vulnerable to the development of pressure ulcers due to immobility, presence of comorbidities, and nutritional factors. In 2004, 11% of nursing home residents had pressure ulcers. The incidence is higher in patients who are immobile (16% vs 11% for mobile residents). [1] Given the high incidence of chronic wounds in elderly patients, the importance of effective wound care in long-term facilities to promote wound healing cannot be understated. A comprehensive wound care program in long-term care facilities is important due to the following reasons:

Elderly Individuals Are Prone To Chronic Wounds

In the United States, around 1.3 million people are residents in long-term facilities as of 2015. [2] With the increase in the aging population, the number of residents in long-term care facilities is only expected to increase. Older individuals are especially vulnerable to the development of chronic wounds due to age-related changes which highlight the need for an effective wound care program in the nursing homes and long-term care facilities. 

There are several reasons for delayed wound healing in the elderly population. Old age is associated with the presence of multiple comorbidities and risk factors that contribute to wound chronicity. Some of these include diabetes mellitus, cardiovascular disease, poor nutrition, impaired mobility, and deteriorating cognition. The concept of "skin failure" is recently being introduced in wound care. It describes the failure of skin to perform its normal barrier function, and as a result, leads to susceptibility to bacterial invasion. [3] The geriatric population is especially susceptible to skin failure and subsequent development of pressure ulcers. In addition to pressure ulcers, the other common types of ulcers in nursing home residents include venous ulcers, arterial ulcers, and neuropathic ulcers. 

Wounds in the elderly take considerably more time to heal and are more prone to complications. Therefore regular wound care under the guidance and supervision of a podiatrist or wound care specialist is critical in long-term care facilities.

Timely Wound Care Can Help Avoid Complications 

Diabetic foot ulcers are a leading cause of amputations worldwide. Moreover, due to the lowered immunity in elderly individuals, chronic wounds are particularly susceptible to infections. The proximity of other individuals in the long-term care facilities allows for the rapid spread of infection. Chronic, infected wounds are a significant physical and psychological burden to the patient and impair the patient's quality of life. [4] They also increase the likelihood of death. Therefore, long-term care facilities need to ensure effective wound care. 

Regular screening and follow-up with a podiatrist and wound care specialists can help avoid wound complications. An accurate and timely assessment and management of the wound allows the wound to heal with minimal scarring. It also limits the potential disability associated with complicated chronic wounds.

Residential Wound Care Can Be Cost-Effective 

The presence of a specialised wound care team in a long-term care facility does not only have improved patient outcomes, but also helps to significantly reduce the costs associated with wound care. In the absence of a dedicated wound care team, deteriorating wounds are not picked up readily which can contribute to complications. Moreover, limited knowledge of staff regarding wound care can be detrimental to patient well-being and lead to the application of unsuitable treatment practices.

The reliance on outpatient wound care facilities can be a feasible option in the absence of a trained wound care staff. However, the majority of residents in long-term care facilities are immobile and regular visits to the wound care center can become costly. In addition, a dedicated wound care specialist team within a long-term care facility is better able to monitor the patient's progress and address various risk factors. In addition, patients experience relatively less stress and are provided effective wound care within their environment. A long-term care facility that implemented a residential wound care program observed a noticeable reduction in the prevalence of pressure injuries and wound care associated costs. [5] Therefore, the presence of a structured, comprehensive wound-care program can be beneficial both from an economic standpoint and for the patients' well-being. 

Wound Care Is A Quality Indicator For Long-Term Care Facilities 

Provision of effective wound care to residents is a legal obligation for long-term care facilities. Failure to meet the required standards of wound care can result in F-tag penalty. F-tag refers to the specific regulations in the Code of Federal Regulations that specify the standards for nursing homes and long-term care facilities. 

Ensuring proper documentation and wound care to the residents is critical for long-term care facilities to avoid the legal repercussions. Federal legislation requires all long-term care facilities to meet the highest standards of wound care provision to its residents. Despite best efforts, certain wounds are unavoidable and deteriorate. However, standards of wound care should be ensured by all long-term care facilities to improve patient outcomes and avoid legal repercussions.

References:

1. Park-Lee E, Caffrey C. Pressure ulcers among nursing home residents; United States, 2004.
2. Nursing home care. (2021, March 1). Cdc.Gov. https://www.cdc.gov/nchs/fastats/nursing-home-care.htm
3. Levine JM. Skin failure: an emerging concept. Journal of the American Medical Directors Association. 2016 Jul 1;17(7):666-9.
4. Woo KY. Chronic wound-associated pain, psychological stress, and wound healing. Surgical technology international. 2012 Dec 1;22:57-65.
5. Xakellis Jr GC, Frantz RA, Lewis A, Harvey P. Cost-effectiveness of an intensive pressure ulcer prevention protocol in long-term care. Advances in wound care: the journal for prevention and healing. 1998 Jan 1;11(1):22-9.