Each wound requires treatment unique to the patient. In situations involving long-term care or nursing home settings, chronic ulcers require a lot of attention from medical staffs, and the treatments are expensive. Pressure ulcer care costs more than $3 billion a year to Medicare alone (excluding private pay, Medicaid, and other payers), and wound care costs are rising as the elderly population grows and prevalence of chronic diseases such as diabetes increase.
The cost of treating wounds rises the longer wounds are not actively managed. Chronic wounds, which are defined as wounds that have “not resolved over a reasonable period of time no matter the cause…and do not progress through the predictable stages of wound healing,” include diabetic ulcers, pressure ulcers, venous insufficiency ulcers, surgical sites, arterial, burns, dermatitis, vasculitis, and radiation [1]. Chronic wound care costs are estimated at over $25 billion annually, according to a study published in 2009 by The Ohio State University Comprehensive Wound Center [2]. Neglected wounds cost more money to treat, as the physiology of wounds is that “fresh” wounds heal quickly, but “old” wounds heal because “old” cells do not regenerate as quickly [3]. Furthermore, some skin ulcers can carry hidden costs. Pressure ulcers are always one of the top two reasons for lawsuits in long-term care (the other being falls). Preventing avoidable pressure ulcers and proactive wound management means preventing litigation and settlements that pose an existential risk to long term care providers.
When a provider such as a nursing home allows patients to develop wounds like pressure ulcers, they are required to publicly disclose each incident, which can damage their reputation with valued providers of patient referrals such as acute hospitals and home health care agencies, which are the lifeblood of metropolitan nursing home providers.
To prevent negative outcomes, a comprehensive wound care plan is necessary. Staff members need to be able to rapidly diagnose wounds, coordinate patient amongst the care team, and proactively change the treatment if the current plan of care is not healing the wound. In some elderly patients, wounds may tragically take years to heal and in some cases, never heal. Constant communication with families and thorough, accurate documentation is a critical to avoid litigation and damage to an organization’s reputation.
[1] Nancy Broderick RN, CWOCN, CFCN, MSN, FNP-C, The Nurse Practitioner: The American Journal of Primary Health Care, October 2009, vol. 34, # 10, pp. 16 – 22.
[2] Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, Gottrup F, Gurtner GC, Longaker MT, Human skin wounds: a major and snowballing threat to public health and the economy, Wound Repair Regen. 2009 Nov-Dec;17(6):763-71. doi: 10.1111/j.1524-475X.2009.00543.x.
[3] ibid., Broderick
[4] ibid., Broderick
