What to Know About Wound Care & How to Advocate for Your Loved One
A pressure wound can start in as little as two hours. That single fact surprises most families I talk to, and it's exactly why I wanted to walk through what wound care actually looks like in an adult family home, and what you can do to help protect your loved one.
Wound care covers a lot of ground. Surgical incisions, diabetic wounds, skin tears, pressure wounds (also called bedsores or pressure ulcers) all fall under this umbrella. It's not the most common issue we deal with, but it comes up often enough that I want families to feel prepared, not caught off guard.
What Counts as a Wound, and Where Do They Come From?
Some wounds arrive with a resident before they ever move into an adult family home, perhaps as result of a fall, insufficient care, or self-neglect.
These situations can look different depending on how they unfold: a fall at home that goes unnoticed for a day or two, a bra strap digging into the skin without anyone realizing it, or poor circulation that keeps someone from feeling a shoe rubbing against a heel or toe. Each of these can turn serious quickly, and often they require skilled nursing in a rehab setting, or even a hospital stay.
If hospitalized, they often will go to rehab prior to going to the AFH. Other times, they admit directly to the AFH with the wound already present. If you're in the middle of that process right now, I've written before aboutnavigating the hospital discharge process and what to expect along the way. Ideally, the wound is well on its way to healing by the time they're ready to move into an adult family home. But that's not always what happens. Sometimes the wound doesn't get the attention it needs in rehab, or the resident isn't making enough progress with physical or occupational therapy, and Medicare determines it's time to move them to a different level of care — wound or no wound.
So we often inherit wounds that started somewhere else, and the adult family home is left with the job of helping them heal.
What Do "Orders" Mean, and Why Do They Matter?
You'll hear the word "orders" a lot in this context, and it's worth defining plainly. Orders are specific instructions from a doctor spelling out exactly how a wound should be cared for: what type of dressing to use, and how often it needs to be changed. Without those orders, caregivers can't legally treat the wound.
Usually, home health is involved too. A nurse comes in once or twice a week to check on the wound and change the dressing. On the days home health isn't there, “delegated” adult family home staff handle it, following the same orders.
Here's something families should know: making sure those orders are in place before move-in is not the family's job. It's the Hospital discharge planner and the adult family home's responsibility to confirm clear orders exist before they accept a resident with an existing wound. If you're touring homes with a loved one who has a wound, that's a fair thing to ask about directly.
Why does this matter so much? Because wound care can't just pause. A wound can start deteriorating quickly, so any gap in care, even a short one caused by unclear or missing orders, can undo progress that took weeks to make.
How Does Wound Care Change Over Time?
Orders can shift as the wound improves or worsens, and that's actually a good sign that everyone involved is paying attention.
In the best case, home health is closely monitoring the wound alongside the adult family home provider. As it improves, home health will recommend a different treatment approach and get updated orders from the doctor. Sometimes that means the dressing only needs changing every three to five days instead of daily, for example.
If the wound isn't improving, that needs to reach the doctor quickly too. At that point, the next step might be bringing in a wound specialist, sometimes through an organization like United Wound Healing, or a trip to a wound clinic for debridement (a process where a specialist removes damaged tissue so healthy tissue can take over).
This is also one of the reasonsa home doctor can make such a difference for residents dealing with a wound. Home-visiting providers understand exactly how orders need to be written for an adult family home setting, so there's no back-and-forth delay getting a prescription corrected. Care moves faster, and the resident isn't left waiting.
What Should Families Watch For?
Ideally, families shouldn't have to manage the clinical side of wound care. That's what the adult family home, home health, and the doctor are there for. But there are simple, non-invasive things you can do every time you visit.
Take a look at your loved one's arms and legs. It doesn't need to be a full inspection, just a habit. A lot of residents wear long sleeves because they tend to run cold, so it may take a small nudge, like helping mom take off her sweater for a minute, to actually see the skin underneath.
Here’s a little tip for keeping an eye on your loved one: I always start with the feet when I do an assessment. If the feet and legs are well cared for, moisturized, and free of tears, that usually tells me the rest of the body is being looked after with good care too. A quick foot massage during a visit is a nice way to check in on that.
If you notice something and nobody has mentioned it to you, that needs to be addressed right away.
A Cautionary Story: When Good Intentions Get in the Way
I want to share something I've seen happen, because it's a real risk, and it usually comes from a place of love.
A daughter at a home I worked with insisted on taking her mother, who had significant wounds on her ankles and lower body, out several times a week. She'd take her to an outside doctor rather than the home-visiting physician, then out for errands and lunch. Unfortunately, the overall effect was keeping her mother seated in a wheelchair for hours at a stretch, without the regular position changes, restroom visits, and hydration and nutrition she would have received with her usual care.
Her mother's skin was already fragile and healing, and this pattern kept undoing the progress made in between outings. The loving daughter did not understand that keeping her mom out for hours was not beneficial for her. The wounds got worse, not better. The AFH didn’t know how much fluid or foods she was eating while out. Eventually, the adult family home had to give thirty days notice because they couldn't continue caring for someone whose family member wouldn't work with them on the care plan to manage her needs and wound care.
The takeaway isn't that outings are bad. It's that when a loved one is actively healing from a wound, sitting for extended periods, whether in a wheelchair or a car, can work against everything the care team is doing. There may be a better time and place for a long outing. While a wound is healing usually isn't it. And it's worth remembering that family involvement matters most when it works with the care team's medical expertise, not against it. Wound healing takes adequate fluids, extra protein and extra calories to rebuild tissue.
How Can You Advocate for Your Loved One Without Overstepping?
If you notice something concerning, don't sit on it. Bring it up with the caregiver on duty right away.
Most of the time, if something happens, a good caregiver will notify their supervisor immediately, and the adult family home should be calling you before you even have to ask. That's the ideal, and it's what you should expect. However, things can occasionally happen, like a skin tear from a resident trying to move independently, that a family member may be the first to notice.
If you find something on your own that nobody has mentioned, raise it as soon as you can. And if you ever feel like a provider isn't being fully honest with you, my advice is to have a direct, calm conversation first and try to understand what happened. Trust is hard to rebuild once it's broken, so it's worth trying to work through it together before assuming the worst.
Questions to Ask If Your Loved One Has an Existing Wound
If you're touring adult family homes with a loved one who already has a wound, a few direct questions can tell you a lot:
Have you cared for residents with wounds before, and are you comfortable working with a wound specialist if needed?
Are you able to reposition someone every two hours around the clock, if that's what's required?
Has the doctor ordered a specialty mattress for pressure relief, and is it currently in place and working properly?
These questions aren't confrontational. They're the kind of thing a good provider expects and welcomes.
Simple Ways to Stay Involved
If you're planning to take a loved one out for the day, especially if they're not ambulatory, it's worth doing a quick skin check together with the caregiver before you leave. Look at the skin, make sure everything is clean, and apply barrier cream if that's part of their routine. It only takes a few minutes, and it means both of you know the skin was in good condition when you left.
If you do go out, try to help your loved one to the restroom before you leave the AFH. Take a clean diaper and wipes with you in case of accidents. Once you return, toilet the resident together with the AFH staff to ensure all skin is intact.
Wound care can feel like a lot to take in, especially if it's new to you. But you don't need to become an expert. You just need to know what to watch for, who's responsible for what, and how to speak up when something doesn't look right. That's really what advocating for your loved one comes down to.
I’m here to help.
If you're navigating a placement for a loved one with an existing wound, or you just have questions about what to expect, I'm happy to talk it through with you.
