Bedsores, also known as pressure ulcers, are a common problem for people with mobility issues. Prolonged pressure can cause injuries to the skin and underlying tissue. Aside from discomfort, bedsores can lead to serious complications, including cellulitis, bone and joint infections, squamous cell carcinoma (cancer), and even sepsis. People who use a wheelchair or are confined to bed should make prevention and treatment of bedsores a priority in their care.
Who is at risk?
Most people who get bedsores have a medical condition that limits their ability to change positions frequently. Immobility can be caused by a number of medical conditions, including spinal cord injury or coma. Neurological disorders can result in a lack of sensory perception that can contribute to pressure ulcer and poor nutrition and dehydration, as well as medical conditions, such as diabetes and vascular disease, can increase the breakdown of tissue.
People who use a wheelchair often develop bedsores on the tailbone, buttocks, shoulder blades, spine, and the backs of their arms. Those who are confined to a bed commonly get bedsores on the back or side of the head, shoulder blades, hip, lower back, tailbone, heels, ankles, and the skin behind the knees.
Preventing Pressure Ulcers
Even if a patient is confined to a wheelchair or bed, there are some ways to help prevent bedsores:
- Shift your weight often (reposition every 15 minutes)
- Use cushions or a mattress designed to relieve pressure
- Lift yourself up if possible
- Elevate the head of the bed to avoid sliding
Comprehensive treatment of bedsores will involve a team of medical professionals who should work together to treat and heal your bedsores. The team may include:
- A primary care physician who will diagnose the wound and oversee the treatment plan
- A nurse or medical assistant to help care for the wound, manage pain, and prevent infection
- A physical therapist to work with the patient to improve mobility
- An occupational therapist to make sure appropriate seating surfaces are in use
- A dietitian to create a plan to improve nutrition and hydration
- A neurosurgeon to address problems with sensory perception
- Social worker to provide resources for you and your family members to address long-term recovery
Treatment options will vary depending on the stage of the wound and can include:
- Over-the-counter medications, such as Advil, Motrin, or Alleve
- Topical or oral antibiotics to fight infection
- Negative pressure therapy (vacuum assisted closure)
- Clinical trials
Medicare Insurance for the Treatment of Bedsores
Care in a Hospital
Medicare Part A will help cover costs of care for bedsores if you are an inpatient in an acute care hospital, skilled nursing facility, inpatient rehabilitation facility, or long-term care hospital. Medicare Part A will help cover:
- General nursing
- Drugs as part of your inpatient care
- Services and supplies necessary for your care
You will qualify for these Part A benefits if:
- A doctor signs an official order stating you have a medical necessity for 2 or more midnights of care
- The hospital formally admits you
- You need care that can only be given at a hospital
- The hospital accepts Medicare
- The Utilization Review Committee of the hospital approves your stay
If you have Original Medicare, you will pay a $1,340 deductible for each benefit period. From Day 1-60, you have no coinsurance. From Day 61-90, you will pay $335 in coinsurance per day of each benefit period. Beyond Day 91, you will pay $670 coinsurance per each “lifetime reserve day” after Day 90 for each benefit period (up to 60 days over your lifetime.) Beyond your lifetime reserve days, you will be responsible for all costs.
Care in a Doctor’s Office
If you are being treated at your physician’s office or as an outpatient, Medicare Part B may help cover the cost of your care for bedsores or pressure ulcers. As long as you visit a doctor or medical provider who accepts assignment, you will likely pay 20% of the Medicare approved amount and will be responsible for the Part B deductible.
Home Health Care
Medicare Part A and Part B may help cover home health care services such as part-time or intermittent skilled nursing care or home health aide care, physical therapy and occupational therapy as long as you meet certain conditions. You will be eligible for home health aide care coverage if:
- You are under the care of a doctor who has designed a care plan and reviews it regularly
- Your doctor must certify that you need intermittent skilled nursing care, are homebound, or you meet specific criteria in regards to physical therapy or continued occupational therapy.
If you are enrolled in a Medicare Advantage plan, you will have at least the same benefits as Original Medicare. Most MA plans offer additional benefits and an annual out-of-pocket maximum.