Chronic Wound Crisis

Elder Care Issues

Medicare and Managing Chronic WoundsIncreased age is a major risk factor for impaired wound healing.

Chronic wounds are a major world health problem. In the United States alone chronic wounds affect more than 6.5 million patients with an excess of $25 billion being spent annually on treatment, according to the National Institutes of Health. Those numbers are rapidly growing due largely to an increase in health care costs, an aging population, and a dramatic rise in the incidence of diabetes and obesity.

A Health Care Burden

The care of chronic wounds, in particular diabetic ulcers, pressure ulcers, and arterial ulcers, places a significant burden on the patient and the health care system. Although billions of dollars are spent each year on the treatment of chronic wounds, many of these wounds don’t heal in an appropriate timeframe. The longer it takes for a wound to heal, the greater the likelihood of dangerous complications such as infection, bacteremia, and sepsis, which often lead to amputation and death. More than 185,000 new amputations are performed each year in this country, with the prevalence rate highest among people age 65 and older.

A Look at Three Common Wound Types

*Diabetic ulcers: Nearly 10 percent of the population has diabetes, and 600,000 diabetics get foot ulcers every year, according to the American Diabetes Association. Cost for treatment ranges from up to $8,000 for a slow-to-heal ulcer to up to $17,000 if it gets infected. And that’s just for one ulcer. Many diabetic patients suffer multiple ulcers. The majority of nontraumatic amputations in this country are due to complications from diabetes.

*Pressure ulcers:  The number of hospital patients who develop pressure ulcers has risen by 63 percent over the most recently reported 10-year period, according to the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ), with nearly 60,000 deaths occurring annually from hospital-acquired pressure ulcers. The average length of stay in the hospital for treatment of a pressure ulcer is 13 days. The estimated cost of managing a single full-thickness pressure ulcer is as high as $70,000, and the total cost for treatment of pressure ulcers in the United States is estimated at $11 billion per year.

*Arterial ulcers: Arterial and venous leg ulcerations affect up to 1 percent of people at some time in their life, reports the National Institutes of Health. Twenty percent of people with leg ulcers have arterial disease. Peripheral artery disease, the circulatory disease commonly associated with non-healing wounds, affects about 8 million Americans and up to 20 percent of Americans age 65 and older.

At-Risk Population

Increased age is a major risk factor for impaired wound healing, according to the World Health Organization, and the senior population is growing faster than any other age group. Seniors with conditions such as diabetes, cardiovascular disease, or obesity, or who suffer from limited mobility, are especially at risk for developing these types of hard-to-heal wounds.

Chronic wounds can take months or even years to heal and some never fully do. That’s why it’s important to understand how to prevent them – and to detect and treat wounds early on before they become a serious medical issue.

Specialized wound-specific prevention, early treatment, and management services minimize the incidence and severity of chronic ulcers and should include:

  • Skilled observation and assessment
  • Management and evaluation of patient care
  • Wound assessment, treatment and instruction
  • Anodyne therapy to treat diabetic neuropathies
  • Dressing changes
  • Negative pressure wound dressings
  • Specialty physician ordered wound dressings
  • Medication management
  • Ostomy care and education
  • Skin integrity assessment
  • Monitoring of acute conditions
  • Nutrition assessment and instruction
  • Pain management, assessment, and instruction
  • Restorative therapy (physical, occupational, and speech)
  • Medical social services
  • ADL assistance