Wound care at home: what to expect from the visiting nurse
How wound assessments work, what supplies Medicare covers, dressing-change cadence, and the warning signs that mean call now. A family guide to home health wound care in Central Florida.
Medicare home health covers nursing wound care, supplies, and patient/caregiver teaching for wounds that require skilled assessment and management. The visiting nurse measures and photographs the wound at each visit, performs dressing changes per the physician’s order, treats the underlying cause (pressure, vascular, diabetic, infection), and escalates to a wound specialist if healing stalls. Most simple post-surgical wounds heal in 2–4 weeks; complex wounds (pressure injuries, diabetic ulcers, venous ulcers) can take months. Supplies are delivered to the home at $0 out-of-pocket.
Five terms in home wound care
- Pressure injury (pressure ulcer, bedsore)
- Localized skin and underlying tissue damage caused by sustained pressure, typically over bony prominences (sacrum, heels, elbows, hips). Staged 1–4 based on depth; deep tissue injury and unstageable categories also exist. The most common preventable cause of new wounds in bedbound or chair-bound older adults.
- Diabetic foot ulcer
- A wound on the foot of a person with diabetes, typically over a pressure point. Driven by the combination of neuropathy (reduced sensation), poor circulation, and elevated blood sugar. Can progress to deep tissue infection, osteomyelitis, or amputation if not caught early. The reason daily foot checks matter so much. 2
- Dressing change
- The clinical procedure of removing the existing wound dressing, cleaning the wound, applying topical treatments per the physician’s order, and applying a new dressing. Frequency depends on wound type and drainage — ranges from once daily to twice weekly. Performed by the nurse initially; family caregivers may be taught for simpler wounds.
- Debridement
- Removal of dead or unhealthy tissue from a wound to promote healing. Methods include sharp (surgical removal), enzymatic (topical agent), autolytic (moisture-retentive dressings), and mechanical (wet-to-dry dressings or pulsed lavage). The visiting nurse performs gentle debridement under physician order; complex debridement may require wound care specialist or operating room.
- Wound vac (NPWT)
- Negative Pressure Wound Therapy — a device that applies controlled suction to a sealed wound, promoting drainage and granulation tissue formation. Used for deep wounds, post-surgical wounds, and chronic non-healing wounds. Medicare covers NPWT under home health when the physician orders it; agencies that handle NPWT regularly have the supply chain set up.
How a home health wound care episode unfolds
First nursing visit: full wound assessment and baseline photo
At the start-of-care visit, the registered nurse measures the wound (length, width, depth), assesses the wound bed (tissue type, drainage, odor, edges), photographs it for the chart, and reviews the physician’s wound care order. The baseline assessment is what every subsequent visit gets compared against.
Establish the dressing change cadence
Depending on wound type, dressing changes typically range from once daily to twice weekly. The visiting nurse performs the changes initially; some patients or family caregivers are taught to do simpler dressing changes between nursing visits. Medicare-covered supplies are delivered to the home.
Identify and treat the underlying cause
Most non-healing wounds have an underlying issue: pressure (for pressure injuries), arterial or venous insufficiency, diabetes, malnutrition, or infection. The wound care plan addresses both the wound and the cause — pressure offloading, compression for venous wounds, glucose control for diabetic ulcers, nutrition support.
Weekly reassessment and photo documentation
The nurse remeasures and rephotographs weekly. Comparing photos over time is the most reliable way to see progress (or lack of it). Patients see incremental change daily and often miss the trend; the photo log makes the trend visible.
Escalate non-healing wounds
If the wound is not making measurable progress in 2–4 weeks, the nurse escalates to the physician for reassessment. Options include wound care specialist referral, hyperbaric oxygen therapy (for select wounds), debridement, advanced dressings, or evaluation for surgical intervention.
Family teaching and transition planning
Throughout the episode, the nurse teaches the patient and family how to perform safe dressing changes, recognize warning signs of infection, manage pain, and prevent recurrence. As the wound heals and the skilled need ends, the family takes over routine care or the patient is discharged from home health.
When to call — and what’s normal
- Redness spreading beyond wound edgesPossible cellulitis. Same-day call. Red streaks = ER.
- Fever above 101°F with the woundPossible wound infection or systemic spread.
- New foul odor or yellow-green drainageSigns of infection or anaerobic colonization.
- Wound suddenly larger or deeperPossible debridement of necrotic tissue revealing depth, OR rapid progression.
- Dressing soaked through unexpectedlySuggests increased drainage; may need cadence change.
- Mild serous (clear/yellow) drainageExpected in early healing. Watch for change in color or volume.
- Slight tenderness around the woundMild tenderness is normal. Increasing or severe pain is not.
- Pink granulation tissue at wound baseSign of healing. Beefy pink/red = good. Pale/gray/dusky = concerning.
- Slow, gradual size decrease over weeksHealing wounds shrink slowly. Day-to-day change is hard to see; weekly photos show trend.
- Slight itching as wound healsNew skin growth often itches. Don’t scratch; keep moisturized per nurse’s guidance.
Why wound care at home matters for Florida families
Wound prevalence in older adults is high — particularly for pressure injuries in bedbound or chair-bound patients, diabetic foot ulcers in long-standing diabetics, and venous leg ulcers in patients with chronic venous insufficiency. The combination of Florida’s aging population and high diabetes prevalence creates substantial demand for home wound care.
Home health is well-suited to wound care because the agency delivers consistent, evidence-based care without requiring the patient to travel to an outpatient wound center for every dressing change. For homebound patients, this is often the difference between a healed wound and a chronic one. The nurse’s repeated assessment also catches infection and other complications early — the patient may not notice the change between visits, but the nurse’s photo log will show it.
For complex wounds that exceed home care capacity (deep wounds requiring operating-room debridement, wounds with arterial insufficiency needing revascularization, wounds suspected of osteomyelitis), the home health team coordinates referral to outpatient wound centers, vascular surgery, or interventional radiology. Florida has a strong network of wound care specialists; Kassy Health works closely with several in Central Florida.
Questions families ask about home wound care
Common wound types managed at home: post-surgical wounds, pressure injuries (bedsores), diabetic foot ulcers, venous leg ulcers, arterial ulcers, traumatic wounds, skin tears, drainage tubes and drains, ostomy care, and IV access site care. Wounds that require operating-room debridement, complex skin grafting, or daily intensive specialist care typically need outpatient wound center or surgical management.
Yes — wound care supplies used during a Medicare home health visit are covered at $0 out-of-pocket as part of the home health benefit. This includes gauze, transparent films, foam dressings, alginates, hydrogels, antimicrobial dressings, and saline. Advanced therapy dressings may require specific physician orders. Supplies the patient or family uses between nursing visits are typically also delivered by the agency and covered.
Highly variable. Simple post-surgical wounds may heal in 2–4 weeks. Pressure injuries and diabetic ulcers can take 8–12 weeks or longer. Venous ulcers often take 12–24 weeks. Wounds in patients with poor circulation, diabetes, malnutrition, or significant comorbidities heal more slowly. The home health team tracks the healing trajectory and escalates if progress stalls.
Call the home health nurse same-day for: increasing redness around the wound (especially redness spreading beyond the wound edges), increasing pain, foul odor, purulent (yellow-green) drainage, fever above 101°F, or wound that is suddenly larger or deeper. Call 911 or go to ER for: red streaks extending from the wound (lymphangitis), significant swelling beyond the wound area, systemic symptoms (chills, hypotension, confusion). These can indicate cellulitis or sepsis.
Often yes, after teaching. Many wounds have simple enough dressing protocols that a family caregiver can perform routine changes between nursing visits — this is part of the patient and family education the home health nurse provides. More complex wounds (deep, irregular, with packing or specialized therapy) may require nursing-only changes throughout the episode. The nurse will guide which dressing changes are safe to delegate.
Non-healing wounds need workup. The home health nurse will escalate to the certifying physician, who may order: vascular studies (for arterial or venous insufficiency), nutrition labs (albumin, prealbumin), wound culture, MRI for suspected osteomyelitis, or referral to a wound care specialist or vascular surgeon. Sometimes the wound care approach needs to change (different dressing, debridement, hyperbaric oxygen therapy). Sometimes the underlying cause needs treatment first.
Repositioning every 2 hours, use of a pressure-redistribution mattress (foam, alternating air, or low-air-loss), keeping skin clean and dry, managing incontinence promptly, nutrition support, and daily skin inspection — especially over bony prominences (sacrum, heels, elbows). The home health OT can recommend specific cushions, mattresses, and positioning aids. Medicare Part B may cover specialized pressure-redistribution mattresses with a physician order.
Yes, with consent. Wound photography is standard practice in home health — comparing photos over time is the most reliable way to track healing progress. Photos are stored securely in the patient’s electronic chart, protected by HIPAA, and shared only with the certifying physician and the home health team. Patients can request copies of photos for their own records.
Sources cited in this guide
Drawn from CMS coverage policy, the National Pressure Injury Advisory Panel (NPIAP), the Wound Healing Society, and ADA Standards of Care. Verified May 2026.
- Centers for Medicare & Medicaid Services (CMS). Medicare Benefit Policy Manual, Chapter 7: Home Health Services. Coverage of wound care, supplies, and skilled nursing. cms.gov →
- American Diabetes Association. Standards of Care in Diabetes — Foot Care. diabetesjournals.org →
- National Pressure Injury Advisory Panel (NPIAP). Pressure Injury Staging System. npiap.com →
- Wound Healing Society. Clinical Practice Guidelines for the Management of Chronic Wounds. woundheal.org →
- Centers for Medicare & Medicaid Services (CMS). Coverage of Negative Pressure Wound Therapy (NPWT). cms.gov →
- Agency for Healthcare Research and Quality (AHRQ). Preventing Pressure Ulcers in Hospitals. Includes home care applicability. ahrq.gov →
- Centers for Disease Control and Prevention (CDC). Healthcare-Associated Infections — Surgical Site Infections. cdc.gov →
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetic Foot Care. niddk.nih.gov →
Need wound care at home?
Our nurses are trained in pressure injury, diabetic foot ulcer, post-surgical, and venous wound care. Supplies are delivered to your home, dressing changes happen on schedule, and weekly photo documentation tracks healing.
(407) 875-1801Mon–Fri 8 am–5 pm · Bilingual (English · Español) Read: What Medicare coversKassy Health · Medicare-certified home health agency founded by Sandra Morales, RN in 2006. Serving Orange, Seminole, Osceola, Lake, and Volusia counties. CHAP-accredited · 4-star CMS Quality of Patient Care.
