Pressure injuries, complicated ostomies, and fistula can be a challenge to treat and manage in the long-term care (LTC) facility settings. LTCs do not have a wound/ostomy care specialist, or even a staff member trained in wounds or care of patients with complex bowel and bladder diversions. The lack of certified wound/ostomy care professionals in these facilities can lead to an increase in:


  • Complications from pressure injuries and skin breakdown;
  • Postoperative complications from complex ostomy dysfunctions;
  • Hospitalizations/re-hospitalizations; and
  • Increased morbidity and mortality.


As a result, the WOCN Society is working with additional stakeholders on a proposal to be submitted to CMMI which would allow reimbursement of care for LTC patients without direct supervision of a physician. This would allow WOC Nurses to conduct routine wound/ostomy treatment on a proactive basis, which will result in fewer patient transports, fewer outpatient/hospital stays, less interruption in care, and better overall care for the patients.


There has been a literature review completed to add data and reference sources to our proposal. Assessment of this review is currently in process.