Resident incontinence represents a major challenge for the long-term care (LTC) industry.
It negatively impacts residents on many levels and has a significant economic impact on the service provider both in terms of the support care required and direct-expense costs.
Urinary incontinence (UI) is defined as the complaint of any involuntary leakage of urine. In LTC facilities, more than 50% of persons experience UI either occasionally or on a regular basis and many would argue the rate is even higher. UI is a contributing factor to skin breakdown, falls, urinary tract infections, social isolation, frustration, anxiety, calling out, and wandering.
Key Facts
• One in three women has some form of incontinence.
• It is estimated that 5-15% of those with urinary incontinence also have fecal incontinence.
• A National Association for Continence survey of its members indicated that 16% of all those 75 years or older admitted that their incontinence had not been diagnosed by a healthcare professional.
A Continence Care Program brings numerous benefits to long-term care communities and individuals with memory impairment. Education and behavioral changes increase the likelihood that residents can maintain continence, regain continence, or lessen the severity of incontinence. Those residents considered at highest risk of developing incontinence are given tools for maintaining control, while others gain new freedoms by addressing reversible factors that may have induced incontinence. Even those with persistent incontinence can learn ways of treating or managing incontinence well.
Resident Benefits:
• Improved quality of life, with a greater sense of independence and self-sufficiency
• Fewer transfers from admissions to hospitals or long-term care nursing home
• Lengthier stays in assisted living with the opportunity to age in place
• Fewer complications and decreased morbidity factors associated indirectly with incontinence, such as falls and fractures, dehydration, and urinary tract infections
Long-Term Care Communities Benefits:
• Retain residents for longer periods by postponing or eliminating the need for nursing homes transfers because of persistent or unmanageable incontinence
• Improve staff morale through training that allow facility caregivers to play an active role in enabling residents to maintain their continence, reverse factors causing their incontinence, or more effectively manage their incontinence
The Resident’s Education Program
An education program specifically for residents and family members should include the principles of “Choice, Dignity and Individuality” to help the resident maintain independence and quality of life to the greatest extent possible. Key points to be integrated are the following:
- Lifestyle changes that can decrease incontinence and voiding symptoms
- Self-toileting programs
- Identification of products that can manage urine leakage, maintain skin integrity and increase activity
- Absorbent products
- Disposables
- Reusable Products
- Perennial Care – Excellent perennial care is recommended with each change.
- Skin barriers and would care ointment
- External catheters for men – Texas catheter with secure method of application
- Intermittent catheterization – with a doctor’s recommendation and order. Supplies are usually covered by insurance.
- Pelvic organ support devices
- Absorbent products
- Framing of attitudes
• Help residents and their families understand that incontinence is not a normal part of aging
• Inform residents and their family members of the variety of approaches to maintain continence. When one approach is not successful, another may be tried.
• Encourage residents to share with caregivers- Their efforts to maintain continence
- Their frustrations when coping with incontinence
- Their successes and their appreciation of staff support
Incontinence need not be accepted as an inevitable, ever-increasing expense in LTC facilities. By educating staff and scheduling for more routine toileting, as well as implementing more robust mobility training programs, elderly residents can achieve higher levels of continence.
Micha Shalev MHA is the owner of Dodge Park Rest Home and the Adult Day Care at Dodge Park and the Oasis at Dodge Park, all located in Worcester, MA. He can be reached at 508-853-8180 or by e-mail at m.shalev@dodgepark.com or you can view more information online at www.dodgepark.com or www.oasisatdodgepark.com.
