Continence management is one of the most complex issues in residential aged care.

Incontinence is one of the top three reasons people enter residential aged care in the first place, according to studies.

And once in aged care, poorly managed incontinence can significantly impact on a person’s quality of life, and lead to loss of dignity, thereby contributing to poor mental health outcomes, says the Continence Foundation of Australia (CFA).

A study from 2011, found that 70.9 per cent of Australian aged care residents had urinary or faecal incontinence, or both.

What do the aged care standards say?

Continence management is one of the Australian Aged Care Quality Agency’s standards.

Standard 2.12 requires that the ‘Care recipient’s continence is managed properly’. The standard is measured by the outcome for the resident: management must be able to show the facility’s continence management practices are meeting each resident’s needs.

However in 2017, continence and bowel management was one of the top five reasons for complaints about residential aged care to the Aged Care Commissioner.

Rather than managing incontinence according to each resident’s needs, some experts say that aged care staff are turning to high-volume continence pads instead to ensure they are complying with the commonly used three-pad system.

The best way to manage incontinence

CFA CEO, Mrs Rowan Cockerell, told HelloCare, “Incontinence should never be accepted as normal for someone in residential care.”

“All incontinence problems should be assessed and managed.”

“It is important to understand that continence needs of every person differ and continence care needs to be tailored to the individual.”

“Pads should be changed as often as needed to keep the person dry and maintain their dignity.”

Why do we need continence pads that hold two or more litres?

Continence pads should be selected for each aged care resident according to their specific requirements, said Ms Cockerell.

“Type and size of pad should be assessed to ensure the best product is chosen for the individual’s incontinence. Incontinence pads come in many sizes, shapes and capacities. There are pads that can hold up to two or more litres,” she said.

Pads that hold the largest volumes are generally for overnight use, said Ms Cockerell.

“Choosing what size pad is needed for people would depend on the volume of urine that they pass overnight. Some people do not pass any urine, whereas others may pass two litres or more,” she said.

But Dr Rodney Jilek, Principal Adviser, Aged Care Consulting and Advisory Services, told HelloCare that often aged care staff focus more on the three-pad system employed in most facilities than on the individual requirements of each resident.

With continence pads seen as an expensive item, there is pressure on staff to use higher volume pads, he said.

“I have seen considerable pressure applied to operational staff to minimise care costs and unfortunately incontinence aids are seen as a high-cost commodity that are easily targeted,” he said.

“There is certainly a common misconception that once incontinence aids are applied, the need for toileting ceases, which in turn requires the use of larger pads,” said Dr Jilek.

The problems associated with leaving pads on for long periods of time

According to Ms Cockerell, if pads aren’t changed regularly enough, skin can become inflamed, resulting in redness, pain and itching and sometimes even swelling, blisters, dryness, or flaking.

The damaged skin is then vulnerable to infection, she said.

Ms Cockerell said today’s continence pads are designed to keep the skin dry, to prevent some of the problems that can arise.  

Dr Jilek said, “Leaving incontinence aids on too long often results in rashes, burning and contributes to impaired skin integrity including the development of pressure ulcers.”

It is really possible to maintain your dignity while wearing a pad holding such a significant volume?

If you have questions questions about incontinence or continence aids, you can contact the National Continence Helpline on 1800 33 00 66 to speak confidentially to a continence nurse.

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