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ong-term care professionals are very concerned about a resident’s quality of life, well being, dignity, and comfort. We frequently think of comfort in physical terms, but there is another aspect of resident comfort that is very emotional in nature and touches many residents in some way: the sensitive subject of incontinence. Few want to talk about it, but many suffer in silence as urinary incontinence (UI) erodes their quality of life.
       The National Institute on Aging estimates that more than 20 million Americans are incontinent in some form. In the nursing home, more than half of all residents experience incontinence, the second leading cause of institutionalization. As this figure grows, the projected cost of incontinence figures to grow exponentially in terms of dollars and emotional trauma. As our society ages, the stigma attached to the loss of bladder control has not lessened in the public eye. Many nursing home residents fear embarrassment or are concerned about offending others if odors associated with incontinence are detectable. Likewise, the fear of public humiliation in relation to bed-wetting and soiling of personal clothing grows in tandem with the resident’s condition. The resultant feelings can inflict profound psychological consequences, including humiliation, depression, and social withdrawal. This concern may limit a resident’s willingness to socialize and interact with others, limiting his or her quality of life.
       The psychosocial influences at work in frail long-term care residents stem from the normal feelings we all experience in losing control of our bodies as we age. It is troubling to feel the loss of control of our physical functioning, and this is accentuated by the loss of personal control that can result from living in a long-term care setting. In moving from a personal home to a managed care home, we may feel that our schedules are now someone else’s, our choices limited. That, coupled with the feeling of losing control of one’s body due to incontinent episodes, may leave the residents feeling an overwhelming sense of helplessness.
       Long-term care professionals can help to reverse these feelings from the beginning of resident care. Involving residents from the time they enter the long-term care setting can help them feel empowered and in control of their lives as they make the transition into this new environment. Members of the interdisciplinary care teams within the facility all have the same role—to ensure the quality of life of their residents. While these teams generally consult, they may not take the time to involve the resident intimately in care delivery. Talking closely to the residents to help them understand their options for incontinence begins from the point of assessment and should be a focus of all staff as part of normal care planning.

Treatment Options

       Treatment options fall into 4 broad categories: behavioral, devices, medications, and surgery. Generally, those options that are least invasive, dangerous, or expensive are tried first. Caregivers cannot treat incontinence without first identifying its underlying cause. Because incontinence is not a normal part of aging, it is critical for the nursing staff to perform a thorough assessment of the resident to isolate the causes of his or her incontinence and then work together to maintain the highest achievable level of continence for each resident. For optimal success and to promote his or her psychological health, it is important to engage the resident in this process as much as possible.
       While open communication is the first step in removing the stigma and involving the residents in their incontinence care, it cannot be accomplished without full staff participation. Involving the staff from every department, including management, is the first, most vital step in this process so that they can work on the appropriate programming and help inform the resident. Every level of the staff is involved with resident care in some regard; therefore, all staff levels should be trained to contribute to individualized incontinence care for residents.

Training Staff

       Training on healthy bladder functioning can help promote the understanding that incontinence is not a normal part of aging but rather a symptom of another problem. Follow-up or additional training on the different types of incontinence, with the causes for each, is necessary for staff to aid in the comprehension that there should be different programming for each resident based on his or her needs. Since facility staff members are busy and may be overwhelmed by the idea of having to design training, requesting outside help from incontinence care manufacturers that already have education programs can be ideal.
       Effectively training staff will lead to a variety of steps that the facility should take in building a successful incontinence program. The formation of an interdisciplinary team is important to the long-term success of any facility-wide program. Building a strong program for promoting continence has many advantages for both facility staff and management. A program that promotes continence and resident psychological health can enhance the facility’s image with family members and in the community. For this reason, strong commitment from management is a prerequisite in the formation of an interdisciplinary committee to address bladder programming.
       The incontinence care committee should be an interdisciplinary team composed of representatives from various departments, ensuring that all levels of caregivers are eventually involved in this aspect of resident care. Different departments that may not have been directly involved with incontinence care, such as dietary, will be very important in developing a holistic view of incontinence and helping to promote an understanding while removing the associated stigma.

Activities

       Another important department to proactively involve is the activities department. This department is critical in promoting the residents’ physical and psychological health. Involving the residents in an exercise program provides a social outlet to help improve their emotional health while keeping them moving as much as possible. This general social interaction will also provide a support group that involves residents who may have felt socially isolated because of their incontinence.
       Based on the varying activity levels, the incontinence care team can develop different programs with the activities department that incorporate exercises targeting the pelvic muscles. When residents gather and engage in the physical activity, it provides a perfect outlet to promote resident education on incontinence with subtlety. The activities staff can then intersperse general information on the causes of incontinence while discussing the overall health of the body and promoting involvement in their personal rehabilitation in a social setting.
       They can also include coaching on the best ways to promote their physical health, including the bladder. Consider offering these classes to both residents and their families, and include education on different systems of the body for promoting general wellness. Participants will not feel embarrassed about attending these sessions because they are not incontinence meetings.

Communication

       Privately, nursing staff can talk to each resident about the causes of his or her symptoms to determine if he or she understands that incontinence can be improved. Offer information and private consultation to ensure that residents do not feel alone or have the misunderstanding that incontinence is a condition without treatment options. Also, assert that the care goal is to promote their highest level of continence. Make residents’ bathroom environments as inviting as possible and provide privacy so that they are comfortable. For many residents, it can be helpful and comforting to be provided the personal care items they used at home. This can also help ease the transition for new residents entering the facility. Work with each resident to promote regular toileting and guide them in choosing quality support products, such as disposable incontinence care products. In choosing incontinence care products, the goal is to select the style and absorbency level to promote the highest achievable level of continence for each individual. Utilizing quality absorbent products designed to promote best outcomes, with superior fit and odor-control capabilities, helps to ensure resident dignity, independence, and skin health.
       Embarrassing visual signs and unpleasant odors associated with incontinence can compromise both resident dignity and long-term care facility image. It is important for the facility to have a strong interdisciplinary team of staff committed to treating this subject sensitively, while empowering the resident in their care and treatment options. Subsequently, providing quality support products to help residents feel secure and confident is greatly encouraged so that they can live their lives to the fullest.