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Incontinence Amongst The Nursing Home Population

My office was recently retained by the family of a woman who developed pressure sores on her buttocks and vagina in a Chicago nursing home.  When asked, the family was unsure if their loved one was technically ‘incontinent’.  After reviewing the woman’s chart, it was obvious that the woman was incontinent and the nursing home failed to provide properly adequate cleaning and timely changes for this elderly nursing home resident.

Incontinence Amongst The Nursing Home PopulationBy some accounts, more that 50% of the people living in nursing homes or assisted living facilities may have some type of bladder or bowl control problems.  Although widely used, incontinence can be defined as the uncontrolled elimination of urine or fecal material from the body.

Incontinence Is Not A Normal Part Of Aging

Despite its prevalence, incontinence is often treatable.  Any resident who has been deemed incontinent should be evaluated by a physician to determine if the cause of the incontinence is physical or psychological.  Once the cause is identified a combination of behavior modification and staff assistance may be of some help.  In other cases, medication or surgery may also help alleviate the incontinence issues.  Diapers or similar undergarments should only be used as a last resort.

Incontinent nursing home residents have an increased vulnerability for developing pressure sores (also called: pressure ulcers, bed sores or decubitus ulcers) for several reasons:

Nursing Home Residents In Denial Of Their Incontinence

Let’s face it, there is perhaps nothing more humiliating to a senior than to admit to nursing home worker, whom he or she may not know, that they have lost their ability to control their bladder or bowels.  Consequently, some nursing home residents are hesitant to notify the staff to their situation and may wind up literally sitting in their own waste.

Inadequate Staffing To Properly Monitor And Change Incontinent Residents

All too frequently, nursing home staff try to implement a ‘one size fits all’ program for incontinent nursing home residents.  This approach is simply not acceptable.  Nursing homes must have a program in effect to monitor each residents changing needs and have staff available to change soiled residents.  Additionally, adequate levels of staffing should be in place to encourage residents who are able to use the toilet.

When urine or fecal material is held against the skin the damp, acidic nature of the wastes cause the skin to become weakened and susceptible to cracking and peeling–literally eroding the bodies natural defenses.  Proper maintenance of the skin, requires the skin to be kept dray and sanitized.  To minimize development of pressure sores, incontinent nursing home residents should:

  • Be cleaned regularly with mild soap and lukewarm water
  • Be moisturized daily
  • Encourage the use of barrier products lotions
  • Use proper turning techniques to minimize time spent in one location
  • Use positioning devices to alive pressure from bony areas
  • Keep the bed elevation as low as possible- this reduces pressure on the sacrum
  • Keep residents clean and dry

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For more information on incontinence and pressure sores in the nursing home setting:

Overview of Pressure Ulcer Management: An Expert Interview With Carol A. White MS, RN, ANPC, GNPC, DNP(c)

For more information on nursing homes in Chicago look here. For laws related to Illinois nursing homes, look here.

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