A particularly disturbing trend in the nursing home industry remains the wide-spread use of undergarments amongst ‘healthy’ nursing home patients. In other words, patients who have bladder and bowel control, being forced to use undergarments as opposed to being allowed to use the toilet.
In addition to the incredibly dehumanizing aspect of the practice, encouraging or forcing the practice inherently results in situations where patients are literally left sitting in their own waste for periods of time before they are changed by staff. The delay in changing patients not only puts patients at risk for complications such as depression or urinary tract infections (UTI’s), but when patient’s are permitted to sit in their own waste over time, the caustic nature of urine and feces encourages skin breakdown which can amplify the development of pressure sores (bed sores / pressure ulcers / decubitus ulcers).
The practice of allowing patients to remain in soiled conditions can be even more troubling– or perhaps life threatening in patients with existing pressure sores as open wounds can allow bacteria from waste direct access to the body. The practice may result in complications such as a systemic infection known in the medical community as ‘sepsis’.
Underlying factors for toileting issues
Yet again, the issue of nursing home staffing rears its head into the quality of patient care when it comes to toileting issues. Even for patients who are capable of using the toilet when they arrive at a facility, some skilled nursing facilities encourage patients to use under-garments as the practice simply proves more efficient and requires less manpower than summoning one, two or three staff members to the aid of a patient who needs to use the toilet.
Sadly, the practice of allowing patients to soil themselves has become so pervasive at some facilities that it rarely gets acknowledged as an unethical and unhealthy practice– and hence, continues on.
It seems like regulatory agencies in Australia have finally recognized the demeaning practice of ignoring patients’ toileting needs as an unacceptable practice. Unlike the majority of nursing home inspections conducted in the United States, I read a recent article about how inspectors at an Australian facility issued citations when the following conditions were identified:
- Staff failing to respond to patient requests to use the toilet
- Inadequate training of staff to identify resident toileting needs
- Failing to have staff make regular rounds to see when patients need to use the toilet
As families with loved ones in nursing homes, the practice of using undergarments in healthy patients should not be tolerated. If a patient the the ability to use the toilet, they should be encouraged to to so. Just as with other care-related issues, families should be aware of the issue and address it when necessary with the facility.
Resources relating to toileting in seniors:
- Urinary and Fecal Incontinence in Nursing Home Residents Gastroenterol Clin North Am. 2008 September; 37(3): 697–x. doi: 10.1016/j.gtc.2008.06.005