Jan 29, 2021

Why are continence pads kept under lock and key in aged care homes?

Some aged care homes are keeping continence aids “under lock and key”, making it difficult for care staff to access additional pads, even when residents need them.

HelloCare readers have left many comments on our social media platforms over the years about the rationing of continence aids, and lately some have complained about pads being kept in locked cupboards, making it difficult to access them.

These comments have sparked heated debate, with some readers sympathising, while others saying pads are not rationed at the homes where they work and are always easy to access.

We decided to speak to some experts in the field about why pads might be locked away, and the best ways to store pads to encourage their appropriate use.

The pros of locking pads away

Rodney Jilek, managing director, Aged Care Consulting and Advisory Services, told HelloCare the issue of storing pads in locked areas is a common “area of debate” in residential aged care.

“Incontinence aids are frequently locked away, so this is not an unusual practice at all,” Jilek said, noting that there are good reasons for doing so.

Locking pads away allows the provider to keep accurate records of use, he said.

It also ensures changes in use are identified, such as if a resident has increasing incontinence, and alerting staff that care needs might need to be assessed.

Jilek said locking pads away is also a way to control costs.

LASA CEO Sean Rooney, said “in some instances” pads are stored in “secure” areas to ensure they are not used “inappropriately” or “used instead of assisting residents to use the toilet”.

Hayley Ryan, Clinical Nurse Consultant – Wound Management (NSW & ACT), Practice Excellence Lead, Uniting, said pads at Uniting are sometimes kept in locked storage to protect them. 

Pads are medical items, and need to be kept clean and in good condition, she said.

So it seems there are plenty of good reasons for keeping pads in locked storage.

Consumers complain when pads aren’t available

Jilek says there are also plenty of reasons not to keep pads in locked cupboards or rooms. 

Doing so can create the impression the pads are being rationed, he said, which does not encourage appropriate use. 

If pads are not available out of usual work hours, complaints may also arise, he said.

Extra pads must always be available

Ryan says the aim for staff at Uniting is to assist the person to the toilet wherever possible, rather than having them wear a pad.

The focus is on maintaining the best possible continence outcomes for each resident, rather than the number of pads they use.

Uniting uses an assessment tool that helps clinicians understand the needs of residents. The assessment is completed over a number of days, and a strategy developed which is incorporated into each resident’s care plan.

Rooney says residents must be assessed for the type and cause of incontinence the person is living with.

“A three-day urinary continence log and seven-day bowel activity record should be conducted to attempt to ascertain the resident’s normal patterns of voiding or opening their bowels. 

“Following analysis and review of these records, a toileting schedule should be established and followed to attempt to maintain continence and dignity,” he said. 

“The correct type, size, shape and capacity of continence aids should be prescribed and made available (in the assessed amounts) to the resident each day.”

But such informed planning, Rooney says extra pads should always be made available too. “A variety of types of extra continence aids should be readily available for staff to use if and when required,” he told HelloCare. 

Pads do not replace toileting

Many staff operate on the premise that “they apply the pad and forget… no toileting required”, says Jilek.

“We often hear staff say, ‘Oh that resident doesn’t need toileting because they have a pad on’.”

“Many staff forget that ‘pads’ are supposed to be an aid to maintaining continence,” says Jilek. 

The appropriate use of pads is as a backup for accidents in conjunction with a tailored “toileting program”, he said.

Documenting pad use is also important

Documenting pad use is vital too, says Rooney.

“It is important to record the use of… extra aids as the increased use may indicate that the prescription is incorrect and needs revision, or an indication of other health conditions.”

In this vein, Ryan says at Uniting, pad use is tracked because it provides a level of “ongoing assessment” and can alert clinicians to problems or changes in the resident’s condition.

While some aged care staff may not like the added paperwork, it is clear that documenting pad use is important. This fact must be clearly communicated to aged care staff.

Pads must be changed as often as needed

Rowan Cockerell, CEO, Continence Foundation of Australia told HelloCare, “The Continence Foundation of Australia supports continence care which puts the dignity, wellbeing and choice of the person receiving the care first.”

“The risks of not changing continence aids often enough are leakage and therefore loss of dignity, increased odour, skin irritation and infections,” says Rooney.

Jan Rice, director of Wound Care Services, told HelloCare that if pads are not changed regularly, the skin can become excoriated and fungal skin breakdown can occur.

“It only takes a few hours in a heavily moist pad to cause damage,” Rice explained.

How often pads should be changed depends on individual circumstances, but as a guide, Rice suggests every three to four hours during the day, and every six to eight hours at night.

Extra pads must always be easy to access, Rice said. “Accidents can happen and accessibility to pads is a must,” she said.

The best way to encourage appropriate use  

The common rationing of pads to ‘three a day’ and promoting the use of pads that hold large volumes might be “attractive” for providers wanting “to pay as little as possible”, but these practices fail to encourage “appropriate use”, says Jilek. 

Similarly, keeping pads under ‘lock and key’ might not encourage appropriate use, for example it may deter carers from changing pads as often as they should.

However, there are still plenty of good reasons to locks pads away – it ensures they remain clean and safe, it’s easier to track how many residents are using, and if their care plans need updating, and it means there is a deterrent to using pads when taking the resident to the toilet might be a better option. It is also common practice.

It’s a fine line providers must walk.

The National Continence Helpline 1800 33 00 66 is staffed by Nurse Continence Specialists and can provide help with questions about continence management.

Image: Alan Swart, iStock.

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