A second pad is sometimes added to aged care residents’ regular continence aids as a ‘shortcut’ to help staff perform quicker changes and continence care, an industry source has revealed.
According to an aged care industry expert with many years experience on the floor, some aged care staff add a booster or slip pad at night (sometimes more than one), so in the morning they only have to remove the top pad, and not perform a complete change for the person.
Thankfully, this shortcut is not widely used, but it has been brought to HelloCare’s attention amid concerns raised about its impact on the dignity and health of aged care residents.
“It’s not good practice … and lazy and undignifying for the resident,” said HelloCare’s source.
Booster pads are continence aids that are designed to be worn in addition to other continence management aids. Their capacity can range all the way from an extra 200mL up to an additional 1L capacity.
Booster pads do not have a plastic backing, so any liquid that enters the booster will flow through to the pad beneath it.
Booster pads can also be used for protection from faecal smearing.
Slip pads are pads that are used to prevent leakage. They do have a plastic backing, so prevent liquid from going through to the bottom pad.
According to a nurse from the Continence Foundation of Australia helpline, booster pads are sometimes recommended for use overnight to boost capacity. However, in the morning both the booster pad and the pad underneath must be changed.
If the pad underneath is not changed, a wet pad will remain in place, which is not only heavy and uncomfortable for the person, but it can also pose a risk to their skin integrity.
The practice of so-called ‘double padding’ demonstrates little respect for the dignity of the person, a requirement of the Aged Care Quality Standards.
The standards also require residents to have a say in how they are cared for. One can’t help wondering if residents are given the choice when double pads are used in this way, or if the carer simply makes the decision on the resident’s behalf.
Hayley Ryan, Clinical Nurse Consultant – Wound Management (NSW & ACT), Practice Excellence Lead, Uniting, told HelloCare that continence management should focus on achieving the best outcome for the resident, not the type of continence aid being used.
“Something we focus on heavily at Uniting is that we assist people to the toilet. We find other ways around bladder control, bowel control, as opposed to just going to an incontinence aid.
“Incontinence aids are always a last requirement,” she said.
Continence management should always begin with a “good, thorough assessment of the person”, and then deciding on what is the best way to ensure the dignity of that person is preserved.
At night, residents usually wear ‘wrap pads’, which hold a relatively large capacity, Ms Ryan explained.
However, if more capacity is needed, ‘interim pads’ are sometimes used, which only hold about half the capacity of the wrap pad.
For example, a wrap pad might be removed at 3am and an interim pad put in, which means the resident is dry and comfortable until the morning, when toileting and a complete change is required.
“It’s all about the dignity of the person and also maintaining sleep at night. So, how do we ensure we get adequate sleep at night without waking somebody constantly to change aids,” Mr Ryan said.
“The booster might be relevant for some people, and if that’s the case use it, but use it appropriately,” she said.
Booster pads can be used to capture ‘smearing’ from faecal leakage, Ms Ryan said. “But I would have to say it’s rarely used at Uniting, if at all,” she said.
Continence aids should never be ‘doubled up’ and care must always be taken to use them properly, Ms Ryan said.
Care must also be taken to protect the skin when using continence aids.
If pads get “bunched up” or they are not applied properly, there is the potential for skin irritation and “pressure to delicate areas”, Ms Ryan told HelloCare.
Make sure the skin is cleaned thoroughly, is moisturised, and that you avoid shear and friction from anything that’s in contact with the skin, Ms Ryan advised.
The focus with continence management should always be on continence, rather than incontinence aid, Ms Ryan said.
Trying to take the person to the toilet should always be the priority, and working out the correct capacity for continence aid is also key.
When thinking about continence aids, the aim is to find “the best possible capacity to provide dignity for the person with incontinence”, she said.