Why double padding ‘shortcuts’ are frowned upon in aged care

Double padding shortcuts

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.

Loss of dignity

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.

Assess and dignify

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.

Always use continence aids correctly

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.

Focus on the dignity of the person

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.

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  1. Working in aged care for nearly 19 years i came across “double padding” quite frequently!
    Working in the private sector each resident was allocated THREE pads per day, the rest were literally under lock and key, .
    Double padding was frowned upon because even though the “outer pad” may have appeared dry the inner pad was usually wet and that was the one that would do the damage, causing irritation to the skin.
    Double padding came down to 2 reasons
    1) To try to avoid leakage making the bed or clothing wet……or
    2)Trying to make sure another dry clean pad was available when unable to get a clean one from under lock and key

  2. Hi. I’ve read your piece on incontinence pads ” double padding”.
    From personal experience as an AIN, EEN AND RN as well as an RN educator in aged care, i know this issue is purely money driven.
    A lot of residence entre aged care continent and soon become incontinence due to many reasons but 1 is inability to use toilet in a timely manner due to no staff being available when they are required.
    Double padding reduces the cost of pad usage. As each resident has funding for only 3 pads per 24 hrs.
    So much more to this.

    1. If adequate staff were present that were not run off their feet the entire shift and the fact that pad allocation is restrictive then we wouldn’t have this issue. It all comes down to money like everything else. Money is the reason many homes have 1 staff to about 15 or 20 residents and pads are under lock and key. While this never changes the care can not change

    2. Yes Jenni there is so much more to this.I worked in aged care for 20 yrs.Since the royal commission inquiry its got worse in aged care.which is so sad.3 pads for 24 hr?we cannot conrol how many times a client needs to be changed.double padding was used but not often.maybe more staff would be a better instead of 2x carers to 15 highcare clients. Duty of care is hard to give when you dont have proper tools to do your job.So very sad.

    3. Jenni is absolutely right.
      100% agree it is about poor allocation of access to pads, totally financially driven.
      As an AIN who worked the 10pm-6am shift many times I was the only staff member for 35 residents. So toileting poor mobility residents is out of the question. Its dangerous to both staff and residents. Having more staff on would accommodate residents being toileted safely …… more staff wow isn’t that the answer to may issues but will never happen in the greedy industry. To call staff lazy shows how ill-informed some powers to be really are.

  3. I feel so sad hearing the above stories.. my husband has been in residential care for twelve months and we have a constant battle with the facility about changing his pad when wet.. I suspected they were only allow three per 24 hrs but each time I ask they assure me that there is no restrictions.. thank goodness I visit everyday. I fear for the residents that don’t have family to advocate for them.. My husband went into care continent but as his condition worsened it was much easier to use a pad I understood that but not once did I think he would be left for an hour or more in a wet pad waiting for staff to change him.. my husband is 73 his mind is good but his body is failing him … my goal is to make sure he is shown dignity and respect but it is a constant battle.. a battle I wish I didn’t have to fight.. When will these facilities put people before profits.

  4. They double padded with boosters, they locked up supplies, often only gave 2 pads per day, told residents to poo and pee in their pads, rather than toileting them because they didn’t have enough time to toilet clients. I saw people in princess chairs with urine puddling under their chairs and the chairs stank. I left aged care, so humiliating for everyone and profit driven. Green pill for me. Never ever put me in an aged residency.

  5. Excellent article. The appropriate use of booster pads is something I am constantly trying to improve but it’s like banging my head against a brick wall. Banning them is the next move.

    Maybe getting staff to wear a wrap around and pack it with up to five boosters will give them a sense of what it feels like as a resident to be treated this way.

    Boosters used for faecal smearing but not to hold off correct toileting and maintain skin integrity

    I’m not sure if the practice is totally driven by cost but cutting corners to save time is a big factor where I work.

  6. Lots of comments saying it’s cost driven! I don’t understand how it is cheaper to double pad, isn’t this still using more than the “allocation”? The allocation is based on the manufacturers recommendations, and the type of pad is supposed to be allocated after a continence assessment is completed. Extra pads should always be available and residents changed after opening their bowels or if very wet between suggested change times. Where I work, and in previous places of employment, there has always been the three pad per day allocation and an extra supply which needed to be documented so if the resident was frequently requiring extra the allocation could be reviewed and changed to meet the residents needs.

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