More than half a decade after initial outcries during the Royal Commission into Aged Care Quality and Safety, frontline workers are still voicing frustration over restrictive access to continence pads. These essential aids, meant to support residents’ comfort and health, are often locked behind layers of security, doled out in strict quotas, and treated like contraband.
What should be a cornerstone of person-centred care has become a “soft deterrent” to spending, leaving carers scrambling and residents at risk of discomfort, infection and humiliation.
Recent discussions in The Aged Care Worker Support Group, a vibrant Facebook community where staff from across the country share raw experiences, paint a stark picture of practices that have not evolved much since the 2019 Royal Commission hearings.
Back then, witnesses revealed how rationing left seniors sitting in soiled pads for hours, risking painful bedsores and life-threatening skin breakdowns. Yet, as one group member lamented, “It’s ridiculous. The residents pay for these aids, so we as caregivers should have access to them as the residents require.” Six years on, the echoes persist.
At the heart of the issue are daily allocations, typically three pads per resident, that fly in the face of unpredictable needs. A carer from Western Australia described how supplies, once accessible to all staff, are now under RN-only key control.
“A resident may be allocated three pads a day but may poop themselves three times per shift!! What does management expect us to do?” another worker fumed, highlighting the absurdity when bowel movements or accidents exceed the tally. It is not uncommon, they added, for residents to destroy pads in attempts to remove them, further straining limited stocks.
These quotas, enforced through meticulous logging, create a culture of surveillance rather than support. One anonymous member recalled facilities where every pad used had to be reported, with warnings issued for “changing residents too frequently.” In extreme cases, staff were instructed to reuse partially used aids unless they were “full,” regardless of odour or saturation.
“Yup, I’ve been to one that unless the aide was full we were expected to put it back on. Didn’t matter how long it’d been on for. What it looked like/smelled,” a carer shared, sparking outrage among peers. Responses poured in: “This is unhygienic for the residents’ care. This goes against standards of dignity.” Another chimed in, “No one has wet underwear at any other stage of their life. So not acceptable practices.”
This is not isolated: it is “pretty normal across the board,” according to multiple contributors. Facilities justify the rationing as a bulwark against overuse or theft, with one explaining, “Every facility seems to have 1–2 dishonest staff &/or relatives where things like that go ‘missing’.”
Residents themselves sometimes hoard or pilfer packets they do not even use, leading to locked storerooms and signed-out spares. Yet, as a veteran carer noted, “People work other jobs and steal supplies which is why they do this,” a symptom of low wages and systemic distrust, not a solution.
The physical barriers are just as telling. Pads are not simply stored; they are fortified. “Ours are locked away with cameras in the room. Gloves, bin bags etc are also all locked away and need an RN to get them for us,” one worker revealed, a practice echoed nationwide.
In some homes, entire “pan rooms” for continence supplies are padlocked, forcing carers to hunt down an RN mid-shift, a delay that can turn urgent needs into crises. “It’s not like an RN is at our beck and call to get us a pad in a matter of minutes either,” a frustrated member pointed out.
Even ancillary items like wipes, towels and gloves face the same fate, locked in keypads or storerooms “able to be locked if need be (some residents would hoard pads).” One carer from a regional facility described trolley-based access in hallways as a rare mercy, but added that bulk orders are calibrated to quotas, leaving no buffer for extras.
“They lock the continence aids away as when they order they only order enough to last them for a month or whatever based on allocations,” they explained, underscoring how funding formulas prioritise cost over care.
This fortress mentality extends to infection control pretexts, with one rising contributor decrying it as “major infection control” hypocrisy: “You’re moving wipes from the room back to a locked room etc. Yet we are told we can’t remove pads from the rooms as it’s infection control. I’d ring the health department on this one and the commission. It’s degrading.” Indeed, the Aged Care Quality and Safety Commission urges complaints for such breaches, and group members frequently share hotline numbers as a rallying cry.
These stories are not new, but their persistence is what is galling. The 2019 Royal Commission heard from advocates like Paul Versteege of the Combined Pensioners and Superannuants Association, who called rationing “quite common” and a direct threat to frail skin.
Witnesses described residents denied proper equipment, from ill-fitting wheelchairs to unavailable shower chairs, all under the guise of affordability. Fast forward to 2021, and reports of “double padding,” layering booster pads overnight as a lazy shortcut, highlighted ongoing dignity deficits, with experts from the Continence Foundation warning of skin risks from unchanged, sodden underlayers.
Yet, as one top contributor in the group quipped, “It all comes down to $. It’s a business and the almighty $ is the driver, should be called aged business.” Peers nodded in agreement. In a sector where residents fund their own care, this commodification rankles. “Totally unfair as the residents pay for them and many times we had to reuse things as they weren’t allocated enough. It disgusted me,” a former aged care worker confessed.
Not every facility is culpable: some stock spares in hallways or resident cupboards without RN gatekeeping, but the norm tilts towards restriction. “Not all facilities are like that. Cupboards in the hallways store them and don’t have to ask the RN’s permission,” one defended, yet the chorus of “yep” and “same at my facility” drowned it out.
The Aged Care Quality Standards demand dignity and resident input in care decisions, yet quotas and locks erode both. As a clinical nurse consultant emphasised in 2021 coverage, continence management starts with thorough assessments and toileting prompts, not pads as a “last requirement.” Boosters have their place, for overnight capacity or faecal protection, but only if changed fully, preserving sleep and skin integrity.
Frontline voices in the support group urge a shift: prioritise access for carers, monitor usage for health insights (like UTI flags from excess changes), and treat theft with targeted accountability, not blanket deterrence.
“Get out while you can. Do community care. Way more rewarding,” one advised, a sad indictment of facility priorities. “Facilities are only in it to make $ no one cares in them. So sad for our oldies.”
As Australia grapples with an ageing population, it is time to dismantle these barriers. Person-centred care is not a buzzword: it is pads on hand when needed, without the ledger or the lock. Until then, the quiet indignity in our aged care homes will keep carers, and residents, trapped. If you have witnessed this, the Commission’s hotline awaits: it is one call to start unlocking change.
