Apr 28, 2021

The Royal Commission overlooked incontinence – but we can’t

Continence Australia hero

While it may have been lost amongst other issues in the Royal Commission final report, people living with incontinence cannot ignore the enormous impact it has on their lifestyle, dignity and quality of life. Anyone with incontinence, or with a loved one who experiences it, deeply understands this.

As the peak body for promoting bladder and bowel health, the Continence Foundation of Australia was saddened when the Royal Commission into Aged Care Quality and Safety findings barely rated continence care in its recommendations.

The Commission’s Final Report mentioned how it heard “terrible examples of substandard incontinence care”, and for many readers, the horrifying accounts heard in the media and hearings would have jumped straight to mind.  But beyond this, it was only in Recommendation 19 that the Commission shared ways to take action and improve continence care in aged care. It called for an urgent review of the Aged Care Quality Standards, to require best practice continence care, listed amongst other conditions.

There is more we need to do, and everyone in the aged care sector can play a positive role.

The current situation

Incontinence has been a pressing and enduring issue in the aged care system. Once a person enters aged care, we often see their incontinence dramatically worsen.

The most recent data shows 75-81% of people in residential aged care facilities live with incontinence, a significant increase from the 2010 figure of 71%. The consequences of improper and unsafe continence management can be severe: increased risk of urinary tract infections, depression, incontinence-associated dermatitis, and falls.

 There are a number of approaches to combat this growing issue, and the Continence Foundation of Australia is focusing on reducing the stigma, boosting awareness, and providing education opportunities for all aged care staff.

The role of stigma

As a society, we’ve been hesitant to speak about bladder and bowel health and generally designate these topics as “not in polite company”. But this also carries through to doctor’s offices and aged care, where seeking help for incontinence is hindered. A 2003 survey showed 65% of women and 30% of men sitting in a GP waiting room reported some type of urinary incontinence, yet only 31% of these people reported seeking help from a health professional.

By opening up the conversation about incontinence, we empower people accessing aged care to make informed choices about the care they receive.

Doing better by staff

Staff deserve to be equipped with knowledge to handle the complexities of bladder and bowel care. However, reports for the Continence Foundation have confirmed the aged care workforce (personal care workers, enrolled nurses and registered nurses and midwives) is largely untrained in safe and effective continence care and incontinence management.

Of major concern is the Certificate III in Aged Care totally omitting a unit of competency in continence care. As the most relevant qualification for workers in the sector, it means we see a large portion of aged care staff left in the dark.

We have a chance to change this: Recommendation 78 of the Royal Commission stood out as a way to ensure meaningful change through workforce support and addressing knowledge and training within the personal carer workforce. Though not mentioning continence specifically, this recommendation is how the Continence Foundation believes safe and effective continence care and incontinence management can be achieved for all people living in aged care.

Let’s not wait to hear more distressing stories of improper continence care in aged care. The Continence Foundation of Australia believes education is the key, and we have cost-effective learning options so aged care staff feel confident and equipped at work.

Join as a free user of continencelearning.com to view the Foundation’s full range of courses and free aged care webinars.


The Continence Foundation of Australia’s new ‘Aspects of Continence Care’ course is designed for personal care workers and nurses in aged care and the disability sector. As the companion course to ‘Essentials of Continence’, Aspects equips participants with the next step – to apply what they’ve learnt about continence.

Course details

Duration: 3-5 hours (90 days to access from date of purchase)

Delivery: Online

Cost: $60 AUD Special Introductory Offer + GST. HelloCare readers can redeem a 50% discount (offer ends 30 June 2021). Register by emailing education@continence.org.au and mentioning HelloCare.

The course is divided into 10 modules:

  • Skin care
  • Assistive products and technologies
  • Person-centered care
  • Toileting habits which promote continence
  • Multidisciplinary care and team-based approach
  • Communication
  • Good lifestyle habits to promote continence
  • Funding assistance
  • Bladder and bowel diaries
  • Where to get help

Participants who complete the course will receive a Certificate of Achievement from the Continence Foundation of Australia.

Are you an aged care or disability provider?

There are package deals available for aged care or disability providers. Contact education@continence.org.au to enquire about options for your workforce.

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  1. Where I used to work biggest issue was lack of staff to toilet regularly and especially on request. Then the disgusting habit of management stating only 3 Continence pads (aids) per day as that’s all there budgeted for. Occasionally staff would squirrel away unused pads into an empty cupboard for extras but when management would fine stash, would be cleaned out and care staff blamed for poor time keeping and compulsory education would ensure but never any acknowledgement by management that there could be a supply issue of insufficient aids and staff. Money, Profits before care!

  2. I have been in this industry for 22 years and no it is a far cry from what it used to be. Continence care comes down to many factors, short staff continuously, pad supply, and lack of creams to mention a few. I was trained as a AIN to do dressings, oxygen etc. Now brought down to a PC and all skills taken away and constantly fighting for pads from a PC that is not given any extra time to work it. And knowing full well ( I am night shift) that people are upping in pads because they simply don’t get the time to toilet them.


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