Three pads a day: should there be a limit on continence aids?

We have heard stories of rationing of continence pads to three per day, with extra pads being kept in locked away in cupboards, and requests for more denied.

Aged care staff revealed their experiences with the rationing.

Aged care worker Wayne Beasley said, “People would get an allocation of three. There was a pad room, and sometimes you would need more, and you’d have to go and ask to get the key.”

“You’d be questioned why you’re needing more,” he said.

Personal care assistant Troy Mann said his requests for more pads to help residents at night were turned down. “I was told, “No,” he said.

Personal carer Tanya Bosch told Four Corners she ignored the three-pad restrictions.

“I ignored that directive because in my view, if there’s faeces on a continence pad, I’m not putting it back on another human being,” she said.

Film secretly taken by Michael Borenstein in his mother’s nursing home room showed her calling out to staff throughout the night. She wanted to get out of bed, but was ignored for hours on end.

“When she woke up in the morning, she would be wet, and often soiled. And so, you can imagine lying in bed wouldn’t be very pleasant,” said Mr Borenstein.

Are three pads per day recommended by industry and experts?

Ms Rowan Cockerell, CEO of the Continence Foundation of Australia, told HelloCare that incontinence poses a “challenge” to aged care operators.

The “continence needs of every person differ and continence care needs to be tailored to the individual,” she said.

Ms Cockerell said that she should couldn’t speak on behalf of operators about the provision or restrictions on continence pads. However, she said it’s important to address and manage the needs of residents “to ensure that their needs, including their needs for dignity, are assessed and responded to respectfully, with evidence-based treatments and support which includes the provision of the appropriate incontinence products.”

Incontinence is not an inevitable part of ageing, Ms Cockerell said, but the incidence of urinary and faecal incontinence does increase with age and is much higher in residential aged care facilities.

Sean Rooney, CEO of Leading Age Services of Australia, said he hadn’t heard that continence pads were restricted to three per day, but said pads should be supplied whenever required by the individual.

“I would have thought, in a model that’s delivering person-centred care, it doesn’t matter whether you use one, two, three or however many, that the system would be delivering whatever is required by that individual,” he said.

“It is not a bad method of managing continence”

Peter Vincent, Director of Aged Care Management Australia, a consultancy that helps nursing homes with accreditation, told HelloCare the three-pad limit is common in residential aged care facilities. But he said continence pads should only be used to prevent against accidents, and residents should be taken to the toilet regularly throughout the day – not simply rely on the pads.

“It is standard practice to operate on a three-pad system,” he said. “The industry has been using this process for many years very effectively.”   

He said if extra pads are required, they should be supplied.

“If a resident needs a additional pad during the course of a day, then of course they are provided extra,” he said.

Mr Vincent said if extra pads are required, the resident should be assessed and higher capacity pads might be recommended.

“Much like baby’s nappies [continence pads] are designed to hold a certain volume of urine.  Individual residents are assessed based on the voiding patterns to ensure they have the right pads in place,” he said. “There are many different types and sizes of pad on the market.”

“This data is recorded and based on the frequency of the extra pads being supplied, the resident is reassessed and a higher capacity pad provided,” he said.

Residents should be taken to the toilet regularly throughout the day, and pads should only be used as an ‘in case’ measure, he said.  

Continence pad restrictions are “not a new thing”, Mr Vincent said. “It certainly is not a bad method of managing continence,” he said.

What do the standards say?

The Australian Aged Care Quality Agency’s standard 2.12 requires that the ‘Care recipient’s continence is managed properly’.

The standard is measured by the outcome for the resident. Management and residents must be able to show that the facility’s continence management practices are meeting the resident’s needs.

Conversely, if the resident’s needs are not being met, the quality standard has not been achieved.

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  1. We visited our mother at late morning/lunch time, and she said she was still in her night pads.
    When I helped her in the bathroom, that pad was orange with urine, and weighed a ton. I cleaned her up, and used creams on her chaffed skin, and then found her full allowance of 3 pads for the day, still in her wardrobe.
    So, we do believe that she had no attention at all, that morning.

  2. I will be entering the Aged Care field soon after the new year. I am disgusted that clients are not being treated properly, and under no circumstances would I continue this treatment – even if it cost me my job (I would not want to be associated with a company that doesn’t treat the elderly correctly, so it would be no great loss to me). I wouldn’t hesitate to deal with individuals that are abusing the aged, or to report institutions that are not doing the right thing.
    I can guarantee that any company I work for will be supply the best possible care – if they aren’t, I won’t be working there.

  3. Pads come in different sizes and from different suppliers and vary in effectiveness and cost. My mother used to pull her pad out and urinate on the carpet causing her room to stink. This was because there was not enough staff to follow the toileting regime outlined in the care plan and she did not like to walk around with a full pad in. A three pad limit per day maybe the accepted standard but I regularly found pads stashed in my mother’s wardrobe which suggested that either she had not been given her daily quota or that her pad wasn’t applied. Either way it is unhygienic to put piles of pads on top of shoes in a cupboard and this is an infection control and a human rights issue.

  4. Peter Vincent, Director of Aged Care Management Australia, …….. said continence pads should only be used to prevent against accidents, and residents should be taken to the toilet regularly throughout the day – not simply rely on the pads.
    I think that this is the problem in Aged Care homes and hospitals-staff don’t take the elderly to the toilet throughout the day-they turn elderly patients/clients into incontinent invalids by being under staffed, uninterested, lazy. When I have asked for my mother to be taken to the toilet in one of these institutions I am told that she is wearing a pad and so shouldn’t need the toilet-it was very distressing for my mother.

  5. I would like to know the role of the person cited above, and the authority he has to make the statements he has. In regard to maintaining dryness needs one, both or even three options. 1. Regular toileting – which required enough staff with training to toilet often enough. 2. Pads which are changed frequently to maintain dryness and prevent excoriation and/or 3. Increased staff plus increased continence aids. The government provides funding for all of these, so isn’t the budget directed, rather than companies looking for money saving (which is what these exercises are essentially about?

  6. Sadly this is the norm, the staff aren’t available. So far I haven’t heard of anywhere this does not happen. It’s a disgrace, but they can’t really fix anything, it will cost too much money, always the bottom line!!

  7. 3 pads a day might work if there were more staff to assist the residents with going to the toilet.
    I wonder if the JERK that made this rule would like sleeping in a dirty wet / soiled pad all night or even be left in it for half a day…I don’t think so.
    Aged care facilities need more staff on every shift…

  8. I worked in aged care for 9 years and it was horrific to see residents allocated only 3 pairs of pull ups or 3 slip pads a day.Also it’s not always about regular toileting not happening,you can’t make people wee on command.Being constantly told by management that people have to be denied nice proper continence aides because they are too dear is just bloody ludicrous.I would like to see these Managers and owners of nursing facilities walk around all afternoon in a wet continence aide because staff have not been allowed to have another aide after asking.Locked cupboards and bring treated like your a criminal because you have gone and gotten another continence aide for a resident is bloody pathetic.Management are always quick off the mark to blame staff and accuse them of not doing their jobs properly before they actually bother to look into this issue and actually give residents what they deserve.Mananagement are more than happy to take residents money and families money but not happy to give residents what they deserve.

  9. I have urgency incontinence and bladder cancer. I have about 10 seconds from “Needing to pee” to actually peeing. No matter where I am – in bed, out of bed, in the street, in the lounge or dining room where I live. My Urologist says to remove damp or wet pads immediately to prevent labial and vaginal infection. If a “dry”pad smell it means infection is starting. Never leave a dry but smelly pad in place. The aged care place I live in will not provide pad pants which do not slip and move, so I am forced to use long thin strip style pads that slip and leak on to my clothes or bedding. My GP recommends pants style pads, but the Home refuses to supply them.

  10. From what I remember, the incontinence aids were supplied after the persons requirements were monitored on an incontinence chart. The residents output was then reviewed and the correct amount of pads required. This incontinence chart is part of ACFI. If you do not know what ACFI is, you should not be making comments about how many pads a person should have. I have been in a position of allocating pads. I also had to understand the sizing and capacity of the pads being supplied. In some cases, the person would have 2 pads for a certain time of day.

  11. This rule applied in the nursing home where I completed several weeks unpaid work when completing a certificate three in aged and community care. Residents would tell me stories of being cold and uncomfortable at night when they lay in a pool of urine until it was time for their shower after 7.30am. The stench for the carers who had to clean up was also difficult to bear. After my experience I swore I would rather be dead than have to live a life of eating food slops, being forced to sit in a sitting room for most of the day with the TV blaring and many of the residents drugged so much that they were in a semi-coma. The greatest indignity, of course, was being forced to wear a pad knowing that if it became soiled the resident would just have to put up with it if they were nearing the limit of their daily allocation.

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