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.