Challenges in Managing Continence in the Rest home

Environment in NZ

Annie SchenkelRosine PryceCarol Hawker

September 2008

Experience

Managed 3 rest home/hospitals over past six years

Registered Nurse with 30 years working in various NZ health settings

Rosine and Carol have collective experience of 45 years working a Health Care Assistants in aged care facilities

Rosine and Carol-Incontinence product ‘specialists’

Cambridge Resthaven

A 70 bed aged care facility providing both rest home and continuing care to elderly residents

Majority of residents are permanentSpend $45,000 annum on incontinence

products.Under the ARRC contract we cannot on

charge the cost of any incontinence product to residents

Change in Culture

All three committed to improving residents’ lives

Theme of current change management process: ‘It’s about them, not us’

The change of culture is wide sweeping. Continence management is one aspect of the desired change to historical culture

Culture change continued…Along with other committed staff we are

passionate about making a home for our residents….not home like nor homely. We are striving for the real thing!

Philosophy

For the residents to all have a toileting pattern as close as possible to earlier in their lives, i.e. when they were not dependant on other people to assist them with this function

For the residents to use a toilet, at all times, rather than any other method of body waste collection (e.g. incontinence products, commode chairs)

Continuing Care residents

The other common name for the level of care required for these residents is hospital level care

Many of these residents cannot communicate when they want to use the toilet, and/or cannot mobilise on their own, and/or have poor control of bodily functions

Continuing Care continued…

We do the optimum for these residents, by using individualised care plans

Care plans altered according to resident need fluctuations, e.g. dementia, acute illness, changes to the physical environment (seasonal temperature changes), and other residents behaviour

Optimising Care for CC

Many continuing care residents wear incontinence products full time

Teaching staff optimal care includes: How to monitor when incontinence products

need changing as individuals vary in their void times

How to select the correct product for the resident How to apply the product correctly and when to

change the product

Rest home residentsThe current tough challenge is

changing the culture for residents who self toilet/require minimal assistance

Very few have access to

en-suite bathrooms, so use shared toilets

Historically most rest home residents have had commode chairs in their bedrooms

Removing the commodes

Attempting to remove commodes from residents’ rooms has been extremely challenging!

Night staff appear to have a secret stash of commodes squirreled away, which they raid some nights! The morning staff discover a commode has been returned to a residents room overnight!

Commode Withdrawal

We believe some of the reasons residents are reluctant to part with having commodes are:

Distance to closest toilet. Residents ‘panic’ and perhaps visit toilet more frequently than required > they do not allow their bladder to fill completely

Not recognising when they need to go to toilet, and not allowing enough time to get there > ‘accidents’

If have reduced mobility may require assistance to get to toilet. Some reluctant to ask for help too often > ‘accidents’

Summary

Continuing to optimise continence of residents at Cambridge Resthaven is a permanent goal for all care and nursing staff

The rewards for optimising continence/ reducing incontinence are many

The rewards include…………..

Summary continued

Rewards:Residents maintain their usual toileting routines

for as long as possibleDignity is preserved for as long as possibleCambridge Resthaven is a charitable trust >

reduction in expenditure on incontinence products enables the money saved to be spent on other benefits for the residents, e.g. staff education, equipment, staffing levels

Summary continued…

Aesthetically residents rooms look better without commodes

Less furniture in residents rooms contributes to less clutter > more floor space for walking frames/wheelchairs to man oeuvre…hazard minimisation, from a health and safety perspective

Any reduction in staff needing to ‘handle’ body fluids is desirable from an infection control perspective

Summary continued

Less incontinence products used means less non-biodegradable waste in landfill

Mobilising to toilets supports the ‘Use it or lose it’ catch phrase, regarding exercising

Keeping residents' bedrooms for sleeping, eating and entertaining only ,i.e. not for toileting, is a cultured, civilized way to live. Who at home has their toilet in their living area?

Conclusion

We’ve started the journey to becoming an aged care facility, which focuses on continence as opposed to incontinence

We’re changing a culture for residents and staff alike

We will succeed

Questions?