Incontinence Signs in Nursing Homes

Incontinence Signs in Nursing Homes

According to a 2009 study, incontinence affects over 50 percent of nursing home residents across the country. Incontinence, defined as the loss of bladder or bowel control, in elderly nursing home patients is often due to psychological conditions, physical conditions or medications. It is up to the nursing home staff to ensure that every patient suffering from incontinence receives proper management and treatment to avoid further complications.

Types and Signs of Incontinence

In general, there are four main types of incontinence that can be identified and treated in a nursing home facility. According to Harvard Medical School, these are:

Stress Incontinence – Stress incontinence occurs when there is poor closure of the bladder. This can lead to urine leakage when pressure is exerted on the bladder such as by coughing, sneezing, laughing, exercising or heavy lifting.

Urge Incontinence – Urge incontinence occurs when there is overactivity in the bladder. This can lead to sudden, intense urges to urinate follow by voiding. Urge incontinence can be caused by minor conditions, such as infection, or more severe conditions such as a neurological disorder or diabetes.

Overflow Incontinence – Overflow incontinence occurs due to either poor bladder contraction or blockage of the urethra. It can be identified by frequent or constant dribbling of urine due to a bladder that does not completely empty following voiding.

Functional Incontinence – Functional incontinence can be caused due to medications or health problems which make it difficult to reach the bathroom in an adequate amount of time. For example, severe arthritis may make a patient unable to unfasten their pants in time in order to properly use the bathroom.

In elderly patients especially, there are several signs and symptoms of urinary and fecal incontinence that may be noticeable by you, staff or other residents. These include:

• Emotional Signs
  • Anger;
  • Decline in Social Activity; or
  • Desire for Attention.
• Sensory Signs
  • Odor of urine and/or feces in the room;
  • Soiling of undergarments or bed linens;
  • Irritation of perineal area; or
  • Accidents while engaged in physical activity, sneezing or laughing.

Common Complications Caused by Incontinence

Most patients who suffer from incontinence also suffer from dementia or are immobile. These conditions all lead to these patients’ full reliance on trained medical staff to manage the incontinence. When not managed well, incontinence can lead to several injuries and illnesses:

• Falls: Older adults with functional incontinence often try to get up and go to the bathroom without the level of assistance they require, which puts them at high risk for falls and fall-related injuries.  Unfortunately, this often occurs when either a resident forgets he needs a greater level of assistance to reach the bathroom, or when his calls for help from the nursing staff fall on deaf ears.
• Skin breakdown: Incontinent residents often require diapers to stay dry. Diapers create a risk for skin breakdown because often nursing staffs fail to timely change the resident’s diapers. When this happens, the resident ends up sitting in their own urine and feces, which causes skin breakdown, such as pressure sores.  Then, as a resident continues to sit in their own waste, the skin breakdown will become infected and lead to further complications.
• Urinary tract infections: A common side effect of incontinence is a urinary tract infection (UTI). These infections are avoidable through constant monitoring, toileting assistance, and regularly changing and cleaning catheters for residents who have them.

Incontinence Management and the Problem of Poor Staffing

Residents with incontinence require toileting assistance at least three or four times within any given 12-hour period. Staff must be available to check in on the residents often, respond to a resident’s call light, ask if the residents are wet and/or if they need to use the toilet.  The staff must also document the amount of input and output for a resident to ensure they are meeting his or her needs.  All of this means that the nursing home must ensure that enough staff is available at all times to provide adequate incontintence care.

Unfortunately, understaffing is a great concern at most nursing homes in Illinois, which means most patients with incontinence do not get the ongoing care they require to stay clean, dry and healthy. Understaffing can lead to increased complications resulting from incontinence-related accidents and also lead to dehydration and malnutrition, all of which are critical signs of potential nursing home abuse.

Programming to Treat Residents with Incontinence

When nursing home residents suffer from incontinence, many nursing homes have policies and procedures in place to dictate the increased level of care and attention they must receive. Nursing homes must meet federal guidelines in order to receive funding from Medicare and Medicaid.  To meet the federal guidelines, the nursing home must  demonstrating its ability and persistence in accommodating residents suffering from incontinence.

A number of resources for implementing and strengthening nursing home incontinence programs can be found at Health Quality Innovators. If you are worried that your loved one may not be receiving the adequate level of care they require due to improper training, consider contacting your loved one’s caretaker or their direct supervisor.

How You Can Help Your Loved One

If your loved one suffers from incontinence, make sure you speak to his or her care providers on a continual basis. Ask to see records that show how and when toileting assistance, such as diaper changes or prompted voiding, occurred. Also, ask your loved one specific questions about the care he or she receives.

Even if your loved one suffers from dementia or other psychological impairment, it is critical that they are asked about the quality of treatment they are receiving as even residents with cognitive impairments can answer such questions accurately.

Contact an Experienced Nursing Home Abuse Attorney

At The Rooth Law Firm, we assist individuals and their loved ones who are facing incontinence issues while in nursing homes. We can help you understand your or your loved one’s care rights and the obligations of the nursing home, as well as what options you may have to pursue compensation for wrongdoing. Learn more by contacting us today to schedule a free consultation and case review.