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Continence Care in Care Homes (England) Policy

Policy Statement

{{org_field_name}} recognises that incontinence — loss of bladder or bowel control — can be a difficult and embarrassing problem for those who suffer from it and believes in a positive policy of continence promotion. Incontinence is not a “normal” or inevitable part of ageing, although it may happen to more people as they grow older, and that, with good advice and support, sufferers may be able to learn to manage their continence or be treated to reduce the effects of incontinence.

The home, therefore, aims to promote and maintain the continence of people who use services for as long as possible, and believes that the management of incontinence should be based on high-quality individualised care aimed at meeting the person who uses services’ individual needs, maintaining their dignity and independence as far as possible at all times.

The policy is in line with best practice guidance and the Health and Social Care Act 2008 (Regulated Activities) 2014 particularly the following.

• Regulation 9: Person-centred Care, includes a requirement to ensure that the care and treatment of people using services is appropriate, meets their needs and reflects their preferences.
• Regulation 10: Dignity and Respect states that people must be treated with dignity and respect.
• Regulation 12: Safe Care and Treatment, includes a requirement for care and treatment to be provided in a safe way for people using services.
• Regulation 18: Staffing, includes a requirement for staff employed in the provision of a regulated activity to receive appropriate support and training as necessary to ensure safe practice.

Background

Incontinence presents as a common problem for a considerable number of people in adult social care. However, urinary incontinence in a care setting should never be viewed as inevitable and is usually a symptom of underlying problems that, with simple assessment and investigation, can be identified and treated. Even when a cure is not achievable, retaining or regaining continence or managing incontinence appropriately are central to maintaining the privacy and dignity of the person who uses services.

Medical conditions often associated with incontinence include:

• infection — not only urinary tract infections but also of the skin between the legs, the commonest of which is a fungal infection in which the skin is red and moist
• oestrogen deficiency — this is common in elderly ladies, causing urinary urgency and a sore, dry vagina
• diabetes — often associated with incontinence and the need to urinate frequently
• neurological disorders such as Parkinson’s, stroke or multiple sclerosis — these affect the central nervous system control of bladder and sphincter
• prostate gland problems — which affect men, and may be treatable
• previous pregnancies — difficult deliveries may result in prolapse or nerve damage which later causes incontinence.

Some older people may have a number of these problems or other chronic conditions and may take a range of medication which in themselves can contribute to urinary incontinence or make its management more difficult. Urinary incontinence is much more common in people who are confused or physically disabled and it follows that alleviating confusion can also reduce incontinence.

It is recognised good practice that every care home should have policies which promote continence for residents and ensure access to specialist community care where appropriate.

Guidelines

{{org_field_name}} adheres to the following evidence-based best practice guidelines.

• Continence Care in Residential and Nursing Homes (2018), British Geriatrics Society.
• End of Life Care in Frailty: Continence Care (2020) British Geriatrics Society.
• CG49: Faecal Incontinence in Adults: Management (2007), National Institute for Health and Care Excellence.
• CG171: Urinary Incontinence in Women: Management (2013), National Institute for Health and Care Excellence.

Continence Management Procedures

High-quality continence promotion care is based on individual needs, as recorded in an individual’s plan for each person who uses services.

It is important that home care staff can identify developing continence problems in the person who uses services early so that they can be helped to get prompt and fair access to medical or other healthcare resources. Incontinence has many causes and many types can be treated or cured, no matter how old the person is, especially if diagnosed at an early stage.

Therefore, in {{org_field_name}}, the following applies.

1. A person new to using services will have their continence needs assessed during the initial needs assessment. This will be done discreetly to avoid embarrassment.
2. Where continence problems are identified, the person should be fully assessed to establish the cause of the problem, and a plan of care should be agreed and entered in the individual plan. This should be conducted by someone qualified to perform such an assessment and should include specialist medical and nursing input wherever relevant and where agreeable to the person. The plan of care should include help needed from care staff (eg help to get to the toilet) and the use of any incontinence aids.
3. Where necessary, the plan of care should include referral to the local specialist continence advisory service or GP. [Insert contact details.]
4. Although thorough assessment by a specialist nurse or doctor is the most likely course of action to lead to a diagnosis and is the key to appropriate continence management, care home staff can make a valuable contribution through:
   a. talking to the person who uses services about their problem and ascertaining how severe it is and what they feel about it
   b. encouraging the person who uses services to drink fluids — many people with urinary incontinence will restrict their fluid intake, particularly before bedtime, and this can lead to other problems such as dehydration
   c. discreetly helping the person who uses services to access appropriate toilet facilities
   d. keeping careful records of fluid intake and frequency of urination.
5. Initial or ongoing treatment options which should be available to the person who uses services and supported by home staff include:
   a. general advice about healthy living, in particular diet and drinking appropriate fluids
   b. improving access to toilet facilities and wearing easily removable clothing
   c. reviewing existing medication
   d. bladder and bowel training programmes
   e. pelvic floor exercises
   f. provision of pads, continence aids and other supplies to help manage incontinence.
6. People who use services who suffer from incontinence should be assisted by care staff to:
   a. maintain dignity
   b. maintain personal hygiene
   c. use appropriate incontinence aids effectively.
7. People who use services should be regularly assisted to the toilet if it is indicated in their plan of care, either on demand or at frequent intervals.
8. The home does not support a policy where all people are routinely subjected to a rigid regime of toileting. All people who use services should be treated as individuals with help and assistance provided on the basis of assessed need.
9. The night-time hydration and continence needs of people who use services will be carefully assessed and included in the care plan wherever appropriate. During the night, the person should be helped to use bedside commodes or urine bottles, if it is indicated in their plan of care, and all people should be encouraged to call for assistance as required.
10. All precautions should be taken to avoid accidents and spillage of urine, etc.
11. Spillage and accidents should be cleaned up immediately using the materials and protective clothing available for this purpose.
12. In bedrooms, where there is likelihood of spills on the carpet, steps should be taken to protect the carpet thus avoiding unpleasant odours building up.

Those with urinary incontinence may become dehydrated, therefore, it is important that staff encourage them to drink adequate amounts of fluids.

At all times, all home staff should be aware that incontinence can be a source of considerable embarrassment for many people. Staff must therefore treat all people who use services with dignity, privacy and understanding at all times.

Training

New staff receive training in the home’s continence policy as part of their induction.

Existing staff receive further training as required by people’s needs and care plans.

Care staff are made aware of the incontinence aids available, their correct use, capacity and when they need to be changed.

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