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Decisions, Decisions

Selecting incontinence products for optimal resident care and your bottom line

By Laura Kuhn

According to the most recent information from the Centers for Medicare and Medicaid Services (CMS), more than half of the nursing home population experiences some degree of incontinence.1 That figure has major implications both for the care that is delivered at your facility as well as your bottom line.

The fiscal impact of incontinence

Disposable incontinence management products account for 8 percent or more of a nursing home's total budget and, on average, an incontinent resident will need upwards of five briefs per day.2 When everything is tallied up, the financial impact is staggering: long-term care facilities spend more than half a billion dollars on incontinence management products every year.3

With so much money on the line not to mention the ultimate goal of putting residents in the best products for their needs - it's a good idea to take a step back and determine whether incontinence management products are being utilized properly at your facility. When products are used correctly, and in the right size, they are less likely to fail and cost your facility additional money.

What to use (and when)

Incontinence management products should be chosen based on the product's fit and ease of use as well as the resident's gender and levels of incontinence and dependence upon others. CMS notes that there are many advantages to using absorbent products to manage incontinence, including the ability to contain urine, provide protection for clothing and preserve the resident's comfort and dignity.1

Keep in mind that absorbent products should not be used as the primary long-term approach to managing incontinence. The healthcare team should work toward identifying the cause of a resident's incontinence and formulate a treatment plan. Other alternative approaches (such as behavioral programs, medication and treating underlying conditions) should also be considered.1

Here is a list of questions that should be answered when determining whether the proper disposable incontinence management product is being used:

  1. "Is this the correct product for the resident?"
  2. "Is it the right absorbency?"
  3. "Is the resident wearing the right size?"
  4. "Is the product being used and applied correctly?"
  5. "Is there a good skin care program available to accompany the incontinence products?"
There is a wide variety of incontinence management products available on the market, and each of them is designed to meet a specific need. The information that follows is a guide to understanding the differences between some of the most popular products.

Adult briefs

Adult briefs are ideal for managing moderate to heavy loss.1 They're also perfect for nighttime wear and for residents who are in bed, contracted, difficult to turn or position, aggressive or combative as well as those who have frequent loose stools or are totally dependent on staff to change them. Recent changes, such as manufacturing briefs with cloth-like, breathable fabric and high-absorbency polymers, have improved performance, enhanced wearer dignity and allowed for better skin care.


Pull-ups, also referred to as protective underwear, are designed for moderate to heavy leakage.1 These products are similar to real underwear and can be pulled up and down like normal underpants, making them easy for residents to manage. They're a good choice for residents who are incontinent and active as well as those in a bowel and bladder program, toilet training or for restless, disoriented residents. The disadvantage to using pull-ups is that the resident's pants must be removed in order to change them, which makes them convenient for daytime use but not at night.

Pads and liners

Pads and liners are a great choice for residents who have only slight leakage.1 Ideally, someone using these products should be ambulatory, weight bearing, use underwear, require one person to assist them in dressing and self-toilet or be involved with a bowel and bladder program. Pads and liners are convenient for both day and nighttime use. They can also be added to adult briefs as "booster pads" for especially heavy wetters who need to be changed more often than every two hours.


Many facilities automatically order mostly large-sized products, thinking that they will fit the majority of their residents. However, this often isn't the case and using inappropriately sized products can lead to excess spending, leakage, discomfort and even pressure ulcer development.4 Bags of products are often priced the same regardless of size, but a bag of extra-large briefs might contain 14 briefs while a bag of medium briefs contains 20. Properly sizing residents could quickly lead to significant savings. Remember: bigger doesn't always mean better. Better fit means better containment.

Simple steps to big changes

If you determine that changes should be made to the way incontinence management products are utilized at your facility, the following four steps will help you implement new practices and take corrective actions when needed. 1. Assess incontinent residents to select the best products for their needs. 2. Using sizing information from the product manufacturer or distributor, determine the correct product size for each resident. 3. Monitor the usage of products (including which sizes are being used). 4. You should be using approximately the same number of products (in the same size) each month. If you start to notice significant variations, evaluate the product usage lists compared to the residents' requirements. While incontinence management products generally work in the same way from brand to brand, your local distributor rep will be able to explain the features and benefits of specific products and work with you to ensure that your financial and care goals are met.


  1. Centers for Medicare & Medicaid Services. State Operations Manual. Appendix PP Guidance to Surveyors for Long Term Care Facilities. Available at: http://www.cms.gov/manuals/Downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed July 21, 2011.
  2. Scharwachter M, Restivo L. Fiscal, clinical and regulatory implications of incontinence. MyZiva's Nursing Home Business. Available at: http://www.myziva.net/members/update/MyZiva_CB_Incontinence.pdf. Accessed July 21, 2011.
  3. HIDA. 2009 Extended Care Market Report. Figure 18. Available at: http://www.hida.org/Content/NavigationMenu/MarketResearch/ResearchSurveys/ExtendedCareMarket/default.htm. Accessed July 21, 2011.
  4. Muller N. Incontinence management. Advance for Long-Term Care Management. Available at: http://long-term-care.advanceweb.com/Article/Incontinence-Management.aspx. Accessed July 21, 2011.