Challenges in Managing Continence in the Rest home Environment in NZ

1. Challenges in Managing Continence in the Rest home Environment in NZ Annie Schenkel Rosine Pryce Carol Hawker September 2008

2. 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’

3. Cambridge Resthaven • A 70 bed aged care facility providing both rest home and continuing care to elderly residents • Majority of residents are permanent • Spend $45,000 annum on incontinence products. • Under the ARRC contract we cannot on charge the cost of any incontinence product to residents

4. 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

5. 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!

6. 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)

7. 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

8. 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

9. 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

10. Rest home residents • The 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

11. 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!

12. 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’

13. 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…………..

14. Summary continued Rewards: • Residents maintain their usual toileting routines for as long as possible • Dignity is preserved for as long as possible • Cambridge 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

15. 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

16. 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?

17. 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

18. Questions?