The Sad State of Incontinence Care

[Sarah_Hillcrest]

Bit of a story and rant here.  I drive by a small secluded house often.  I noticed a several weeks ago that there was a pile of stuff that looked like it had just been tossed from the front door off the porch and in front of the house  The top of the pile was a wheelchair.   Eventually when driving by I noticed the really intense blue green colors of Prevail packaging in the pile.  It made sense that if there was a wheelchair they would have diapers or pads.  I kept driving by day after day and the pile wasn't moving and I never saw a car so eventually I stopped and checked it out.  The pile had been out for weeks.  There multiple cases of Prevail Pull-ups, chair pads, and Wal-Mart baby wipes.  Much of it was ruined from weather.  I would have knocked on the door but it was impossible to get to the door, so I grabbed a a case of wipes and pull-ups.

My wife is currently sitting with an elderly person who wears the same pull-ups.  According to her their clothes are always wet.  Yesterday I had the day at home mostly alone and decided to see what it would be like to wear the pull-ups.  I started at 5AM with two of them, putting holes in the first and put on some snap crotch short-alls since I figured I'd be changing frequently.  They were really comfortable, and really felt just like wearing underwear.  I hadn't pee'd yet and  I always pee alot in the morning so by 6AM I had two leaks on the short-alls.  I changed.  The tear off sides are annoying, I'm pretty strong and it wasn't easy.  I slid on a new one, and continued with my day.  Two wettings later at 8 I had leaked again.  I changed into adult sweat pants and did things around the house.  It was nerve wracking, and I ended up with a big stain in front of my sweat pants, and a small stain on the couch and another one on my desk chair.  

By 2PM I took off my 6th pull-up and declared the experiment over.  These would be fine for mild incontinence but it's insane that these pull-ups have become the ubiquitous adult diaper.  I have a theory.  Of course they are cheap, and appear to be a good deal, but I think it's obvious that more absorbent garments would be more cost effective.  A garment that held three times as much and needed to be changed three times less would save both supplies and manhours.  But that would mean not changing people when they are wet.  Our system often focuses on striving to do the most correct thing and failing as opposed of doing something less perfect that actually works.  The correct thing is to change someone as soon as they are wet.   

For example, nursing home patients will sit in soaked pull-ups with soaked clothes on a soaked chair pad for hours.  They are supposed to be checked and changed every hour but staff is always short and will be lucky to change them a few times per 24 hours.   I've noticed that even with babies people do the same thing.  New parents are constantly changing diapers that are just a little wet.  While a year later I've seen them not bat an eye and just change when it's convenient or smelly.  

I think we all know that if you're wearing a good diaper it can really wet and your skin still dry and comfortable.  

[Little Sherri]

I think a lot of the best-selling "medical" incontinence products were designed for people in Heaven's waiting room, with an expectation that neither the diaper, nor the user, will last very long, so who cares? The stuff you can buy at the drug stores are all junk, really - they leak early and often, and they're uncomfortable once they're wet, as well. And I've yet to discover a good pullup, even from the better manufacturers. 

I used to work in long term care centers as part of my job, and believe me, they're not striving to change them once an hour. Most of them have policies about the wetness indicators that require the diaper be at 3/4 of indicated capacity before they are changed - they budget 3 diapers a day per resident on average, and they typically buy low-end products, because the purchasers neither wear the diapers, nor change them, and the cost of hot water and chemicals to clean linens hits someone else's budget, so their guiding star is the lowest possible cost per unit. Typical care allotments are 2 to 4 person hours per day per resident, and that includes feeding, bathing, dressing, and diapering, so one diaper change every 8 hours is par for the course. 

I hope when that time comes for me, I'll have enough money to be able to choose my own diapers! 

[WetDad]

I have always paid for my diapers, even though I'm on Medicaid. I used Seni Super Plus as my normal diaper as they are thin-ish and very reliable & quiet. Disposables have been essential for the amount of travel I was doing pre pandemic, but I have stopped traveling for work and I'm contemplating cloth diaper use.

I recently looked up what the state would pay for me to start using cloth diapers. One document shows that I can buy up to 36 each month. Wow!! But the next table shows that the state will only pay $2.40 each. They've got to be kidding.

[oznl]

I was at somebody’s home where they were trying to care for their demented, aged mother who was doubly incontinent.  There were packets of Molicare pull-ups everywhere: actually quite an expensive product.

There were chair pads, bed pads, towels on the floor because whenever mother let rip, her nappy simply leaked.  The poor woman could not sit or lay upon anything without getting it wet (or worse).  The laundry work must have been phenomenal.

They would have spent FAR less money per unit on some BetterDry.  She would have been just as, if not more comfortable and the family would have enjoyed dry clothing and furniture but it was far from my place to propose this, clad though I was in an Abena L4 + booster at the time.

I also remember a similar deal at an ageing relatives high-care home (where ALL residents were diapered by policy it seems: I’ve no idea if said relative was incontinent or not but she was clearly diapered when I saw her there as was every other resident).

It was those useless pull-ups all the way again.  I’ve no idea why.  Quite expensive and they don't work very well.  I've tested them.  Perhaps there are some marketing people who require some Douglas Adams marketing therapy here...

[spark]

That's a shame.  It's what happens when the end user is not the one making the decision.  No matter how well  intentioned people are, there will always be some financial aspect to choose.

In the case of the elderly patient sitting in wet clothing because the Pull Up is essentially useless when the incontinence is much more than a leak- and even then they are useless with more than a few ounces of urine. 

On the other hand, a premium diaper like a Mega Max may cost twice as much per unit, but they can withstand far more before needed to be changed.   With residents, it's financial, but when looking after somebody that you love and care about their comfort- the choice might be with the premium diaper.    I typically can get a good six hours in a Mega Max or Crinklz diaper without needing to be changed.   I would probably need to checked after 4 hours by a CG, and then depending on the wetness- 2 hours later.   Most likely, I would be changed 3 times a day.  On the other hand, I'd likely need to be changed every 2 hours in Pull Up.  My guess is that a Pull Up is much hard to change when the patient isn't able to change themselves.  Adult Pull Ups are really designed for the same thing that child Pull Ups are.  Worn just in case, and meant to catch potential accidents.  The patient/child is still meant to take care of their toileting in the bathroom.  If the child isn't taking care of their toileting in the toilet, they should remain in diapers, and it's the same for patients.

[oznl]

38 minutes ago, spark said:

That's a shame.  It's what happens when the end user is not the one making the decision.  No matter how well  intentioned people are, there will always be some financial aspect to choose.

On the other hand, a premium diaper like a Mega Max may cost twice as much per unit, but they can withstand far more before needed to be changed.   With residents, it's financial, but when looking after somebody that you love and care about their comfort- the choice might be with the premium diaper.

I suspect that investing in diapers that residents can be left to marinate in for 6 hours is going to fail the headline test BUT down here at least, the pull-up vs tabbed diaper cost equation fails at almost any level.

Checking with the medical supplier that I get my "daily driver" Abena from, an L3 Abena is about AUD2.35 per unit and is ISO rated at 3400ml.  The "comparable" Abena Abri-flex L3 pull up is AUD2.77 per unit and only rated at only 2400ml.   These are ISO ratings and are so meaningless for real world conditions (probably triple what you'd actually get out of them) but they're nevertheless useful for comparison amongst themselves.  Like for like, down here pull-ups are a premium price relative to conventional diapers.

I wonder if the problem is to do with OH&S logistics around changing in an institutional context...

 

[anned]

i spent almost 4 months in a wound care facility last year and was in the cheap diapers the whole time and the worst part was getting woke up every two hours for a diaper change

the funny part was i had three XP 5000s in my bag and one of the nurses checked the bag and found them.

she asked if they were what i normally wore and i said yes because they lasted all night.

i saved them for when i went home and wore one when i left the facility. as it was at least 4 hours before i would get home.

[spark]

On 11/25/2021 at 3:24 PM, oznl said:

I suspect that investing in diapers that residents can be left to marinate in for 6 hours is going to fail the headline test BUT down here at least, the pull-up vs tabbed diaper cost equation fails at almost any level.

Checking with the medical supplier that I get my "daily driver" Abena from, an L3 Abena is about AUD2.35 per unit and is ISO rated at 3400ml.  The "comparable" Abena Abri-flex L3 pull up is AUD2.77 per unit and only rated at only 2400ml.   These are ISO ratings and are so meaningless for real world conditions (probably triple what you'd actually get out of them) but they're nevertheless useful for comparison amongst themselves.  Like for like, down here pull-ups are a premium price relative to conventional diapers.

I wonder if the problem is to do with OH&S logistics around changing in an institutional context...

 

I think the problem is that the end consumer is not the person who is making the decisions.  We see this with food pred.  It happens on both ends of the age spectrum.  School cafeteria is pure crap, because it's not important to the people paying for it.   The admin in long-term care facilities aren't the ones who are sitting urine soaked clothes, and they aren't cleaning up after the patients, so they don't see the wasted man hours.

I'm quite sure they could sure they could get through 8 hours per product, even with bowel incontinence- provided the caregiver knew the routine.   That would ultimately be more efficient than the model that they currently have.  However- the initial cost is significantly more.

Mind you-even last year I fell victim to the cost thing.   I ordered the base Amazon diapers at half the price to my regular diaper.  Absorbtion- sucked.  Tapes were useless.  Basically useless as a diaper.

[Dubious]

Incontinent people in Norway only get free cloth-like.

Cloth-like is shit, and I assume they only started using it cause it works for babies and kids.
Some users here like it, but most prefer plastic, and some cloth.  I would rather use cloth, than cloth-like.
So even if I became incontinent, I most likely wouldn't bother getting free diapers.

When it comes to healthcare when old... you better off to rob a bank, and end up in prison, cause criminals get their own room with TV and a fridge.
Elderly often have to share room.

[Little Cub Pants]

6 minutes ago, Dubious said:

Incontinent people in Norway only get free cloth-like.

Cloth-like is shit, and I assume they only started using it cause it works for babies and kids.
Some users here like it, but most prefer plastic, and some cloth.  I would rather use cloth, than cloth-like.
So even if I became incontinent, I most likely wouldn't bother getting free diapers.

When it comes to healthcare when old... you better off to rob a bank, and end up in prison, cause criminals get their own room with TV and a fridge.
Elderly often have to share room.

Hahahaha! Hahahaha! Hahahaha! Hahahaha! Hahahaha! Hahahaha! LMAO!!!!!!!?????

[Cruiser 03]

Every real criminal knows when hostage negotiator shows up, you can get crazy cool diapers for granny as long as she can hold a weapon ( we hope that’s longer than #1 or 2 )

[Newbee]

In the care facility that I work at the residents are allocated 3 diapers a day they use Tena brand( I personally don’t like that brand) I’m not a care worker I work in the kitchen but still I talk to the care staff all the time and they say that some residents need something with better protection 

[anned]

What do care facilities do when someone uses too many diapers is to restrict water from them to the point they get dehydrated.

They  did not do that with me because i still had my old EMT card in my wallet and a phone, and they knew what i would do.

That and I knew one of the head nurses that was from my hometown that i had worked with back when i was a EMT.

The ones they put on me kept falling down when i did rehab, and of course I never tried to hold them up because i used a Walker or my walking stick just so i could annoy the rehab nurses, I did not need rehab so it was a nuisance for me to do it.