Toileting practices in nursing homes are complicated, because each case is complicated. Some residents can control their bowel and bladder, and others cannot. Some can get to the toilet on their own, others need assistance, and some cannot get to a toilet at all. So, there are multiple different options for toileting in the nursing home. Of course, there are residents who can practice the same toileting routines that they did since they were toilet-trained as young children, however, many need assistance. The main types of assisted toileting are assisted bathroom trips, bedpans, incontinence briefs and ostomy/catheter regimens.
In assisted trips to the bathroom, an aide, nurse, or other professional assists the resident is walking to a bathroom in order to use a toilet. The professional should always retain whatever privacy they can. If the resident is able to use the toilet on their own and is stable while sitting, the aide should help the resident to the toilet and then stand outside the door. This can be altered in whatever way strikes a balance between safety and privacy. This is the form of toileting that offers the most pride and privacy and fosters the most self-confidence in the resident. However, if there are safety issues, safety should always be the utmost concern, followed by privacy and respect. This regimen also only works if the resident retains bowel and bladder control so that they can use their call lights and wait while the aide assists them.
Some patients do not have bowel and bladder control for trips to the bathroom to work. If this is the case, incontinence briefs may be the best option. If incontinence briefs are used, aides will help to change the resident’s incontinence briefs. While incontinence briefs make it possible for residents to not have to sit in soiled sheets and for aides to not have to change all of the sheets multiple times per day, incontinence briefs can lead to skin irritations. Also, aides need to be sure to not sheer residents while removing the briefs. With proper training, aides should be able to remove the briefs correctly and delicately, respecting privacy as much as possible. Incontinence briefs can be used both in immobile and ambulatory patients.
Conversely, some patients do have proper continence, but do have the mobility for trips to the bathroom. In these situations, it may be most advantageous to use bedpans. If a patient can ring their call light and remain continent until an aide arrives, an aide can assist them with placing the bedpan and will remove and take care of the bedpan. There are also special bedpans for patients with hip or back problems. Bedpans show minimal safety risks, and if the aide is sensitive, are fairly private.
In some residents, continence problems, gastrointestinal disease, kidney disease or other problems may make it necessary for the resident to use an ostomy bag for bowel movements and a catheter for urination. If this is the case, aides should be sure to keep the apparatuses clean and in working order. They should also be sure that receptacles are not overflowed. Aides, nurses, other professionals and visitors should be especially sensitive about these devices. These devices can be difficult for residents to cope with, as it makes real the idea that the resident has absolutely no control over his or her bowel and bladder function.
It would be the hope of all that our parents and grandparents are receiving the best care and the most humane care. Unfortunately, this is not always true in toileting practices. There are reports every year of patients that developed rashes and bedsores from having had incontinence in their beds as well as from unchanged incontinence briefs. More common, but rarely reported are instances of complete lack of privacy for the patient and shearing and damage while changing bed clothing or incontinence briefs. In some facilities, even in developed countries, elderly residents can be left in soiled bedding for hours or even days. These situations should never happen, and are considered acts of elderly abuse. Criminal neglect charges can be pressed against those who commit these acts, and their licenses may be revoked.
It can be difficult to face the prospect of losing control over one’s body. With optimal involvement between doctors, support staff, social workers, the resident and the resident’s family, a toileting regimen best suited to each resident can be worked out.