Memory Care Incontinence Management

Current marketing of incontinence products is “discrete” and “private”. The ultimate is a bed pad that is colored so it is difficult to see if it is “wet and embarrassing.” “Reduced leaks” was interpreted as an infrequent event; not every morning. “Keep your loved one dry” referred to the person rather than the bed.

Maggie and I took about a year to break through this barrier. Sum six factors descended upon us at about the same time. (-1-) MoliCare Mobile Extra, 915848, was redesigned as MoliCare Premium. The product is odor free (negative 5.5 pH) with a morning and evening change (915834, X-Large, $1.61 each online, 56 count).

(-2-) A change of the Provision Living at Columbia Executive Director, the Director of Nursing, and night Charge Nurses was accompanied with a change (-3-) from MoliCare pull ups, to Attends Advanced Underwear, Classical Super Plus Design, (APP0740, X-Large, heavy absorption, $0.75 each in house, 14 count), pull up, and Attends Stretch (DDSLXL, L/XL, severe absorption, $0.46 each in house, 24 count) brief.

I returned to our apartment from breakfast to a stench I can easily remember when we were looking for a nursing home for my Mom. The odor stayed in the room for several hours.

Attends does not have a pH control to eliminate odor. Change Attends more frequently to eliminate odor.

Water on Surface of MoliCare

Attends Bursting

Attends keeps the patient drier than MoliCare when pressure is placed on saturated areas. It took some time for caretakers to adjust to Attends bursting when pressure was applied to a fully soaked pull up. Change more frequently.

(-4-) So we then went from one pull up, to a pull up when the resident was out of bed, to a brief when in bed. A brief is much easier to put on in bed than a pull up and it cost much less ($0.46 brief and $0.75 pull up with Attends).

Unfortunately this did not keep the bedding dry. We experimented with over $100 worth of the best items in stores in Columbia, MO, and on the Internet; even a $2.00 each item from France that never seemed to fit right and also failed the “sit up and turn” test.

All items failed the “sit up and turn” test when getting out of bed. A bed pad is an essential item in an incontinence management system. It takes at least four, as three can be in the laundry at one time; and six when things do not go as expected.

Damaged Depend as a Tabbed Brief

We found Depend Adjustable Underwear (19184, L/X-Large, maximum absorption, $0.75 each online, 16 and 48 count) comparable to Attends. This item is novel in that it comes as a pull up for out of bed application, but can be converted to a tabbed brief, by opening from a difficult to find spot, for in bed application. It takes some practice to find the spot and apply the tabs without destroying the garment.

(-5-) An incontinence management system is then composed of a pull up for out of bed application, a tabbed brief for in bed application, and a large bed pad (in box under head of bed). Three-hour bed checks keep Maggie and the bed dry. There is no odor problem.

[The pull ups, $0.75, and briefs, $0.46, are placed side by side in the bathroom to prevent the closest one being used, and to promote restocking before each one runs out, rather than waiting to restock after the last one is used.]

(-6-) Along with the changes in personnel and incontinence items came a concussion with eleven stitches and the partial loss of use of her fingers on both hands. She was bedridden for three days and then up in a wheelchair. No more trips to the bathroom at night.

The cost of the incontinence management system, to a resident, changed from two changes at $3.21 per day with MoliCare pull ups (with toileting), to four changes at $2.40 per day, and six changes at $3.60 per day with Attends. The bed has been dry for over a month with Attends.

MoliCare, Attends and Depend all seem to fit Maggie. This is important. Poor fitting increases leaking and can injure the skin (especially with double briefing). It can also aggravate the skin rash Maggie has battled all summer. The Attends stretch brief has superior tabs and fit.

My opinion is a large washable bed pad, with the lowest cost pull up and brief, that prevents an overflow of the bed pad, is the optimum condition. I do not see a diaper cover being practical at night. Frequent toileting reduces the need for a diaper cover during the day.

Thank you to all the caregivers who took part in our investigation.