Incontinence: Allowable Health Conditions

Understanding Facility Practices

Title 22 §87625

Facilities are permitted to accept or retain residents who have a manageable bowel and/or bladder incontinence condition provided the condition can be managed with any of the following:

(1) Self care by the resident

(2) A structured bowel/bladder retraining program designed by an appropriately skilled professional that assists the resident in restoring a normal pattern of continence

(3) A program of scheduled toileting at regular intervals

(4) The use of incontinent care products

If a facility chooses to provide care for a resident with an incontinence issue, they are responsible for ensuring all of the following:

(1) Residents that would benefit from scheduled toileting are assisted an/or reminded to go to the bathroom at regular intervals rather than being diapered.      

Diapering should be used as a convenience and comfort for the residents, NOT for the convenience and comfort of the facility staff.    

(2) Residents that are incontinent are checked  during those periods of time when they are known to be incontinent, including during the night.  

(3) Residents that are incontinent must be kept clean and dry and the facility must remain free of odors from incontinence.

(4) Bowel and/or bladder programs are designed by an appropriately skilled professional with training and experience in care of elderly persons with bowel and/or bladder dysfunction and with experience in the development of retraining programs for restoration of normal patterns of continence.  

(5) The appropriate skilled professional who developed the incontinence program for the facility provides training to facility staff responsible for implementing the program and must re-assess residents' conditions and evaluate the effectiveness of the current program. 

(6) Privacy is always afforded when care is provided.

(7) Facilities and their staff are never allowed to withhold fluids to control a resident's incontinence nor are they allowed to catheterize an incontinent resident for the convenience of staff.

While not mentioned in Title 22, another important issue here is the facility's policy on charging for incontinence care and supplies.  These are policies seen by CARR within local RCFEs:

  • Some facilities include incontinence care and supplies in the monthly rate.

  • Some consider incontinence care as part of standard care provided, and include it in the monthly rate but charge for supplies; some give residents/their families the option provide their own disposable briefs. 

  • Still other facilities consider incontinence care an additional service, and charge residents for care based on the level of assistance needed, as well as charging for the supplies.

Ask facilities about their individual policies, and also read the admissions agreement carefully to be prepared if incontinence issues arise, or if they become more severe.  Familiarize yourself with the experience and oversight of the staff by an appropriately skilled professional regarding incontinence care.  During CARR's review of the public files, and based on our field experience, many accidents, injuries and conflicts have  occurred during times when the resident was being assisted with toileting, and/or from lack of attention to incontinence needs.  Proper technique, critical thinking skills, and compassion are necessary to ensure safe and dignified incontinence care for the resident.  Also explore the willingness, experience of the staff, and the staffing levels of a facility to see if your resident will receive the attention s/he requires.

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