Abstract:
Incontinence: A Major Problem for Patients, A Major
Concern for OBRA
Mary H. Palmer,
PhD, RNC, FAAN. "Incontinence: A Major Problem
for Patients, A Major Concern for OBRA." Nursing
Home Medicine 4 (September 1996) 9: 260-68.
Objectives:
* Palmer discusses the problem of incontinence in nursing
homes, including its cost, the patterns and types of
urinary incontinence, and assessment and treatment strategies.
She also describes quality assurance measures that may
help nursing homes to meet OBRA requirements, and emphasizes
the pivotal role of the medical director in improving
treatment of incontinent residents.
Conclusions:
* Incontinence among nursing home patients incurs heavy
financial costs (an estimated $5 billion annually).
* The cost of incontinence is not merely financial.
It can also result in increased staff turnover and lowered
staff morale, and lowers the quality of life for nursing
home residents, who may withdraw from social activities
and personal relationships as a result of their condition.
* The Omnibus Budget Reconciliation Act of 1987 (OBRA
'87) requires nursing homes to provide evidence that
incontinence is an unavoidable result of the resident's
clinical condition, and states that the maintenance
of as much normal bladder function as possible is the
responsibility of the nursing home.
* Research shows that incontinence is not a normal characteristic
of aging.
* "Urinary incontinence is not a disease; it is
a symptom or condition."
* The differences in health and physical abilities among
nursing home patients necessitates the development of
individualized and multidisciplinary care plans. "Identifying
the underlying cause is essential in order to provide
an effective remedy to resolve the incontinence."
* "Sensitivity to the psychological effects of
incontinence . . . must be addressed in the treatment
plan. . . . In a recent survey, almost two thirds of
the community-dwelling incontinent respondents reported
no satisfaction with the care received."
* "Proactive strategies to aggressively assess
and treat incontinence while protecting dignity, incorporating
the resident in decision-making about treatment as much
as feasible, and using predetermined outcomes to measure
the effectiveness of treatment are some of the measures
to use to ensure quality of life and quality of care."
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