Helping a parent with incontinence at home

Why this comes up

The laundry is what usually brings a family to this. There are two or three loads a day, a chair she has started avoiding, a bathroom trip that does not quite get made in time, and a parent who apologizes and changes the subject.

If you are reading this feeling like you should have sorted it out months ago, you have not missed an obvious step. Nobody tells a family what to do about this, so most people find out the way you are finding out now, by going looking. Families rarely raise it out loud, and a lot of them are handling it alone. It also tends to be the point where an adult child begins wondering whether home is still possible, and that question can wait past this month.

Have it looked at before you buy anything

Ordering supplies is a sensible first move, and you will probably need them either way. Start with one clinic visit anyway, because some of what causes this can be treated.

The National Institute of Diabetes and Digestive and Kidney Diseases, in its page on the symptoms and causes of bladder control problems, says that "temporary incontinence is usually a side effect of a medicine or short-term health condition," and that "some health problems can be short-term, like a urinary tract infection or constipation." The same page says a health care professional "may be able to treat your UI by recommending lifestyle changes or a change in medicine."

So a new problem that arrived in the last few weeks deserves a phone call to the clinic before it gets treated as permanent. Ask specifically whether any recent medication change could be involved and whether a urinary tract infection has been ruled out. In an older adult, a bladder infection can show up as new confusion with no pain, which is one reason these get missed at home.

The institute also distinguishes types, including stress incontinence, which happens when something physical puts pressure on the bladder, and functional incontinence, where the problem lies in the signals between the brain and the bladder. The two have different treatments, and the clinic is the one to tell you which this is. The clinic will work out which type it is. Bring what you have noticed and roughly when it started.

Medicare and incontinence supplies

Medicare's page on incontinence supplies and adult diapers says that "Original Medicare doesn't cover incontinence supplies or adult diapers," and that "you pay 100% for non-covered items and services, including incontinence supplies and adult diapers." Some Medicare Advantage plans add benefits that Original Medicare does not cover, so if your parent is on an Advantage plan, that plan's member services is the place to ask. Most families assume this is covered, and finding out otherwise is a bad surprise. If that was your assumption, it was a reasonable one.

Supplies add up at a pace that surprises people, and nobody warns you in advance. Buy in bulk, try two or three brands before committing, and ask the clinic which product fits the specific type of leakage. Almost nobody gets the right product on the first order, which is the reason to buy small quantities until you know what works.

What help at home covers

Personal care at home includes this work. It means help getting to the bathroom on a schedule, changing and cleaning up, keeping skin dry and checking it, managing the laundry, and getting a parent showered without a fight. The page on personal care lists what the work includes, and what a visit looks like walks through how an ordinary shift runs.

Most families arrange the two or three hours where the problem concentrates: the morning, bedtime, and the middle of the night if that is when it happens. Hours at home goes through how families usually size this.

Abloom Senior Living does this work in the East Metro, under a comprehensive home care license from the Minnesota Department of Health. That license also covers care that often becomes necessary at the same time. It includes dementia care at home, and two-person transfers for cases where one caregiver cannot move your parent safely. Families pay privately or through a long-term care insurance policy, and paying for care sets out the routes if you would rather look at them before you talk to anybody.

Getting her to accept the help

A parent who has been managing this privately may treat a caregiver in the bathroom as worse than the problem. That reaction is about dignity, and it usually softens once a caregiver has been in the house a while doing other work.

What tends to work: start the caregiver on something neutral, like meals, driving, or housekeeping, and let the personal care follow once your parent knows the person. Ask her who she would rather have help her, and take the answer seriously even when it is inconvenient. Use the words she uses for what is happening. If she is going to refuse the first time, it helps to know that in advance, and how to talk to a parent who does not want help covers more of that conversation.

Some parents will take this kind of help only from a paid caregiver they are not related to. That is common, and it does not mean you handled the conversation wrong.

Two risks to watch for

The first risk is skin breakdown. Skin that stays damp for long stretches starts to break down, and a pressure sore on an older adult can take months to heal and sometimes lands her in a hospital. Prevention comes down to dry changes, barrier cream, and someone checking the skin on a regular schedule, all of which are easy to let slide when one person is doing every change.

The second risk is falls. A parent who hurries to the bathroom at two in the morning, half awake and in the dark, is at high risk of falling. Clearing the path, lighting it, putting a commode next to the bed, and getting her up on a schedule before she has to rush all reduce it. How to prevent falls in a parent's home covers the rest of the house.

The laundry and the broken sleep also land on whoever lives in the house, and that is usually one person. If that is you, paid hours let you sleep while someone else handles the night.

What the agency has to tell you

Minnesota's home care bill of rights, at Minn. Stat. 144A.44, puts several things on the agency. Your parent has to be told what the provider charges before services start. She has a real say in building the plan, changing it, and judging whether it is working. Changes to services or to charges have to come with reasonable advance notice. And she can complain about her care, to staff or to anyone else she chooses, without the agency threatening to end services over it.

The right to be told the charges up front and the right to a say in the plan are the two to use. A service plan for this should say who does what, at which hours, with which supplies, and what happens when the schedule does not hold. Without those details written down, nobody knows what to do when a shift is missed at two in the morning. Asking for them in writing is an ordinary request, and any agency should be able to put it on paper before you commit to anything.

When incontinence changes the plan

Many families manage incontinence at home for years. It becomes the deciding factor most often when it arrives alongside a transfer problem or night waking and nobody in the house is sleeping.

If you reach that point, Abloom Senior Living also runs a five-resident customized living home in Woodbury, which means a family already arranging care at home through the company would not be starting a search from nothing. You do not have to choose between the two now, and care at home can continue while you look.

Where to start

If you want to talk through what the mornings and nights would need, you can request in-home care and say as much or as little as you want in the form. Someone will come to the house and look at the bathroom, the bedroom, and the route between them with you, or you are welcome to come see the Woodbury home first. Abloom Senior Living may not be the right fit for your family, and if that is how it turns out, you will be told so and pointed toward someone better suited.

This article is general information from a care provider in Woodbury, Minnesota. It is not legal, financial, or medical advice. Bladder problems have medical causes that need a clinician, and coverage rules vary by plan, so check anything here with your parent's own clinic and plan.

Frequently asked questions

Does Medicare pay for adult diapers or pads?

No. Many families assume it is covered, so if you did, you assumed what most people assume. Medicare's own coverage page states that Original Medicare does not cover incontinence supplies or adult diapers, and that you pay 100 percent of the cost. Some Medicare Advantage plans include supplemental benefits that Original Medicare does not, so ask the plan directly.

Can a home care aide help with toileting and changing?

Yes. Help with toileting, changing, bathing, and skin care is personal care, and it is standard work for a home care aide in Minnesota. Ask any agency you talk to how it staffs the overnight hours if those are the ones you need covered.

Should I take her to the doctor or just manage it at home?

Take her, particularly if this started recently or got worse quickly. A clinic visit is the step that tells you whether any of this is treatable. Federal health information from the NIDDK notes that temporary incontinence is usually a side effect of a medicine or a short-term health problem such as a urinary tract infection or constipation, and that some cases are treatable with a change in medicine or in habits.

How many hours of help do families usually arrange for this?

Most start with a morning block and an evening block, the hours where the problem clusters. An agency should be willing to start small and add hours, and you should ask what the minimum visit length is before you sign anything.

Related reading

• A dementia routine worksheet for families
• Can Mom stay at home? Five questions that answer it
• Does Medicare cover in-home care?

Sources

• National Institute of Diabetes and Digestive and Kidney Diseases, Symptoms and Causes of Bladder Control Problems (Urinary Incontinence)
• Medicare.gov, Incontinence supplies and adult diapers
• Minnesota Office of the Revisor of Statutes, Minn. Stat. 144A.44, home care bill of rights