Assisted Living and a Resident in Need of an Indwelling Urinary Catheter

Posted on by Emily Kil

There can be a considerable amount of confusion surrounding what types of medical devices are permissible for use within a California assisted living facility. The reality is that quite a number of medical devices are permissible in an assisted living facility if appropriate regulatory and medical protocols are followed at all times. If you are considering or living in assisted living, if you have a parent considering or in assisted living, you may wonder whether or not an indwelling urinary catheter can be used by a resident of this type of long-term care facility. The quick answer is that the use of this type of urinary catheter is possible.

Role of Assisted Living Facility Administration

The decision to permit an assisted living resident the ability to use an indwelling urinary catheter rests with the administration of an assisted living community. Administration have the final say as to whether an applicant with an indwelling urinary catheter will be accepted into a facility. In addition, administration of a facility has the final say as to whether a current resident who ends up needing an indwelling urinary catheter will be permitted to continue to reside in the community. 

Assisted living administration can make the decision to accept an applicant or keep a resident with an indwelling urinary catheter provided California regulations on the subject otherwise are satisfied. These regulations are now presented in this article.

Legal Requirements for Use of an Indwelling Urinary Catheter by an Assisted Living Resident

An assisted living community is permitted to accept or retain a resident who must use an indwelling urinary catheter if these three initial criteria are satisfied:

  • Resident (or prospective resident) must be physically and mentally capable of caring for all primary aspects of the condition and use of the device except:
  • Irrigation
  • Insertion
  • Removal
  • Irrigation shall only be performed by an appropriately skilled professional in accordance with the physician’s orders
  • Catheter shall only be inserted and removed by an appropriately skilled professional under physician’s orders

After accepting or maintaining a resident who needs an indwelling urinary catheter, the assisted living facility does have some specific responsibilities in regard to that individual and the use of this medical device:

  • Assisted living administration and staff must ensure that insertion and irrigation of the catheter shall be performed by an appropriately skilled professional
  • Assisted living administration and staff must ensure that the bag and tubing are changed by an appropriately skilled professional should the resident require assistance

In addition to these elements of care, an assisted living facility need also take some additional steps in regard to addressing the needs of a resident in the community that requires an indwelling urinary catheter. The regulatory requirements in this regard are:

  • Bag may be emptied by facility staff who receive instruction from an appropriately skilled professional
  • There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of the facility staff who have been instructed 
  • Assisted living administration shall ensure that the professional reviews staff performance as often as necessary, but at least annually
  • Ensure waste materials shall be disposed of as specified by California law
  • Privacy shall be maintained when care is provided

Overview of Indwelling Urinary Catheter

You may now only be learning that you or your aging parent is in need of an indwelling urinary catheter. Therefore, a bit of a primer on this medical device may be necessary. 

An indwelling urinary catheter is also known as a Foley catheter. This type of catheter is inserted into the urethra and travels to the bladder. It actually enters into the bladder itself. Urine is transported directly from the bladder in the tube that runs through the bladder to a collection bag outside of the individual’s body. The collection bag is changed from time to time as urine collects in it over the course of any given day or night. 

A Foley catheter typically is inserted and removed by a nurse. If there are complications, a doctor may be required to undertake the insertion of an indwelling urinary catheter.

Most Common Reasons for Use of an Indwelling Urinary Catheter

It is important to understand the most common reasons for use of an indwelling urinary catheter. Keep in mind that some of the reasons for an indwelling urinary catheter would mean that an individual would not qualify to live in an assisted living community as a general rule. The most frequent reasons why an individual might have to use an indwelling urinary catheter are:

  • Retention of urine leading to urinary hesitancy, straining to urinate, decrease in size and force of the urinary stream, interruption of urinary stream, and sensation of incomplete emptying of bladder
  • Obstruction of the urethra by an anatomical condition that makes it difficult for one to urinate
  • Urine output monitoring in a critically ill or injured person
  • Collection of a sterile urine specimen for diagnostic purposes
  • Nerve-related bladder dysfunction, such as after spinal trauma (A catheter can be inserted regularly to assist with urination.)
  • Imaging study of the lower urinary tract
  • After surgery

Cleaning Skin Around Catheter

As mentioned a moment ago, cleaning the area around the catheter is significantly important. Medline Plus (informational service of the United States Department of Health and Human Services) provides valuable instructions in regard to cleaning the skin around a Foley catheter:

Items needed for cleaning the skin around an indwelling urinary catheter:

  • 2 clean washcloths
  • 2 clean hand towels
  • Mild soap
  • Warm water
  • A clean container or sink

The following cleaning and skin care guidelines are to be undertaken on a daily basis (each and every day) and more often if necessary:

  • Wash your hands well with soap and water before beginning the cleaning process around the indwelling urinary catheter. Be sure to clean between your fingers and under your nails
  • Wet one of the washcloths with warm water and soap it up generously.
  • Gently wash all around the area where the catheter goes in with the soapy washcloth. Females should wipe from front to back. Males should wipe from the tip of the penis downward.
  • Rinse the washcloth with water until the soap is gone.
  • Add more soap to the washcloth. Use it to gently wash your upper legs and buttocks.
  • Rinse off the soap and pat dry with a clean towel.
  • Do not use creams, powders, or sprays near this area.

Cleaning the Exterior of the Catheter Device

Infection is the most significant health issue associated with the use of a Foley catheter. The supply list mentioned previously include items to be used for this process as well. This cleaning of the exterior elements of the catheter device needs to be undertaken twice a day (and more often if necessary):

  • Wash your hands very well with soap and water. Be sure to clean between your fingers and under your nails.
  • Change the warm water in your container if you are using a container and not a sink.
  • Wet the second washcloth with warm water and soap it up.
  • Gently hold the catheter and begin washing the end near your vagina or penis. Move slowly down the catheter (away from your body) to clean it. Never clean from the bottom of the catheter toward your body.
  • Gently dry the tubing with the second clean towel.

Contact a Doctor if Symptoms of Infection Appear

As mentioned previously, infection is the most commonplace medical issue associated with the use of an indwelling urinary catheter. A physician should be contacted if a person with an indwelling urinary catheter appears to be suffering from infection. Signs of an infection associated with the use of an indwelling urinary catheter include:

  • Pain around the sides or lower back of the person with a Foley catheter.
  • Urine smells especially bad, is cloudy, or had become a different color.
  • Person with an indwelling urinary catheter experiences fever or chills.
  • A burning sensation or pain in the person’s bladder or pelvis area.
  • Discharge or drainage from around the catheter where it is inserted into the individual’s body.
  • A person doesn’t feel like his or her self. The individual may feel tired, achy, and have a hard time focusing.

Other Times to Contact a Doctor

When using a Foley catheter, other situations can arise in which a doctor should be contacted. These include:

  • Your urine bag is filling up quickly, and you have an increase in urine.
  • Urine is leaking around the catheter.
  • You notice blood in your urine.
  • Your catheter seems blocked and not draining.
  • You notice grit or stones in your urine.
  • You have pain near the catheter.
  • You have any concerns about your catheter.

In summary, there are situations in which a resident of an assisted living community in California can require the use of an indwelling urinary catheter. Understanding all of the necessary procedures, practices, and protocols is fundamental to a situation in which an assisted living resident may be in need of an indwelling urinary catheter.