Managed Incontinence in a California Assisted Living Community

A California assisted living community is permitted to accept or keep a resident that is diagnosed with manageable bowel or bladder incontinence. Bear in mind that an assisted living community is not required to retain or accept a person with managed incontinence as a resident. Rather, California law permits assisted living communities to accept or retain residents with managed incontinence provided certain requirements are satisfied. Through this article, we present the essential elements of California laws and regulations as they pertain to managed incontinence in an assisted living setting.

Requirements for a Resident With Managed Incontinence to Reside in Assisted Living

A California assisted living facility is able to accept or retain a resident with incontinence. In order to accept or retain a resident, an individual’s incontinence condition can be managed in one of these ways:

  • The incontinence condition can be managed via self-care by a resident
  • A structured bowel and/or bladder training program is possible to assist a resident to restore a normal pattern of continence
  • A program of scheduled toileting occurs at regular intervals
  • The use of incontinent care products

Requirements of an Assisted Care Facility in Regard to Resident With Managed Incontinence

An assisted care facility has certain requirements it must be able to satisfy in order to support the residency of an individual with managed incontinence. According to California law, these requirements include:

  • Ensuring that residents who can benefit from scheduled toileting are assisted or reminded to go to the bathroom at regular intervals rather than being diapered
  • Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night
  • Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors associated with a resident’s incontinence
  • Ensuring that 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 development of retraining programs for restoration of normal patterns of continence
  • Ensuring that the appropriately skilled professional developing the bowel and/or bladder program provide training to facility staff responsible for implementation of the program
  • Ensuring that re-assessment of the resident’s condition and the evaluation of the effectiveness of the bowel and/or bladder program be performed by an appropriately skilled professional
  • Ensuring that the condition of the skin exposed to urine and stool is evaluated regularly to ensure that skin breakdown is not occurring
  • Privacy shall be afforded when care is provided
  • Ensuring that fluids are not withheld to control incontinence
  • Ensuring that an incontinent resident is not catheterized to control incontinence for the convenience of assisted living community staff

Most Frequent Causes of Fecal Incontinence

In addition to understanding requirements, rules, and regulations associated with managed incontinence in an assisted living community, understanding the most frequent causes of fecal and urinary incontinence is important as well. The most commonplace causes of fecal incontinence are:

  • Muscle damage
  • Nerve damage
  • Constipation (resulting in impacted stool)
  • Diarrhea
  • Hemorrhoids
  • Loss of storage capacity in the rectum
  • Surgery
  • Rectal prolapse
  • Rectocele (rectum protrudes through the vagina)

Most Common Causes of Urinary Incontinence

The most commonplace causes of urinary incontinence include (noting that a couple of these causes are not applicable to a resident of assisted living):

  • Pregnancy
  • Childbirth
  • Changes with age
  • Menopause
  • Enlarged prostate
  • Prostate cancer
  • Obstruction (tumor or urinary stones, for example)
  • Neurological disorders (including multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor, or a spinal injury)

Support of a Resident Beyond Legal Mandates

An assisted living resident that develops incontinence faces some significant emotional challenges as well. Arguably, this particularly is the case for a person who has fecal incontinence. Nancy J. Norton, President and Founder of the International Foundation for Functional Gastrointestinal Disorders, succinctly addresses the emotional challenges faced by an individual dealing with incontinence, particularly fecal incontinence:

Summoning the courage to admit to incontinence is the first step in managing it. Given the feelings of shame, embarrassment, isolation, and depression that many people experience, this is a difficult task. To make matters worse, after finally saying, “I can’t control my bowel movements” out loud, too many people are met with disinterest, disgust, or a lack of understanding and sympathy—responses that only heighten feelings of hopelessness or isolation. One of the most important things a doctor or caregiver can do for a person who has fecal incontinence is to acknowledge the problem with sympathy and support.

In the final analysis, when an assisted living care team works in conjunction with a resident and that individual’s healthcare team, the management of incontinence effectively can be undertaken. A resident of an assisted living community with managed incontinence is able to live a fulfilling, healthy life today and into the future as well.