Managed Incontinence in an Assisted Living Community

There are situations in which a person with managed incontinence is able to reside at a California assisted living community. This includes an individual with either bowel or bladder incontinence. In this article, we present the regulatory conditions in place in California that need to be satisfied in order for an individual with managed incontinence to be able to reside in an assisted living community licensed by the state. 

Methods to Manage Incontinence in an Assisted Living Community

The state of California requires that an assisted living resident’s incontinence be managed in the following ways:

  • Self-care undertaken by an assisted living resident personally
  • A structured bowel or bladder retraining program designed to assist an assisted living resident in restoring a normal pattern of continence
  • A program of scheduled toileting at regular intervals throughout the day (or night, if necessary)
  • The use of incontinent care products

Responsibilities of Assisted Living Community for Resident Incontinence Management

California law requires an assisted living facility to provide the following support and assistance for a resident with managed incontinence:

  • Ensuring that residents of an assisted living community 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 assisted living 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 resident incontinence.
  • Ensuring that bowel or bladder programs are designed by an appropriately skilled professional with training and experience in care of elderly persons with bowel or bladder dysfunction and development of retraining programs for restoration of normal patterns of continence.
  • Ensuring that the appropriately skilled professional developing the bowel or bladder program provide training to facility staff responsible for implementation and maintenance of the program.
  • Ensuring that re-assessment of the resident’s condition and the evaluation of the effectiveness of the bowel or bladder program be performed by an appropriately skilled professional at suitable intervals.
  • Ensuring that the condition of a resident’s skin exposed to urine and stool is evaluated regularly as a means to ensure that skin breakdown is not occurring.
  • Privacy shall be afforded when incontinence 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 the staff and administration of an assisted living facility.

Types of Urinary Incontinence in Older Adults

There are four causes of urinary incontinence that most frequently occur. These are:

  • Stress incontinence occurs when urine leaks as pressure is put on a person’s bladder. This can occur during exercise, coughing, sneezing, laughing, or lifting heavy objects. This is the most common type of urinary incontinence among women. It’s the most common type of bladder control problem in younger and middle-aged women. 
  • Urge incontinence happens when people have a sudden need to urinate. With this type of urinary incontinence, a person cannot hold his or her urine long enough to get to the toilet. Urge incontinence is a problem more common among people with Alzheimer’s disease, multiple sclerosis, diabetes, Parkinson’s disease, or stoke. 
  • Overflow incontinence occurs when small amounts of urine leak from a bladder that is always full. This occurs in a man who has an enlarged prostate that is blocking the urethra. Diabetes and spinal cord injuries can also be the underlying cause of overflow incontinence.
  • Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it more difficult for them to move rapidly.

Types of Bowel or Fecal Incontinence in Older Adults

There are nine underlying causes of bowel or fecal incontinence that more frequently occur. These are:

  • Muscle damage is a common cause of fecal incontinence. Injury to the rings of muscle at the end of the rectum, or the anal sphincter, can make it difficult to hold stool back properly. This kind of damage can occur during childbirth. This is especially the case if a woman has an episiotomy or forceps are used during delivery.
  • Nerve damage is another underlying cause of fecal incontinence. Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can result in fecal incontinence. This type of nerve damage can be caused by a number of reasons that include:
    • Childbirth
    • Constant straining during bowel movements
    • Spinal cord injury
    • Stroke

In addition, some diseases, such as diabetes and multiple sclerosis, can affect these nerves and cause damage that results in fecal incontinence.

  • Constipation can result in fecal incontinence. Chronic constipation may cause a dry, hard mass of stool to form in the rectum and become too large to pass. This is also known as impacted stool. The muscles of the rectum and intestines stretch and eventually weaken. This results in watery stool from farther up the digestive tract to move around the impacted stool and leak out. Chronic constipation may also cause nerve damage that results in fecal incontinence.
  • Diarrhea can result in fecal incontinence. Solid stool is easier to retain in the rectum than is loose stool. Loose stools of diarrhea can result in or worsen fecal incontinence.
  • Hemorrhoids cause fecal incontinence in some instances. When the veins in your rectum swell, causing hemorrhoids. This prevents a person’s anus from fully closing. As a result, stool will leak out.
  • Loss of storage capacity in the rectum is a potential cause of fecal incontinence. Normally, the rectum stretches to accommodate stool. If a person’s rectum is scarred or stiff as the result of surgery, radiation treatment, or inflammatory bowel disease, the rectum can’t stretch as much as is necessary. This can result in excess stool can leak out.
  • Surgery can result in fecal incontinence. For example, surgery to treat hemorrhoids as well as other types of operations that involve the rectum and anus, can result in muscle and nerve damage. In turn, this can lead to fecal incontinence.
  • Rectal prolapse can result in fecal incontinence. This occurs when the rectum drops down into the anus. The stretching of the rectal sphincter by prolapse damages the nerves that control the rectal sphincter. The longer this persists, the less likely the nerves and muscles will recover and function normally
  • Rectocele is yet another cause of fecal incontinence. This occurs when the rectum protrudes through the vagina. It can result in fecal incontinence.