Introducing a dignified approach to continence care in residential aged care

‘Every interaction is an opportunity to uphold or diminish a person’s dignity’ — Dr Joan Ostaszkiewicz

The Royal Commission into Aged Care Quality and Safety heard compelling firsthand evidence that the quality of continence care in Australia’s residential aged care homes does not align with community expectations. Managing incontinence and promoting continence in this setting is a significant issue, and vital to the health and wellbeing of older people.

Research has found that:

  • 73% of aged care residents have urinary incontinence
  • 54% of aged care residents have faecal incontinence
  • 23-71% of aged care residents have constipation.

In 2019, the Continence Foundation of Australia commissioned researchers from NARI to co-design, and pilot test, a best practice model to inform the delivery of continence care in Australian residential aged care homes. The Best Practice Model of Continence Care in Residential Aged Care articulates the characteristics of quality continence care for older people with continence care needs in residential aged care homes. These characteristics are articulated in the following principles. 

Continence care:

  1. Is person-centred through supported shared decision-making
  2. Is clinically informed through an assessment process
  3. Is informed by the best available evidence
  4. Protects a resident’s dignity
  5. Optimises a resident’s functional abilities
  6. Is timely and responsive
  7. Is inclusive and respectful of a resident’s culture, diversity, identity and life experiences
  8. Is safe
  9. Is provided by an appropriately trained and skilled workforce
  10. Is appropriately resourced.

Translated by the Continence Foundation of Australia into Continence SMART Care, the Model is:

  • Person-centred
  • Based on the best available evidence
  • Consistent with the expectations of people with incontinence and their families
  • Designed to support aged care providers to meet or exceed the Aged Care Quality Standards.

In 2021, the International Continence Society awarded the researchers a Best in Category Prize in Geriatrics/Gerontology for their abstract and presentation at ICS2021 about the model.

NARI thank the Continence Foundation of Australia for funding this project, and members of the Project Advisory Group, and expert advisors, who kindly and generously shared their expertise and were vital to the development of this model. Chaired by Dr Susan Hunt (Aged Care Consultant, Leisten Hunt Pty Ltd), the Project Advisory Group included people with the lived experience, and representatives from the Continence Foundation of Australia, the Australian Government Department of Health, Alzheimer’s WA, the Australian Nursing and Midwifery Federation, Bolton Clarke, Carers Victoria, COTA Tasmania, and Edith Cowan University.

You can find out more about the model on the Foundation’s website here: Continence SMART Care

Contact at NARI: Dr Joan Ostaszkiewicz

Or contact the Continence Foundation of Australia