Incontinence/UTI in SNF/AL

[dxbcoaching]

Hi all,

My late grandfather had heavy incontinence and contracted UTI. I started researching this and quickly realized that other seniors (especially with dementia) face similar issues in nursing homes/assisted living. Being an entrepreneur, my goal would be to compile feedback and create solution to resolve this. Would appreciate insight into following questions:

1) How often do UTI's occur in a 30 day period at a SNF/Assisted living and is this mostly due to hygiene issues or old age?

2) It seems like nurses do a rotation every 2 hours to check on diapers. Is this the case in majority of SNFs and Assisted living? Would aide change diaper in between the 2 hours or does senior just sit there with soiled diaper?

3) if they are truly sitting there for 2 hours waiting to be changed, seems like higher chance of UTI occurrence. If UTI does happen, how long does it typically take to recover and is there a cost to SNF/AL?

4) Who pays for the incontinence supplies at SNF/Assisted Living Homes? Is it all paid privately by patient or does medicare/mediaid partially/fully cover the cost? Tad confused on this

5) I'm looking to get feedback from geriatric nurses to ensure I'm making a solution that helps nurses/seniors. I visited SNFs/ALs in area but keep getting referred to Director of Nursing who are not responsive. Are there conferences or events you'd recommend I check out (I'm in SoCal) where I'd be able talk to multiple nurses?! I'd truly appreciate quick phone convos with nurses on this forum.

Thanks so much and look forward to your responses.

Warm Regards

[amoLucia]

Just to tell you, facility-acquired UTIs are NOT looked upon kindly by CMS or other survey agencies. I know that the MDS process looks at new onset of incontinence after admission.

So like I said, it is a very touchy subject for SNFs/ALs. I'm NOT surprised that you are meeting resistance from DONs who are reluctant to discuss the issue at their facilities.

Now I am fuzzy on this (I retired 6+ years ago) but I think facilities are reimbursed by diagnosis. If a negative dx occurs, like a facility-acquired UTI or decubitus ulcer (bedsore), the facility 'eats' the costs for care & treatment. Routinely, costs for supplies are bundled into reimbursement (like for meals and clean linens), but the facility can't claim the new UTI or bedsore.

Funny thing that I always thought about is how many pts admit to the facility with already present, but undiagnosed UTIs??? Asymptomatic UTIs are quite common in the elderly. If a UTI is NOT causing any problems, then who knows it's there? Causes of UTIs vary. Because of the different anatomies, women are very prone to UTIs. But it is an equal-opportunity infection for men too. Hygiene is but one cause.

Diagnosis and treatment depends on whichever germ is at fault; quite freqently E.coli, a germ in BM, is at fault. But a sterile urine specimen needs to obtained and analyzed in a lab to clearly identify the causative germ. Then the appropriate antibiotic is selected for treatment. Germs are becoming very smart and resistant to many of the good 'ole standby antibiotics, so new ones must be used. And they're costly, be they oral or IV meds. And some infections don't clear up due to germ resistance. This information is easily found, even in fundamental nsg books.

By your questions asked, I am getting the impression that you are NOT a nurse, nor do you have any real exposure to healthcare. So to tell you, usually, the task of incontinence care falls to the ancillary nurse aide staff (CNAs). And yes, they usually/routinely do diaper checks every 2 hours or so for any urine/BM incont. But they have multiple pts, so they start one end of their assignment and work the way down. By the time they finish one round, it's time to start all over again. But the biggest issue they face is that just as fast as they check and walk away from a 'dry' pt, then oops, that pt becomes incont. Just that fast!!! And they won't be checked again until the next 2 hour check!

Not the optimum system, but I can't think of any other except for a pt to receive private duty care. And that rarely happens. And NO, facilities will not be increasing their staffing ratios. I'd be curious what your ideas are. If you can build the 'better mousetrap', then good luck!

[CoffeeRTC, BSN, RN]

We try to toilet residents every two hours. Same for the incontinent residents...check and change every two hours. Does this always happen? Sad, but no. Staffing is the biggest barrier we encounter. Two CNAs to take care of 24-48 patients?

Incontinence care is more than just changing a soiled brief. Making sure proper peri-care is provided is important. Hydration in also key. Lots of elders do not drink enough fluids. Private duty care would be awesome :)