The nursing costs of urinary incontinence in a nursing home population

The labor resources and costs of caring for incontinence in a nursing home population are explored. Data from a work measurement study have been applied to patient assessment results to estimate the total costs of labor for three states and the U.S. as a whole. Incontinence care costs an estimated $1.1 billion per year in the US; this represents 3 to 4 per cent of all Medicaid payments made to nursing homes.

Incontinence. Implications for health care policy

The impact of health policies on the delivery of health services to the elderly must be considered a high priority by public policy makers. Incontinence is symptomatic of a major health policy crisis in the care of the elderly.

Reduction of urinary incontinence in nursing homes: does it reduce or increase costs?

Labor and supply costs associated with the care of urinary incontinent patients in three nursing homes were measured. First, normal nursing home changing patterns and their associated costs were measured. Second, the costs were documented when patients were checked by research staff and changed on an hourly basis as needed. Nursing home staff changed patients significantly less frequently than patient voiding as detected by the hourly checking system. Thus, cost of incontinence during the hourly checking condition ($3.35) per 12-hour patient-day was significantly higher than the cost normally incurred in nursing homes ($1.52) per 12-hour patient-day. The cost of an incontinence rehabilitation program, which significantly reduced incontinence episodes, was contrasted to the cost of incontinence as measured under both of the previous conditions. The rehabilitation program produced significant labor and supply savings only when compared with the hourly checking and changing system. Maintaining patients in a more continent condition costs significantly more than the direct incontinence cost normally incurred by the nursing home. Quality of life and other second-order benefits must be considered if continence rehabilitation is to be judged cost-effective.

The economic impact of urinary incontinence

This article provides a conceptual framework for estimating the economic impact of urinary incontinence on the society. Using this framework, the cost of urinary incontinence is estimated to be about $8 billion annually: $2 billion for nursing homes and $6 billion for the community setting. Because of a lack of reliable epidemiologic and health care utilization data, these estimates should be considered primarily illustrative. They do, however, underline the potential economic benefits to the society of reducing the incidence of urinary incontinence among the elderly.

What's best--reusable or disposable incontinence products?

To use paper or cloth? The director of nursing for a 72-bed intermediate care facility opted to continue using reusable incontinence products based on the results of a three-week study conducted by her staff.

Case-mix and resource use in long-term care

This study developed a case-mix patient classification system for long-term care. Patient assessment and resource consumption data, collected for 1.151 patients within 23 hospital-based and freestanding long-term care facilities in California, were used to develop a patient classification system made up of 13 homogeneous patient groups. The 13 groups, formed on the basis of nine patient assessment variables, explained 68.5% of the overall variance in resource use. The relatively high variance reduction achieved in the creation of a limited number of groups demonstrates the feasibility of developing measures of case mix based on patient resource use for long-term care. Case-mix classification may provide a useful tool for long-term care reimbursement reform.

The costs of urinary incontinence in nursing homes

A simple model was used to calculate the contribution of urinary incontinence (UI) to the costs of nursing home care. First-order costs are defined as the costs of managing UI: supplies, laundry, and labor. Second-order costs are defined as the costs of managing the complications of UI. Data were gathered from nursing homes, medical supply companies, and a large laundry company. First-order costs of four common methods of managing UI range between $ 3.00 and $ 11.00 per incontinent patient per day. Based on these estimates, UI accounts for between $ 0.5 and $ 1.5 billion (3-8%) of the costs of nursing home care. Management of UI with indwelling catheters results in the lowest first-order costs, but the second-order costs (as well as the potential increased morbidity and mortality risks) probably outweigh any cost savings. More active evaluation and treatment of UI in nursing homes could result in considerable cost savings and improved well-being for both patients and caregivers.

Some issues in the clinical, social and economic evaluation of new nursing services

This paper describes a study of a new nursing post, that of the adviser on incontinence. Some of the difficulties encountered in the study were the composition of a study and control group and evaluation of change in urinary incontinence. Retrospective checks on the two groups showed that the items in which they differed did not have any relationship with changes in incontinence or its management. The findings were unable to support the Regional Health Authority's hope that hospital admissions would be reduced or the more general belief that overall resource use would decline. In addition to improvements in incontinence half the subjects identified other benefits such as increased understanding of the problem and the opportunity to discuss it with someone with a knowledge of incontinence. Issues were also raised of the organization and nature of the advisers work load.