Continence Care

Urinary and faecal incontinence affect up to 80% of people living in residential aged care facilities and are significantly more prevalent in people with dementia. Incontinence is not a normal part of ageing — it is a symptom of an underlying cause that warrants assessment and management. Common causes include: urinary tract infections (UTIs), pelvic floor weakness, prostate enlargement, constipation, immobility, medications (diuretics, sedatives), cognitive decline affecting the ability to locate or use the toilet, and environmental barriers.

A thorough continence assessment should include: • Bladder and bowel diary (frequency, urgency, volume, leakage episodes) • Fluid intake assessment (type, quantity, timing) • Medication review (anticholinergics, diuretics) • Cognitive and functional assessment (ability to reach toilet independently) • Environmental assessment (clear pathway to toilet, grab rails, appropriate seating) • Skin integrity check (moisture-associated skin damage/MASD) • Post-void residual bladder scan (to detect retention) The Minimum Data Set (MDS) and Resident Assessment Instrument (RAI) in Australian aged care facilities include standardised continence domains that must be assessed and documented.

Evidence-based interventions include: 🔵 Prompted voiding: Scheduled toileting every 2 hours with verbal prompts — significantly reduces incontinence episodes in people with cognitive impairment. 🔵 Bladder training: For those with capacity — progressively extending voiding intervals. 🔵 Pelvic floor exercises (Kegel exercises): First-line for stress urinary incontinence in women and men post-prostatectomy. 🔵 Fluid management: Encouraging 1.5–2 L/day of water; limiting caffeine, alcohol, and carbonated drinks. 🔵 Bowel regimen: High-fibre diet, adequate fluids, mobility, timed toileting post-meals (gastrocolic reflex). 🔵 Skin care: Barrier creams, pH-balanced cleansers, absorbent products matched to level of incontinence. 🔵 Assistive devices: Bedside commodes, urinals, raised toilet seats, grab rails.

Absorbent products should match the type and volume of incontinence: • Light incontinence pads (for stress incontinence, light leakage) • Pull-up pants (for mobile individuals with moderate incontinence) • All-in-one/shaped pads (for individuals who are dependent in ADLs) • Bed pads and chair pads (for furniture protection) • Indwelling urinary catheters (only when clinically indicated — associated with UTI risk) • External catheters (condom catheters for men) • Intermittent catheterisation (for urinary retention) Skin integrity monitoring is essential when using absorbent products — change regularly, cleanse gently, apply barrier cream at every change.

🇦🇺 The Continence Aids Payment Scheme (CAPS): CAPS is a direct payment to eligible Australians to help with the cost of continence products. To be eligible you must be 5 years or older, be an Australian citizen or permanent resident, and have permanent and severe incontinence due to an eligible neurological condition, confirmed by a registered health professional. The 2026–27 payment rate is up to $739.40 per person. It is paid annually in July, or half-yearly in July and January, into your nominated bank account. It is not taxable income and does not reduce any other payment you receive. Apply via: Services Australia | servicesaustralia.gov.au/continence-aids-payment-scheme 🇦🇺 CAPS and Support at Home — eligibility changed twice in 2026: Access to CAPS for people receiving Support at Home or the Commonwealth Home Support Programme (CHSP) has moved twice during 2026, so confirm the current position before relying on it: • From 1 November 2025, no new CAPS approvals were granted to Support at Home participants. • From February 2026, CAPS eligibility ended for all Support at Home participants, who could no longer receive continence products through CAPS. • From 1 July 2026, CAPS access was RESTORED for people receiving Support at Home or CHSP, following sustained advocacy by Continence Health Australia. This is the current position and it is a settled government decision, not a proposal under review. Eligible people can now hold CAPS and Support at Home funding at the same time. The CAPS payment is separate from, and in addition to, your Support at Home budget — it is not deducted from it. 🇦🇺 Support at Home — funding classifications (Home Care Packages no longer apply): Support at Home replaced the Home Care Packages (HCP) program on 1 November 2025. It uses EIGHT funding classifications for ongoing services, not the four HCP levels. People assessed as eligible for an HCP as at 31 October 2025 transitioned to an equivalent Support at Home funding level (a former HCP Level 4 maps to a "Transitioned HCP Level 4"), and new assessments use the eight-classification structure. Budgets are allocated quarterly, and amounts are indexed each July. Continence-related support under Support at Home can be funded through: • Nursing care consumables (clinical supports category) — continence products and nursing assessment • Continence nursing management (clinical supports category) • Assistive Technology and Home Modifications (AT-HM) scheme — reusable and washable continence products such as urine bottles, washable absorbent products, and washable underpads for chairs and bedding 🇦🇺 Personal care contributions removed from 1 October 2026: From 1 October 2026, all personal care services on the Support at Home service list move from the Independence contribution category to the Clinical Supports category, and the Australian Government fully funds them. Participants no longer pay an out-of-pocket contribution for personal care services they are approved for and have funding for. The definition of personal care includes non-clinical continence management — so from 1 October 2026 there is no participant contribution for non-clinical continence management delivered under Support at Home. Clinical continence nursing management is already fully funded with no participant contribution. Claims for services delivered before 1 October 2026 still attract a participant contribution, even if they are claimed for after that date. 🇦🇺 National Disability Insurance Scheme (NDIS): Continence supports (products, assessments, nurse visits) may be funded under NDIS for eligible participants aged under 65. 🇦🇺 Free Continence Nurse Advisor Service: The National Continence Helpline connects callers with continence nurse advisors free of charge. 📞 1800 33 00 66 | www.continence.org.au ⚠️ Check for updates before relying on this information: Continence funding under Support at Home has changed repeatedly through 2026. CAPS access for Support at Home participants was removed in February 2026 and restored on 1 July 2026, and participant contributions for personal care — including non-clinical continence management — were removed from 1 October 2026. Given how recently and how often this has moved, confirm the current position with Services Australia, the Department of Health, Disability and Ageing (health.gov.au), or Continence Health Australia before advising a client, resident, or family member.

Continence care must be delivered with compassion, privacy, and dignity: • Always knock and seek permission before entering for care • Use preferred language — ask the person how they refer to toileting (e.g. "bathroom", "the loo") • Never leave someone exposed unnecessarily during care • Maintain a non-judgmental, calm tone — incontinence causes significant shame and embarrassment • Document all incontinence episodes accurately — volume, colour, consistency, associated pain • Report any change in continence pattern immediately — it may signal infection, delirium, or medication side effect • For people with dementia: use visual cues (open toilet door, contrasting toilet seat colour), regular toileting reminders, and familiar language