A Behavioral Analysis of the Labor Cost of Managing Continence and Incontinence in Nursing Home Patients

Abstract

Two hundred and thirty-one continent and incontinent patients in three nursing homes were assessed as to their ability to independently toilet. A 21-item behavior checklist (Independent Toilet Assessment Inventory) reliably categorized patients into four categories ranging from total independence to total dependence. There were significant differences between continent and incontinent patients with continent patients more capable of idependence (x² = 190.5, p < .001). Seventy-eight percent of the incontinent patients were incapable of independent toileting. Direct time observations of 116 cleaning and 132 toileting episodes revealed that assisting a patient in toileting consumed more time than simply changing an incontinent patient (7.97 minutes versus 5.55 minutes, t = 2.97, p < .004). This time differential means it takes nursing staff more time to maintain continence in a dependent patient than it takes to manage incontinence. The implications of the work incentive to maintain incontinence is discussed from a management perspective.