THE FOLLOWING ARE SELECTED EXCERPTS FROM CMS F315 RELATING TO URINARY INCONTINENCE IN NURSING HOMES.
FAMILY HEALTH MEDIA'S 17-MINUTE VIDEO, "TREATING URINARY INCONTINENCE" IS A GUIDE TO BEHAVIORAL METHODS AND IS USED FOR STAFF AND RESIDENT EDUCATION IN LONG TERM CARE FACILITIES THROUGHOUT THE U.S.
THE FULL CMS DOCUMENT CAN BE VIEWED AT www.cms.hhs.gov/transmittals/downloads/R8SOM.pdf
Centers for Medicare & Medicaid Services
§483.25(d) (1) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident’s clinical condition demonstrates that catheterization was necessary; and
§483.25(d) (2) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.
The intent of this requirement is to ensure that: each resident who is incontinent of urine is identified, assessed and provided appropriate treatment and services to achieve or maintain as much normal urinary function as possible;
Options for managing urinary incontinence in nursing home residents include primarily behavioral programs and medication therapy.
Behavioral Programs - Interventions involving the use of behavioral programs are among the least invasive approaches to address urinary incontinence and have no known adverse complications. Behavior programs involve efforts to modify the resident’s behavior and/or environment. Critical aspects of a successful behavioral program include education of the caregiver and the resident, availability of the staff and the consistent implementation of the interventions.
Programs that require the resident’s cooperation and motivation in order for learning and practice to occur include the following:
• “Bladder Rehabilitation/Bladder Retraining” is a behavioral technique that requires the resident to resist or inhibit the sensation of urgency (the strong desire to urinate), to postpone or delay voiding, and to urinate according to a timetable rather than to the urge to void. Depending upon the resident’s successful ability to control the urge to void, the intervals between voiding may be increased progressively. Bladder training generally consists of education, scheduled voiding with systematic delay of voiding, and positive reinforcement. This program is difficult to implement in cognitively impaired residents and may not be successful in frail, elderly, or dependent residents. The resident who may be appropriate for a bladder rehabilitation (retraining) program is usually fairly independent in activities of daily living, has occasional incontinence, is aware of the need to urinate (void), may wear incontinence products for episodic urine leakage, and has a goal to maintain his/her highest level of continence and decrease urine leakage. Successful bladder retraining usually takes at least several weeks. Residents who are assessed with urge or mixed incontinence and are cognitively intact may be candidates for bladder retraining.
• “Pelvic Floor Muscle Rehabilitation,” also called Kegel and pelvic floor muscle exercise, is performed to strengthen the voluntary periuretheral and perivaginal muscles that contribute to the closing force of the urethra and the support of the pelvic organs. These exercises are helpful in dealing with urge and stress incontinence. Pelvic floor muscle exercises (PFME) strengthen the muscular components of urethral supports and are the cornerstone of noninvasive treatment of stress urinary incontinence. PFME requires residents who are able and willing to participate and the implementation of careful instructions and monitoring provided by the facility.