Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care

Australas J Ageing. 2016 Jun;35(2):119-26. doi: 10.1111/ajag.12218. Epub 2015 Sep 13.

Abstract

Aim: Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care.

Methods: Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures.

Results: Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use.

Conclusion: There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities.

Keywords: incontinence; quality of health care; regulation; residential aged-care facility.

MeSH terms

  • Accreditation
  • Attitude of Health Personnel*
  • Australia
  • Benchmarking
  • Fear*
  • Fecal Incontinence / diagnosis
  • Fecal Incontinence / economics
  • Fecal Incontinence / therapy*
  • Government Regulation*
  • Grounded Theory
  • Guideline Adherence
  • Health Knowledge, Attitudes, Practice*
  • Homes for the Aged* / economics
  • Homes for the Aged* / legislation & jurisprudence
  • Homes for the Aged* / standards
  • Humans
  • Incontinence Pads
  • Interviews as Topic
  • Nursing Homes* / economics
  • Nursing Homes* / legislation & jurisprudence
  • Nursing Homes* / standards
  • Policy Making
  • Practice Guidelines as Topic
  • Process Assessment, Health Care* / economics
  • Process Assessment, Health Care* / legislation & jurisprudence
  • Process Assessment, Health Care* / standards
  • Professional Competence
  • Quality Indicators, Health Care* / economics
  • Quality Indicators, Health Care* / legislation & jurisprudence
  • Quality Indicators, Health Care* / standards
  • Treatment Outcome
  • Urinary Incontinence / diagnosis
  • Urinary Incontinence / economics
  • Urinary Incontinence / therapy*