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OPINION

How to make someone incontinent overnight

  • 2 Comments

How can we as nurses preserve the dignity of patients when all that we strive to do to maintain this is taken away in an instant without thought of the patient?

A recent news story concerned the dignity of a celebrated former prima ballerina. She was told by the country’s most senior judges that the State has no duty to provide her with a helper so she can live with dignity in her own home. This Lady had a stroke in 1999 which had left her with limited mobility and a small neurogenic bladder which meant that she needs to urinate 2-3 times a night. Her care package included night time carers to ensure she was able to get to the toilet during the night. This was unfortunately withdrawn by the local Council to save money (£22,000) and she was supplied with pads for the night although she was not incontinent!!

She went to the Supreme court to appeal this judgement but all the Judges except one said she had no right to demand a helper and that social workers were within the law when they withdrew the carer

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She stated that ‘I have the right to live with dignity, and for me that means to be able to go to bed knowing that I have the help I need to go to the toilet in the middle of the night. Having night-time care would give me the freedom not to worry all day about what will happen at night.’

This lady will now become incontinent as she will have no other option if there is no help to get her to the toilet at night. This, as we know, could lead to serious complications such as incontinence associated dermatitis leading to skin breakdown and possible pressure sores. Urinary infections which if then treated with antibiotics could make her faecally incontinent! Insertion of a catheter with all the associated risks! Need I go on! It’s much more than just her dignity that has been taken away from her and I wonder how many other people this is this happening to that that are not able to appeal their case in court.

The RCN (2008) suggests that “when dignity is present people feel in control, valued, confident, comfortable and able to make decisions for themselves. When dignity is absent people feel devalued, lacking control and comfort. They may lack confidence and be unable to make decisions for themselves. They may feel humiliated, embarrassed or ashamed”. I would suggest that this lady and many others like her have gone from the beginning of the statement to the end overnight!

Obviously I am only aware of what I heard and read about the case and don’t know the full facts but it does highlight the issue of making people incontinent when they don’t need to be! Undoing all the hard work that we do to ensure that people either regain their continence or prevent them from becoming incontinent therefore promoting rather than diminishing their dignity.

Wendy Ness, Association for Continence Advice.

  • 2 Comments

Readers' comments (2)

  • Gemma Watford

    I think this is an outrageous statement made by the council, refusing this elderly lady the right to comfort and dignity in her own home, via social work help, to have a carer on night duty, just to save £22,000! The cost of treating the incontinence alone would amount to more than that per year, with endless rounds of antibiotics, unecessary catheterisation, pressure sores, faecal incontinence and dermatitis that this would cause. so someone out there please show this lady the humanity she deserves in being able to prevent incontinence in the first place! the aim here is to promotion of continence and independence, so she can live a normal life. Hope this will send the message to ignorant, cost cutting councils with no thought for the people they serve in tbheir community, shame on you!

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  • Unfortunately this is not new! As continence care is classed as social and not health by many areas, the social care is only allowed for maximum of 4 calls a day; this includes waking hours only. No care for overnight. This has been the case for years in many areas.
    Community services have to provide a pad absorbent enough to cover urination overnight which for many elderly people is increased due to nocturnal diuresis. And yes the risk of skin damage. UTIs etc then increases. Faecal incontinence is dealt the same way.

    Continence assessments have to be thorough and if there is risk of skin damage and/or UTIs etc this needs to be brought forward to highlight the need for health care rather than social.

    Continence assessments also have to show that all treatments have been explored and all management other than pads have been tried. Older people with co-morbidities plus bladder or bowel dysfunction should be offered referral to specialist services such as a Geriatrician specialising in bladder & bowel dysfunction. This is not happening.
    Pads are usually seen as the first and last solution.

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