Incontinence products: trends in upgrading.

Manufacturers are pioneering better care - but will providers and government payers follow?

Many experts cite incontinence as the most common reason for nursing home placement. At least half of all nursing home residents are affected by incontinence and the annual cost of caring for those individuals exceeds $3 billion. It follows, then, that incontinence products and devices are big business: catheters, containment systems, washes, moisturizers, barriers, and so forth.

What's more, the business is broadening its territory. Take assisted living, for example. Where once incontinence "disqualified" individuals for acceptance into assisted living, leaving nursing homes as the only - and often inappropriate - alternative, today the trend is toward accepting individuals into assisted living who are able to manage their own incontinence. Products are evolving to expedite this.

Though R&D in this field appears to focus more on product upgrades to meet consumer needs, rather than on introducing entirely new and different products, this apparent trend is very much technology-based. It coincides with an increased understanding of incontinence, especially as it relates to skin care, nutrition and resident comfort and dignity.

Exemplifying this product development trend is Procter & Gamble, a major player on the incontinence/skin care scene for more than 15 years. As defined by a P&G spokesperson, the trend is toward better technology in the form of products that move beyond basic containment needs - which are already being met fairly well by many products - toward improvements that help to meet higher-level needs related to skin health and breakdown prevention, as well as comfort and dignity.

More specifically, vendors are marketing products designed to draw wetness away from the skin more quickly and lock it away more effectively. A case in point is P&G's recent full-line upgrade of its widely-used Attends products with what they call PermaDry technology, which actually lowers the pH of urine, bringing it closer to the natural pH of the skin. This development is based on the understanding that the high pH of urine is irritating and more likely to cause breakdown. Wetness is also wicked away from the skin more rapidly with new fast-absorption curly fibers and locked away more effectively through the use of AGM, a super-absorbent polymer.

P&G predicts that these types of features will become more and more common in containment products, and will be part of a cost-effective management strategy for many facilities.

Another P&G upgrade involves its washcloth. According to the spokesperson, the new Attends Skin Protectant Washcloth cleans and moisturizes, as before, but now incorporates PeriSeal, a dimethicone that creates a barrier to wetness. This upgrade is based on an FDA monograph indicating that products with this medical-grade dimethicone were found to help treat and prevent perineal dermatitis. Its application may eliminate the needs for creams or other barriers (and, P&G says, will be provided at no additional cost).

There is yet another new aspect to this product development trend - staff training to use the products appropriately. P&G's case-in-point is its Attends Caring Practices Education Program, consisting of multimedia educational and staff training modules on all aspects of incontinence care. The concept, in short, is a product system. It consists of the products, the technologies to deliver and maximize their benefits, and staff education and other vendor services in support of appropriate use. It is a marketing concept that may well become the industry norm.

No amount of sophisticated product development or marketing will work, however, without a receptive audience - and that is where nursing home administration comes in. Even though prevention of skin disorders is a common theme with today's upgraded products, facilities applying for reimbursement for such care know all too well that the government lags behind the industry in realizing the cost-effectiveness of prevention. The bottom line is, "facilities follow funding," and prevention is neglected. Managed care, with its own incentives toward cost-saving prevention, may help change that, but for now it remains a relatively small influence in the market. It is therefore up to administration to purchase cost-effective products and document its wisdom in doing so. Then maybe "funding will follow facilities," for once, and beneficiaries will actually benefit from the industry's progress.