Incontinence Care: Racial Disparities in Nursing Homes (Research, Video 1:12)

Incontinence occurs when patients are unable to restrain natural discharges or evacuations of urine or feces. Their ability to control bowel and bladder functions ranges from needing toileting assistance to having no control and being completely dependent upon caregivers to prevent pressure ulcers and infections. Few actions toward patients are more disrespectful and humiliating for them than caregiver neglect of incontinence. In addition to promoting patient well-being, preventing incontinence can reduce healthcare treatment costs.

Research on incontinence care was done to determine the prevalence of older continent adults who received primary prevention of incontinence at nursing home admission, to assess whether there were racial or ethnic disparities in incontinence prevention, and to describe factors associated with any disparities. Disparities were analyzed for four minority groups with these results:

1)   Twelve percent of nursing home admissions received incontinence prevention.

2)   There was a significant disparity (2%) in incontinence prevention for Blacks. Fewer Black admissions were observed to receive incontinence prevention than was expected had they been part of the White group.

3)   The percentage of White admissions receiving incontinence prevention was 10.6%. No disparity disadvantage for the other minority groups was found.

Racial disparities such as this are not only healthcare tragedies, but moral ones. Like many other healthcare disparities, equitable incontinence prevention at the time of nursing home admission is an attainable goal that continues to go unmet. There is a tendency among some healthcare workers to assume that the solution to this problem rests with leaders of the institution when, in fact, it belongs to each person making up the institution. In spite of overwhelming research to the contrary, most healthcare workers continue to say they treat everybody the same. Recognition of the problem is the first step toward improvement.

Research on disparities often concludes with the need for staff training, organizational commitment, and monitoring to eliminate disparities. These are all obvious and appropriate strategies for eliminating disparities. But, until ongoing conscious commitment and actions in equitable practices are made by every healthcare worker to make that happen, vast numbers of particular patient populations will continue to be unjustly victimized. 

Disparities impact not only the victims, but also their families, communities, and ultimately our nation. In addition to generational suffering and repercussions on numerous levels, disparities create long-term economic burdens and major losses of productivity. Racial and ethnic disparities must be eliminated before America will ever realize true equality in healthcare among its diverse populations.

The following video explains the importance of incontinence care from the perspectives of patients and their caregivers:

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
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