Six weeks after she moved in
Your mother walked to the toilet on her own when she arrived. Now she is in pads, and when you ask, you are told it is "easier for her" or "safer at night". Nobody discussed it with you, and nobody discussed it with her.
This is one of the most consequential changes that can happen to a resident, and very often it is not a clinical decision at all.
Continence is assessed, not assumed
In an older person, incontinence is a symptom with causes, many of them reversible, not an automatic consequence of age. The order is always the same: assess, treat what is treatable, and only then use products.
The Aged Care Quality Standards require care that is safe and effective and that optimises each resident's function and quality of life, planned with the resident. Continence care sits squarely inside that. So the question to put in writing is not "why is she in pads?" but: "She was continent on entry. What continence assessment was done, by whom and when, and what is in her care plan to restore function?"
And note that she remains a Medicare patient: a GP review and, where appropriate, a referral to a continence service or a continence nurse advisor are available to her exactly as they were before she moved in.
What should have happened
- Reversible causes ruled out: urinary tract infection, constipation, diuretics and the time of day they are given, sedatives — and very commonly, simply not reaching the toilet because the walker is out of reach or nobody answers the call bell.
- A toileting program in the care plan: scheduled assistance at set times, matched to her own pattern. This is the most effective intervention and the one most often skipped, because it costs staff time and pads do not.
- Dignity treated as a care planning item. The Statement of Rights covers dignity, respect and control over one's own life. Putting someone in pads who can still use a toilet is not neutral.
The two things that usually caused it
The call bell. Someone who waits twenty minutes twice will stop ringing and wet the bed instead. Ask whether response times are recorded, and what they are overnight.
The night shift. Pads at night are frequently a staffing solution dressed as a clinical one — and in Australia you can check the claim. Providers report care minutes per resident per day and must have a registered nurse on site 24/7. Ask for the overnight roster numbers specifically, because care minutes are a daily average and can be met while the night runs thin.
Then ask the question that separates the two explanations: is she being woken to be changed? Waking someone every few hours who could be walked to the toilet is rostering, not care.
What to ask for now
Ask for a care plan review and for these in writing:
- a continence assessment with a date and a named assessor;
- a toileting schedule with times and who carries it out;
- a pharmacist medication review covering the bladder, including diuretic timing — fundable and requestable through the GP;
- walker and call bell within reach, a clear path to the toilet, night lighting;
- a date to reassess whether pads are still needed.
What not to accept
"It's easier for her." Easier for whom is the question, and the answer belongs in the record.
Pads with no toileting at all. That combination produces skin damage, urinary infections and falls when she tries to get up alone — and both falls and pressure injuries are mandatory quarterly quality indicators the home already reports.
A catheter for convenience. Catheters raise infection risk and require a documented clinical indication, not fewer changes.
If nothing changes
- A written request and a care plan review, with the assessment and schedule documented.
- The provider's complaints process, in writing.
- The Aged Care Quality and Safety Commission, which takes complaints directly and for which dignity, clinical care and staffing are core compliance matters. You can ask that your name not be given to the provider.
- The Older Persons Advocacy Network, free and independent, which will help you put it in writing.
The wider signal
A home that puts continent residents in pads is telling you how it solves staffing problems generally — and here you can check that against the star rating and the reported indicators before you decide anything.
If you have reached that conclusion and do not have another round of calls in you, that is the part we do. Tell us the area, your parent's care needs and what changed here, and you get a shortlist worth calling, for A$109. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here
This article is general information for families, not medical advice. Clinical decisions belong to the treating clinicians, and aged care staffing and reporting rules change over time. Curalune does not allocate beds and does not guarantee availability.