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 something you assess, not something you assume
NICE guidance and NHS continence services are built on a simple sequence: assess first, treat what is treatable, and only then consider containment products. Incontinence in an older person is a symptom with causes — many of them reversible — not an inevitable consequence of age.
So the question to put in writing is not "why is she in pads?" but: "She was continent when she moved in. Has she had a continence assessment, by whom and when, and what is being done to treat the cause?"
And note that moving into a care home does not remove NHS entitlement. Your mother is still registered with a GP and can still be referred to the community continence service. That referral is available and routinely not made.
The pad allowance question
Here is the part families rarely challenge. Continence products supplied through the NHS are meant to follow an individual assessment of need. A home that works to a fixed number of pads per resident per day, regardless of assessment, is running a stock control policy, not a care plan — and if the consequence is that your mother is left wet because the allocation ran out, that is a dignity issue and a safeguarding one.
Ask directly: "Is her pad provision based on her individual assessment, and what happens when more are needed?"
What should have happened instead
- Reversible causes ruled out: urinary infection, constipation, diuretics and the time of day they are given, sedatives — and, very commonly, simply not being able to get to the toilet because the frame is out of reach or nobody answers the call bell.
- A toileting plan in the care plan: scheduled assistance at set times, prompted toileting, 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.
- Her dignity considered. Being put in a pad when you can still use a toilet is not neutral. Person-centred care and dignity are fundamental standards, not aspirations.
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. Ask how many staff are on at night for how many residents — England has no national minimum ratio, so the home must be able to explain how it decided its numbers — and ask whether she is 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, and a referral to the community continence service;
- a toileting schedule, with times, and who carries it out;
- a medication review covering the bladder, including when diuretics are given;
- the frame 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 causes skin damage, urinary infections and falls when she tries to get up alone.
A catheter for convenience. Catheters cause infections and are for documented clinical need, not for saving changes.
If nothing changes
- A written request for a care plan review with the manager and the GP, with a date.
- The home's complaints procedure, then the Local Government and Social Care Ombudsman.
- The local authority safeguarding team, if she is being left wet or pads are rationed to her detriment.
- CQC, for whom dignity and person-centred care are fundamental standards — it will not resolve your case, but this is exactly the pattern it inspects.
The wider signal
A home that puts continent residents in pads is telling you how it solves staffing problems generally.
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 needs and what changed here, and you get a shortlist of homes worth calling, for £69. 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 or legal advice. Clinical decisions belong to the treating clinicians, and continence service arrangements differ across England, Wales, Scotland and Northern Ireland. Curalune does not allocate beds and does not guarantee availability.
