Solving Clinical and Economic Issues Related to Heavy Adult Incontinence in Retirement Homes – Marketplace Columns

James Bogner, Ph.D., MBA, MA

Case studies conducted by directors of nursing (under the supervision and involvement of executive directors/facility administrators) using a new category of products with extreme absorption (defined as approximately 200% to 300% greater state of the art products – high absorbency adult incontinence briefs) that were conducted in 2021 and 2022 showed promising results.

Both were clinical outcome studies rather than purely commercial studies, although beneficial economic outcomes were also documented during the studies. The residents enrolled in the studies had all been diagnosed with uncontrolled heavy incontinence before, during and after the trials, and they required 24-hour nursing care and assistance.

No outside representatives (such as manufacturer or distributor personnel) interacted with a caregiver or resident, except in rare instances where a director of nursing might occasionally provide direct nursing care to a resident – e.g. example, to cover a staff shortage. Notwithstanding the infrequent exception above, interaction with the company representative was limited to the initial pre-study meetings with facility management (i.e. the Director of Nursing and Executive Director) to include providing instructions for use for incontinence products used in resident testing and sizing, which involved using resident hip and waist measurements and mapping resident heights and weights on the manufacturer’s size chart.

DONs and/or EDs provided instructions for use to staff, and 17,100 data points were recorded by staff members and analyzed by study investigators during the combined two months of testing.

The same brand of extremely absorbent adult protective briefs and underwear was used in both case studies (NorthShore brand of NorthShore Care Supply [NSC] based in Green Oaks, Illinois).


For incontinence-associated dermatitis, 99.3% of study participants had healthy skin throughout the trial. Through clinicians’ use of a five-point skin rating scale in the Facility 2 trial, the use of extreme absorbent products in accordance with the manufacturer’s instructions for use allowed to register 98.6% of the skin condition of the test residents at the most favorable level (healthy, no irritation). There was no evidence that infrequent product changes (eight hour protective underwear, 12 hour adult briefs) had any adverse effect on residents’ skin. There were no skin lesions.

With respect to urinary tract infections, there were no new diagnoses of urinary tract infections among trial residents during the trial period. Thus, although an eight-hour protective undergarment and a 12-hour adult brief go beyond traditional “two-hour check-and-change” paradigms or other clinical perspectives on the presence of urine and stool like Because of IAD or UTI, the use of the extreme absorption products in the trials did not align with these traditional paradigms and clinical opinions.


The number of uninterrupted nights of sleep between 10 p.m. and 5 a.m. increased fivefold. On average, each resident experienced four to five nights of uninterrupted sleep during each trial week, compared to zero nights of uninterrupted sleep during the baseline data collection week.

Use of detergent/laundry

There was a complete elimination of linen changes and associated washing of sheets that were used during the case study data collection period.


Extrapolating the data from the trial on the reduced time associated with fewer incontinence product changes, it can be seen that in a facility of 50 residents that matched the clinical presentation of the case study residents (c’ i.e. diagnoses of heavy and uncontrolled incontinence before, during and after the experiments, and requiring 24-hour care and assistance), the social impact for the establishment would be 1,000 hours saved per month (possibly redeployed to other care activities using these freed up hours, or creating a reduced need for manpower while maintaining care activities unchanged). With 70 residents, this would equate to nine fewer full-time equivalents needed per week.


Through a combination of reduced product usage and reduced labor, the annual financial effect for facilities was determined to be $8,467 in cost savings per resident. Adding in savings from reduced laundry, reduced adjunctive skin therapies, reduced mortality and comorbidities would add an additional financial benefit to a facility.


Following the upcoming publication of the full studies in a peer-reviewed clinical journal, one or more large-scale randomized controlled trials of the emerging new product class of adult incontinence products can be expected to extreme absorption (as defined in this article) be initiated to further validate the results presented in these two small case studies.

With external research comprising a large enough sample, statistically significant and clinically meaningful results can be documented on this emerging category of adult incontinence products and its implications for IAD, UTIs, clinical work/staff levels, clinical work utilization, laundry/laundry utilization, improved resident sleep and its associated clinical benefits, decreased frequency of resident falls, improved resident hydration at night and others dynamics associated with the care of incontinent residents in residences for the elderly.

James Bogner, PhD, MBA, MA has 35 years of experience in the medical industry in 50 US states and over 40 countries, 25 of which have included his employment by three different manufacturers in the adult incontinence industry . He earned his Ph.D. and M.S. from Fielding Graduate University and his MBA from University of California, Los Angeles. Bogner is vice president of corporate strategy for NorthShore care provision, the company whose products were used in the case studies. Bogner had no interaction or relationship with the case study facilities or study participants before or during the trials.

The opinions expressed in each McKnight Senior Residence market column are those of the author and are not necessarily those of McKnight Senior Residence.

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