Treating incontinence-related skin issues is a financial and clinical conundrum.

While such incontinence problems have no direct impact on reimbursement, the costs of caring are significant, according to Gentell Wound and Product Specialist Ellen Thompson, BSN, RN, CWS, FACCWS.

“Incontinence skin problems do not bump a facility up in pay [PDPM] category,” acknowledged Alli Renfroe, RN, director of nursing at Maplewood Care Center in Tulsa, OK.

“Toileting hygiene assistance falls under Section GG for ADL scores, but there is no specific mention of incontinence-related skin problems,” added Nelda Bell, LVN, MDS nurse at White Settlement Nursing Center in White Settlement, TX. 

Still, long-term care providers need to stay focused on maintaining dignity and preventing skin complications, said Crystal Luna-Anderson, director of clinical services for the Medline Post-Acute Skin Health Team. Unfortunately, initial assessments that don’t identify bowel and bladder issues or, worse, severity, could lead to overlooked prevention strategies, unintended pressure injuries and higher costs, Luna-Anderson added.

Leah Klusch, RN, BSN, FACHCA, executive director of the Alliance Training Center, believes seniors are still not being properly assessed for their level of continence or incontinence at time of admission. 

Moreover, incontinence and urinary tract infections (UTIs) can be overlooked as related issues. 

“[Urinary tract infections]are a frequent reason for elder health status decline, and while documentation of it on the MDS doesn’t have a direct influence on rates, it does have a tremendous negative impact on quality measures and Five-Star [Quality Rating System],” Klusch added.

Bladder training is essential.

“If a resident has a pressure ulcer and incontinence was a contributing factor, then the development of an individualized toileting program has an impact on both the care plan and the reimbursement,” explained Amy Stewart, vice president of curriculum development for the American Association of Post-Acute Care Nursing.