More nursing care facilities take no-diaper approach: Japan

Help may be at hand for elderly people who need assistance in carrying out their bodily functions but are unhappy--or embarrassed--about having to wear diapers.

Nursing care services find extensive use of diapers creates additional expenses and a need for extra staff, so they are adopting a new approach aimed at reducing their employees' workload and making life more pleasant for the senior citizen under their care.

When one 80-year-old woman asked nurses at a hospital to change her diaper, they responded, "Have you gone to the toilet again?"

However, after transferring last year to Midori no Sono, a facility for elderly people requiring around-the-clock nursing care in Kanoya, Kagoshima Prefecture, she was persuaded to not wear a diaper.

"When I was in the hospital, the staff would not change my diapers [as often as I wanted] and I felt uncomfortable. But when I took my diaper off, I felt happy," she said.

She said wearing a diaper reduced her desire to urinate or defecate, but her bodily functions returned to normal soon after removing it.

After she discarded the offending garment about a week after entering the facility, her eldest son said, "My mother's face glowed with happiness."

Midori no Sono started reviewing its previous policy in 2009, when 70 per cent of about 80 elderly people at the facility, including short-stay residents, were using diapers. The rate has dropped to about 30 per cent, and staff help take the others to toilets at set times.

Checking for signs

Midori no Sono is not the only facility to adopt this approach.

Facilities around the nation are studying the body language of elderly people, such as whether they act nervously or rock back and forth, to try to learn when they have to go to the toilet. When diaper use for some residents was discontinued they had no problem using the lavatory.

Midori no Sono introduced high-tech equipment to record the bodily functions of its residents. The facility's staff checks on residents' food intake, the quantity of water they drink, the volume of urine and the weight of stools.

In addition, ultrasound equipment measures bladder content before and after urination over a 48-hour period. This data helps staff determine when an elderly person needs assistance to go to the toilet.

The facility previously tried a no-diaper approach. However, in many cases the residents were taken to the toilet only to have nothing happen. The staff became exhausted and the effort was abandoned.

Midori Yoshimoto, head of Midori no Sono, said, "The new approach is based on data we collated, and we are confident we're on the right track."

The facility holds weekly meetings to discuss its new approach with the facility's nutritionists, those in charge of nursing care services, and doctors at an adjacent clinic.

The management of Midori no Sono believes having residents go without diapers and leave their beds to visit the toilet restores not only normal bodily functions but also their pride. It also thinks this motivates its staff to provide better services.

A 26-year-old male nursing care staff member said: "Before, when we prepared to change diapers, the elderly residents would suddenly become expressionless, and I felt extremely uncomfortable."

With the new approach, the staff observe how the residents eat their meals and what expressions and gestures they use as they do so, and it is easier to converse with them, he said.

An added bonus is financial. The facility's annual cost of buying and disposing of diapers has dropped from 6 million yen (S$100,000) to 4 million yen.

Help with bodily functions

Unicharm Corp., a major manufacturer of daily necessities, conducted a survey in 2008 on what kind of services people would need if they required nursing care. The survey covered 542 men and women in their 40s to 80s.

Help with bodily functions topped the list of needs for 92 per cent of those surveyed, indicating this problem was related to the dignity of elderly people.

Midori no Sono's methods have been adopted by 20 other facilities, including Kohoen, a social welfare corporation in Tottori Prefecture.

Shimin no Tachiba kara no Omutsu Herashi Kenkyu Gakkai, a Tokyo-based citizens group studying ways to reduce diaper use, provides guidance.

"Ensuring elderly people's comfort could improve their rehabilitation and prevent infectious diseases," said Tomoe Tanaka, a representative of the group. "We hope nursing care providers will completely review their services, starting with assistance to elderly people in carrying out their bodily functions."