Urinary incontinence (UI) adversely affects the quality of life of older adult long term care home residents. Delivering care is time consuming but the amount of time spent is largely unknown as existing data show discrepancy between times reported by staff versus simulation labs. Therefore, this study aimed to objectively measure time spent by long-term care staff on continence care tasks.

This observational study examined time spent in continence related tasks (product check, product change, toileting assistance, product leakage requiring clothes and/or bed linen change, applying treatment for very severe skin problems related to incontinence associated dermatitis). The time spent in continence related tasks was recorded by a stopwatch for each of 5 dependency profiles ranging from mostly independent with occasional toileting support, to care dependent residents requiring full toileting assistance. For each of the need profiles, a minimum of 10 observations during the day shift (7am - 7pm) and a minimum of 4 observations during the night shift (7pm - 7am) were made. Time spent on each continence related task was calculated using descriptive statistics. Field notes were taken by the observer to understand the context in which the continence related tasks were undertaken. Prior to the start of the study, the observer spent some time in the long-term care facility to familiarize themselves with the continence related tasks, the unit routine and for the staff and residents to become comfortable with an observer being present.

The most time-consuming day shift task was toileting assistance with pad/product change. The mean (SD) time (mins, seconds) for profiles for less dependent residents was 7’57 (5’32) and, for more dependent residents, 10’28 (4’57). Pad/product check/change during the day shift took a mean (SD) time of 4'07 (7'30) for less dependent residents and 2’19 (2'25) for more dependent residents. For night shifts, the mean (SD) time for toileting assistance with pad check/change was 2'31 (0'54) and 9' 15 (4’23) for less and more dependent residents respectively. The mean time for pad check/change followed by skin care was 3’10 (1'21) for less dependent and 3’54 (1'31) for more dependent residents.

Considerable time is spent in the delivery of continence care but tasks are often intertwined with others, making estimates difficult. Some tasks, such as pad/product check and change for more dependent residents took less time than might be expected as two staff were available to assist the resident. Toileting assistance for the more dependent residents was seldom performed during the night shift. Results from a single care home may lack external validity.

The results of this study allow assessment of potential efficiency gains in the workplace brought about by interventions to improve workflow in care delivery.

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