The disparity between the size of the frail, aging population and the nursing workforce that provides care for the elderly is growing, and will continue to expand at an alarming rate. Though the government and the public may demand that nursing homes provide high quality of care to elder residents, the current prospective payment system does not sufficiently reimburse facilities to hire and retain appropriate staffing levels. The correlation between a resident's quality of life and the amount of direct care time spent with nursing staff is well documented;however, without significant changes to the reimbursement system, residents should expect even less time devoted to direct care in the future. Incontinence is a condition for which many older adults are institutionalized. Staff time required to provide incontinence care is substantial. The proposed study will investigate the efficacy of a technology-assisted management of incontinence (TAMI) system that addresses three of the key quality indicators used to measure the quality of care provided by all nursing homes. Investigators hypothesize that use of the TAMI system will reduce the total time required to deliver incontinence care, while simultaneously improving individualized care. The overall potential benefits for residents, staff and management of nursing homes include improved quality of life for residents, higher staff productivity, and reduction in cost and suffering caused by skin breakdown related to time spent in wet conditions. Ultimately it is expected that nursing homes can utilize net savings in labor to further focus attention on other basic and preventive care processes. The proposed clinical study will be conducted in 3 nursing home facilities using a repeated measures design to determine if use of the proposed technology 1) incurs time savings in the provision of incontinence care, 2) reduces skin wetness upon change of briefs, 3) reduces incidence of blanchable erythema, 4) is consistently and effectively utilized when research staff are not present, 5) is cost effective from the perspective of facilities, and 6) results in perceived improvements in care for which families are willing to pay. The commercial potential for this process quality control system is discussed. Previous attempts to introduce similar technology into the nursing home facility have met resistance primarily due to the cost, unwieldy operation, and ineffectiveness. Moreover, the systems were not designed to meet the needs of the most critical element within the nursing home care process: the nurse aide. Incontinence is a condition for which many older adults are institutionalized and are labor intensive to prevent and to treat. We hypothesize that use of Technology Assisted Management of Incontinence: TAMi will reduce the total time required to deliver incontinence care through targeted intervention and that nursing homes can utilize the net savings in labor to attend to other basic and preventive care processes. The overall potential benefits of this time savings include improved quality of life, higher staff productivity, and potential cost savings resulting from avoidance of adverse outcomes.
