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EFFECTIVE PROGRAMS LACKING IN NURSING HOMES One obvious key to program success is assessment of resident responsiveness to the intervention. In the absence of these initial assessments, it is impossible to objectively determine who should receive toileting assistance and who should be diapered. Nevertheless, in a recent study of 14 nursing homes, we found that all the facilities failed to evaluate incontinent residents' responsiveness to toileting assistance, a finding in keeping with those from other studies (1, 11). The upshot of this widespread failure is as inevitable as it is clinically and ethically unjustifiable. In most nursing homes, all incontinent residents receive substandard toileting assistance. In some facilities, the system--or lack of it--discriminates in favor of the most able-bodied, clear-minded residents, reserving the poorest care for the frailest residents, those least able to tolerate it (11). (prev | next)

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