CMS Tag F741 Non-pharmacological Approaches – Individualizing Bathroom Routines

CMS Tag 741 includes a long list of examples of individualized, non-pharmacological approaches to help meet behavioral health needs. We will be reviewing all of them. Food preferences, exercise, pain relief and individualizing sleep and dining routines have been discussed in previous articles and now we highlight:

• Individualizing sleep and dining routines, as well as schedules to use the bathroom…

I have learned that this topic belongs to everyone. No matter your role in a LTC home as … falls do not belong to nursing.

Do you agree? Everyone always agrees that falls do not belong to nursing that falls belong to all of us. However, think for a moment… who is usually in charge of the fall committee or fall data at QAPI…? Nursing. We act as if falls do belong to nursing and we continue to have a prevalence of people falling. Therefore, in my estimation we have to do things differently to see a reduction in people falling.

I teach a 12-part curriculum called Proactive Practice to Prevent Falls and improve Quality of Life and this very topic is a stand-alone topic of the twelve practices that I teach. I call this Proactive Practice: Anticipating Needs, particularly bathroom, by ALL.

What is the main reason for falls? Most falls experienced by people living in LTC homes
revolve around needing the bathroom. Do your own trending. Ask a group. Every crowd I’ve ever asked, “What is the main reason for falls?” always says needing the restroom.

Notice, not toileting… How many of us say, “I have to go toilet myself?” Referring to toileting is institutional. Use of the bathroom or restroom is normal. Veterans bring up the latrine. Some say they need to freshen up. Please, please become a voice for using normal language instead of the over-used, degrading institutional language. None of us refer to our toileting or announce we just toileted ourselves or ask each other if you can toilet yourself. Even though the terrible word toileting is still in CMS regs and the MDS, you don’t have tos use it and I recommend we all stop using it. Going potty, likewise, is for toddlers, not adults.

Become an advocate for normal language.

Become an advocate also for being proactive. Knowing that needing the bathroom is the number one reason for falls, any one of us can proactively inquire if a person might need the bathroom in every interaction. Yep. That helps people to not fall so much. The idea is to be ahead of the need instead of behind it which may very well be a fall.

Isn’t it wonderful that ANYONE can ask a person if they need to use the restroom? It is not HIPPA protected. We should celebrate this and use it to our advantage.

One time a housekeeper said, “I had no idea I could help prevent falls.”

One time a director of human resources shared that she can tell that people (residents) feel more comfortable around her now because she first asks if they need to use the restroom and if not, she also asks when they are done talking! Wow. Proves the point as to how powerful this is.

Most people move to a LTC home, a nursing home in particular, due to needing help with the bathroom and this need results in most falls. We need to make helping people get to the bathroom our #1 priority! We do.

Individualizing bathroom needs is then what comes next naturally as we learn a person. In the culture change movement we call it being well known. When the person becomes well known, we can anticipate his/her needs, timing, routine, schedule. Don’t we love it when someone anticipates our needs? Anticipating a person’s bathroom needs is proactive, preventative, individualized service.

By learning an individual, by anticipating their needs, by being aware that proactively helping a person to the bathroom and at the least inquiring if they need the bathroom, we will see fewer precious people falling. Some of us are not qualified to help a person in the bathroom so we are the ones who can inquire, help get the call light on, even wait for the right person to come… why? Because that will prevent falls. Some leaders have also served as role models getting cross trained as a CNA in order to be able to help more. Even administrators over the years have proudly stated they became CNAs so that they could actually help people instead of embarrassingly having to say in essence, although I’m the administrator and you pay a lot to live here, I am not qualified to help you… that is changed culture!

Ensuring one uses the bathroom when they need to is more dignified for the individual. It is also more efficient, it saves time and money. If we all concern ourselves with this number one need, using the bathroom, we all can help to proactively prevent falls, incontinence and more. When bigger issues or problems are prevented, it is then when individuals can take in the day, enjoy what they enjoy, live a quality-of-life life – something we all want.

We can avoid medications, we can avoid falls, we can avoid incontinence if we all work together as this smart example indicates right within the federal requirement for Non-pharmacological approaches.

Carmen Bowman, MHS, Regulator turned Educator of Edu-Catering: Catering Education for Compliance and Changing Institutional Culture is an activities/engagement/community life, regulatory compliance and culture change consultant.  She offers new or not-yet-qualified activity director consultation and personalized continuing education for professionals/teams/associations. At www.edu-catering.com join The Be Encouraged Blog, Become a Leader of Normal Life with the eResource GUARDIANS OF NORMAL LIFE: How Activity/ Recreation/ Engagement/Community Life Professionals can Save the World of LTC and share with your team the eBook Individualizing Medication Administration using Regulations. At the Edu-Catering YouTube channel, see documentaries that highlight changed cultures.