Growing Need, Growing Category

Manufacturers of incontinence products are generally optimistic about the future.

For one thing, Americans are living longer than ever before: the Centers for Disease Control and Prevention recently announced that life expectancy in the U.S. has reached a new high of nearly 78 years. Also, baby boomers, who comprise a significant portion of the country’s population, are getting older, the first members of the generation having reached age 60 last year.

“Incidence and consumption of incontinence products increases with age,” notes Sam Martin, associate brand manager for Kimberly-Clark. “With Americans living longer and the influx of baby boomers who are now approaching the age of 60, demand for incontinence products is expected to grow at an annual rate of 5 percent to 10 percent over the next 15 years.”

People are also staying home longer before going into a nursing home, or are choosing home care and other options as alternatives.

A study by the Lewin Group found the number of nursing home residents age 65 and older has dropped by 120,000 since 1999, because seniors are healthier and wealthier; nursing homes have focused on post-acute rehabilitation; there are more widely available alternatives; and states have worked to reduce the number of admissions to nursing homes by steering people away from them at critical times like hospital discharge.

John Moulden, senior vice president, sales, for Dynarex, explains that, “in terms of the long-term care facilities, people are spending more time at home, the more assisted-living type situations, and these are all areas where incontinence care products are important.”

That doesn’t mean it’s all smooth sailing.

As with other segments of HME, there are two foreboding words for manufacturers and providers of incontinence products: competitive bidding. Though not included in the product categories selected for the first round of the program, manufacturers worry that its future inclusion would drive down price points and squeeze margins for them and their distributors, making it difficult for either to operate.

Not only that, several manufacturers in the market say they are already experiencing very real pressures from low-cost sources that have entered the U.S. market from countries like China, pushing prices down even as the costs of raw materials increase.

Yet on the whole they say, the need for these products is growing, and “home health is where a lot of the growth is going to be coming from for incontinence care products,” states Kendra Nicholson, product manager, Covidien.

Consumers Looking for Help

An estimated 25 million adult Americans experience some type of transient or chronic incontinence, according to the National Association for Continence. Because of the degree to which incontinence varies from person to person, a wide variety of absorbent products are available in today’s incontinence marketplace, providing different levels of protection and product attributes to meet consumers’ unique needs.

“Generally speaking, consumers are first looking for products that provide sufficient protection from leaks, with comfort, fit and discretion also being important attributes to identify the product that best meets [their] needs,” Martin says.

But, perhaps contrary to stereotype, the condition doesn’t just affect the elderly; it is, in fact, a younger demographic that Martin predicts will present the industry with one of its major challenges.

“Younger consumers entering the incontinence category will demand products that allow them to continue to live an active lifestyle,” he says. “As a result, manufacturers of absorbent incontinence products have the challenge to continue to deliver innovations that provide superior protection without sacrificing comfort, fit and discretion for these consumers.”

The strongest segments? According to Martin, underwear and pads are the two largest within the absorbent incontinence category, making up approximately 80 percent of category sales with growth expected to continue.

“Two smaller segments, pantiliners and male guards, are also seeing rapid growth of approximately 10 percent annually,” he notes.

Meanwhile, Lauren Fuller, associate product manager at Covidien, says the company is starting to focus more on bariatric products. “People are getting older, but they’re also getting bigger,” she says.

Adds Covidien’s Nicholson, “Briefs are the bread and butter, but I think protective underwear is what we’re seeing grow more than anything. The reason for that is because it’s discreet. It’s like underwear; it’s not like a big diaper. People are looking for more discreet options, things that are less bulky, things that you can’t really see, that they can carry around in a purse.”

Because “discreet and dignified” are what people want in incontinence products, Fuller says, that’s what Covidien is aiming to give them.

“Cloth-like products are big right now, so that when someone’s walking around with a brief on, you don’t hear noise, and it’s also more comfortable,” Nicholson says. “It’s more dignified and discreet, because you can’t hear it squishing. It looks and feels less clinical. It’s less diapery.

“With a cloth-like material, it’s more breathable,” Fuller adds. “A lot of people that are wearing these have fragile skin, so if they have too much plastic on the skin it will lead to irritation. With a cloth-like product, you’re hoping for less irritation and [fewer] wound care issues.”

Moulden says Dynarex, whose products include wipes, underpads and pantiliners, has actually seen its underpad business decline slightly, “simply because, I think, people in a number of markets are selling better briefs, and when the briefs are better, the underpads are not as much of a consideration.”

He notes the company has also seen a movement toward plastic bag refill packs for adult/incontinence wipes, which historically have been packaged in plastic tubs.

“From an environmental perspective, they don’t have to deal with disposing of the tubs, and it’s simply … more economical,” he says.

Selling Against the Big Boys

Manufacturers point out a number of ways that providers can better sell incontinence products. A challenge is that many incontinence products can be found in big, traditional retail stores like Wal-Mart and Target. But Nicholson and Fuller say HMEs can take the advantage by being more knowledgeable and providing better service.

“You go to [an HME], they know about reimbursement, they know the legal issues, the clinical issues — all the different issues that these customers face,” Nicholson says. They can offer help in these areas where big retailers can’t.

In fact, because their clients may be depending on such knowledge, if providers are not experts in the area, adds Fuller, “then they’re going to get killed by their competitor DMEs and HMEs that know more than they do.”

Larry Salk, president of Salk, Inc., says that’s also true for suppliers of his company’s reusable incontinence products. The best hire “field sales reps that really understand the home care market” for incontinence products, he says.

To better compete with big box retailers, providers should also consider direct shipping to their customers’ homes, manufacturers note.

Covidien provides discreet packaging to cater to such practices. “If it’s sitting on [the customer’s] front porch, the neighbors aren’t going to see what it is,” explains Fuller.

Will rising costs — most notably, in recent years, fuel — keep providers from continuing to provide services like delivery? Fuller and Nicholson don’t think so.

“Because of the whole baby boomer population getting older, there’s always going to be a need for these products,” says Fuller. “I don’t see that changing.”

“DMEs need to continue to differentiate, and the way that they’ll do that is by offering those value-added services,” adds Nicholson.

Kimberly-Clark’s Martin agrees that providers should offer direct-to-consumer delivery to provide discretion for the user and convenience for the “time-starved” caregiver. He also recommends that providers offer a full range of products at competitive prices, and notes that the Internet is “one of the fasting growing channels” for buying incontinence products.

Among the best practices of Covidien’s top sellers is handing out samples to their customers, say Fuller and Nicholson. Fuller is currently putting together small sampling packages that will contain two briefs, two underpads or two pairs of protective underwear so HMEs can give them to consumers.

“They’ll be able to provide the consumer what they want by allowing them to test it first,” Fuller says.

“The superstars are already doing that,” adds Nicholson.

Also important, manufacturers say, is having products available on store shelves. In the past, Nicholson says, Covidien focused on the clinical market, where a lot of product is provided in clear bags.

“They don’t display well,” she says, “so we’re trying to move more toward a retail-type packaging where there are printed graphics on the bag.”

This kind of display marketing can be particularly important when it comes to making add-on sales to customers purchasing equipment in the store. Manufacturers say it can be helpful to remember that a person with incontinence is not necessarily an elderly person.

Nicholson remembers an incontinence patient panel at a recent conference where “every demographic was represented.” A woman in her early 30s, for example, who may be in the store for an orthotic or a piece of equipment for an elderly family member, might need an incontinence product for herself. If such products are prominently displayed, she will better be able to notice it.

Moreover, consumers today are less stigmatized by the condition.

“People are becoming more accepting of it, so these people are going out seeking solutions, whereas, in the past, they wouldn’t have done that, because they would have been too embarrassed to admit that they had that issue,” Nicholson says. Keep the Business Coming
One of the most attractive aspects of providing incontinence products is that it’s a non-durable product, so consumers have to keep coming back, manufacturers say.

“We emphasize that these are residual, annuity-type products that will just continue to roll, because as long as anyone’s in a home care-type environment, once they are at that age and are requiring these incontinence products, unfortunately, that doesn’t change,” says Dynarex’s Moulden.

“It’s not like someone having their gallbladder out and everything heals and you’re fine. This is a persistent condition, especially for the elderly.”

“As long as [providers] service those customers properly, it’s going to be repeat business,” adds Nicholson. “Disposables allow them to build repeat business.”

Nicolas Mazzesi, export manager for Cleanis, notes that, with annuities, “there is a deeper relationship involved with the client.

“Having a disposable product brings the customer back into the shop,” he says. The more the customer comes in, the more the provider can “push and sell other products and services, because they know the client better.” Get Set for Growth
The future appears to hold some challenges for this market, not the least of them the potential threat of being included as a competitive bid product category. But the manufacturers of incontinence products say they are encouraged by the market’s prospects for themselves, the HME companies that provide these products — and even for the consumers they serve.

“The market for incontinence products is attractive for manufacturers and retailers based on the category size and increasing number of consumers with incontinence,” Martin says.

“As a result, competition for this consumer is expected to increase, leading to improved solutions that allow the consumer to effectively manage incontinence with confidence.” Facts and Stats
Incontinence, or loss of bladder or bowel control, can be caused by a broad range of conditions and disorders including birth defects, pelvic surgery, injuries to the pelvic region or the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection and degenerative changes associated with aging. It can also occur as a result of pregnancy or childbirth.

Incontinence from surgery is a transient condition that can follow operations such as hysterectomies, caesarean sections or lower intestinal surgery.

• Urinary incontinence affects 200 million people worldwide.
• An estimated 25 million adult Americans experience transient or chronic urinary incontinence.
• 75 to 80 percent of those people are women, 9 to 13 million of whom have severe symptoms.
• One in four women over the age of 18 experience episodes of leaking urine involuntarily.
• One-third of men and women ages 30 to 70 have experienced loss of bladder control at some point in their adult lives.
• Two-thirds of men and women ages 30 to 70 have never discussed bladder health with their doctor.
• One in eight Americans who have experienced loss of bladder control have been diagnosed. Men are less likely to be diagnosed than women. Men are also less likely to talk about it with friends and family and are more likely to be uninformed.
• On average, women wait 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problem(s).
• Two-thirds of individuals who experience loss of bladder control symptoms do not use any treatment or product to manage their incontinence.

Source: National Association for Continence Experts Interviewed:
Lauren Fuller, associate product manager, and Kendra Nicholson, product manager, Covidien, Mansfield, Mass.; Sam Martin, associate brand manager, Kimberly-Clark, Dallas; Nicolas Mazzesi, export manager, Cleanis, Paris, France; John Moulden, senior vice president/sales, Dynarex, Orangeburg, N.Y.; and Larry Salk, Salk Inc., Boston, Mass.