An Unspoken Problem Worth Talking About

Incontinence is a condition that is widely misunderstood and stigmatized. Little wonder so many suffer in silence, even as more products are available to enable them to lead fuller lives while managing the condition.

New products offer improved levels of performance and discretion, but communication and education are still missing pieces of the puzzle — and ones HME providers are almost uniquely positioned to provide. There are an estimated 25 million people dealing with incontinence in the United States, and although it is more prevalent among women, incontinence also affects men, according to the National Association of Continence.

Steve Blazejewski, U.S. president, Medical Supplies, Covidien, contends that raising awareness of the facts about incontinence can encourage people to bring up the subject to someone who can help. Many with the condition do not know that management options are available, or how to choose a product that fits their needs. “We need to help educate them on their options so they can get back to living their lives in comfort and with dignity,” says Blazejewski.

As baby boomers age, incontinence could even be the deal-breaker when considering home care versus a nursing home.

“Providers need to understand how much incontinence impacts the decision for a family to move a loved one into a professional care environment,” says Dan Lafferty, director of marketing, alternate channels, for SCA’s Personal Care North America division. Results of an SCA survey last year showed that 18 percent of unpaid caregivers considered moving — or did move — their loved one into a nursing home as a result of his or her incontinence.

“The industry is recognizing that more people are opting to stay at home longer,” says Lafferty. “This means that care plans should be designed to promote the greatest level of continence and independence as possible, which translates to making a broader range of products available and providing increased education around them.”

Care outside of an institutional setting also suggests a need for more specialized products, whether overnight pads or gender-specific underwear. “You also need to take into account the fact that there will be an increasing number of unpaid or unprofessional caregivers who do not have the expertise or background regarding the application of incontinence products,” says Lafferty.

The challenges of incontinence are worse because it is not an easy topic for polite conversation. “Oftentimes, a person suffering with incontinence tends to resist discussing the issue with doctors, family members or friends due to feelings of shame, embarrassment or the fear of losing their independence,” Blazejewski says.

“It’s important to help customers understand that they are not alone in this condition,” he says. “There are millions of people living with incontinence, and there are options available to help them have a full life without the worry of leakage, odor and loss of dignity.” HME providers, he says, have an advantage because they can “work with people in a professional and discreet manner.”

Fit the Budget, Fit the Body

Medical West Healthcare, St. Louis, Mo., is a provider that is among the more successful at selling incontinence products. “We try to fit the budget, and we try to fit the body,” says Mark Rogers, director of Internet sales for the company. “It’s like how a real estate agent wouldn’t want to show you a house you would love to buy but can’t afford. I give them samples, two choices or maybe three, that they can try.”

The HME business offers a variety of incontinence brands, among them Attends, Depend, Dignity, Poise, Prevail, Tena and Tranquility. When a customer settles on a product, Medical West delivers it in a discreet brown box to the front door, and often sets the customer up on a recurring purchase schedule.

In addition to incontinence products, Medical West also provides nutritional products, breast prosthetics, diabetic testing supplies and respiratory services. The company sells both online and through three retail stores in the St. Louis area.

“I think what we are seeing in the market is that the quality of the product has had to increase because of the environment it is used in,” Rogers says. For example, in an institutional health care setting with less staff, the products have to be designed to be changed only every three or four hours, he says.

Rogers laments the lack of choice of incontinence products in large retail environments: “It’s a shame we have more choice in dog food than for incontinence for the elderly.”

An HME provider can fill the gap by offering a wide range of products, Rogers says, adding that manufacturers pay for shelf space in the supermarket, which favors high-volume products that are not geared to specific needs. Also related to less expensive products at mass retailers, Rogers warns that case sizes may not be consistent. For example, a retailer might sell a 60-count case of medium pullups versus the usual 72-count case; a shopper looking only at the price might not be aware of the lesser quantity.

“We all buy things from Walmart for convenience, but if you need medical supplies, [it makes sense to] go to the people who know what they’re talking about,” says Rogers.

He contends that better and more specialized incontinence products are worth a higher price. “You pay an extra quarter, but it’s a quarter well-spent,” says Rogers, who notes many customers seek out Medical West’s larger variety of products because the product they were using before didn’t work.

Dealing with Misconceptions

“There is a misconception that incontinence is inevitable and a normal part of aging,” says Covidien’s Blazejewski. “The truth is there are several causes of incontinence, and many are treatable. Incontinence is a symptom, not a disease. Unfortunately, because people are not comfortable talking about it, many suffer in silence.”

While explosive growth in the nation’s senior population is definitely contributing to market growth, Lafferty of SCA also points out that incontinence is not limited to the old and infirm. The reality is that the condition can happen at any age. One in four women and one in 10 men over age 40 have experienced some level of incontinence, which can happen as a result of pregnancy or childbirth, prostate surgery or even an aggressive sports activity, among other causes.

“People needlessly place this taboo on the condition, which results in people not having important conversations with their doctors, family or friends and failing to find the products and solutions that help them manage the condition,” Lafferty says. In the SCA survey, nearly 40 percent of women with incontinence had never discussed it with anyone, including their doctors. “We are trying to overcome this through education, advocacy and communications that are aimed to break the stigma,” he says.

Another misconception is that all incontinence products are alike, and the cheaper the better. Lafferty points to hidden costs associated with buying less expensive incontinence products that can more than offset the money saved. “The cost of incontinence goes far beyond the product itself,” he says. Choosing a less expensive product could increase the chance of leakage (which increases laundry costs), a higher incidence of skin issues (which leads to medical bills), or a more frequent change rate (which increases product costs).

“We are working to help educate professional and non-professional caregivers around making the right incontinence choices that lead to better quality of life, as well as reduced costs,” Lafferty says. “We have worked to design our products so that they are easy to use with highly intuitive application for the caregiver.” An example is the new Tena Stretch brief with large tabs and broad stretch panels.

Product Choice Rules

According to Tom Bergin, director of marketing, products and insights, for SCA Personal Care NA, incontinence products should go beyond absorbency to address the specific style and anatomical needs of consumers. SCA’s Tena line includes products designed for men and women, or for customer preference for a more fitted and discreet style versus full coverage.

The protective underwear for women and men is now more absorbent to serve the desires of even those with moderate to heavy leakage for a product with close, body-hugging fit and cottony feel. “It presents an option for people who need heavy protection but don’t want to sacrifice style and dignity, and really supports the move toward more individualized care,” says Bergin.

The company’s range of products covers the entire spectrum of needs related to incontinence care, including liners, pads and two-piece style products as well as pullup style underwear, re-fastenable briefs and underpads. The Tena line of skin care products includes a 3-in-1 wash cream and wipes.

Covidien offers a line of incontinence care products to meet light, moderate or maximum incontinence, including bladder control pads or guards for men for light incontinence, protective underwear for moderate to super incontinence and an array of adult briefs for maximum incontinence. The company’s SureCare Protective Underwear was developed for those with moderate to super incontinence. It is a disposable undergarment that offers a secure fit and underwear-like look and feel for ease of wear, according to the company.

Blazejewski sees a trend in incontinence care away from plastic-backed products to more cloth-like products. Benefits include better skin wellness and more dignity for the wearer. While plastic-backed products can contain fluid, cloth-like products are softer and quieter, he says. Less plastic also means there is less heat buildup, which keeps skin cooler and drier.

The Role of HME Providers

Jennifer Weathers, DMEPOS coordinator for Ken Glover Drug, Dora, Ala., says she makes her private office available to avoid embarrassment in discussions about incontinence. However, even buying incontinence products at wholesale prices, it is impossible to compete with pricing at big box retail stores, she says, so privacy, advice and service are what works for her company.

“The products we have are more medical-grade, not going to leak, hypo-allergenic, and some are more geared to bed-bound patients,” she says. The provider also offers the advantage of delivering incontinence products, such as dropping them off when employees are servicing oxygen equipment.

Blazejewski says providers working in the incontinence market should understand how their products compare with those sold by large retailers in their area. They should make options available at competitive prices, while making it known they provide an additional advisory service not available at larger retailers.

“Home medical providers play an important role in the purchase decision, and this can go a long way in building relationships with customers,” he says.

Providers should also understand Medicare and Medicaid reimbursement rates and guidelines in the market, which will help customers maximize their ability to obtain the products they need. Manufacturers encourage providers to stay informed, as some states have made a variety of proposals in recent years based on the concept of bidding for incontinence supplies, notably Texas, Ohio, North Carolina, Florida and Indiana.

Weathers points to the matter of reimbursement as well. One insurance company covers incontinence supplies (adult wipes, diapers or briefs) only if they come from a DME provider, and Alabama Medicaid covers the products for patients under 21 with prior authorization if they are purchased from a DME provider.

The stigma of incontinence also translates into point-of-sale considerations, says Lafferty. For example, a customer is less likely to spend time browsing the incontinence aisle. “An intuitive organization [of products] is important. People spend less time in the incontinence aisle because of the risk of being seen, so anything a retailer can do to make the decision process quick and easy goes a long way,” says Lafferty.

“Also, I believe that offering a full range of products in the store — especially some of the newer items that provide greater dignity and style — can help break the stigma that you need to wear a bulky product in order to be protected.” Lafferty also sees the Internet as a great sales channel for incontinence products; the discretion of online shopping enables customers to learn more about the products and to purchase them in private.

Moshe Klerer, CEO of K2 Health Products, agrees that home delivery in discreet packaging is a way for smaller providers to differentiate themselves from mass merchants. “Medical supply companies also have a tremendous benefit with better brands and better performance, and there is someone there to talk to who knows about the product,” Klerer says. “The smaller mom-and-pops should educate themselves about the brands, the differences in the products and help the consumer by educating them and answering their questions.”

Providers should also differentiate themselves with a larger selection of brands and a variety of absorption levels. “They may not be able to compete on price, but they can compete on selection and service,” Klerer says.

K2 Health manufactures Inspire Incontinence Products, which include both a line of disposable incontinence products and a line of reusable underwear and bed pads that are absorbent and more economical over time. Attractive packaging is important to any retail market, Klerer believes, adding that K2 offers a bed pad in a full-color glossy box that looks good on the shelf.

Klerer sees bariatrics as a growing sector in the incontinence market, and anticipates a trend toward higher absorbency products as baby boomers age and the elderly look for ways to stay out of nursing homes.

Anothr approach to more sales is through impulse or add-on sales, says Klerer. For example, placing reusable underpads on the shelf beside pullups will help raise awareness. “Reusable products may not be on someone’s radar, but if it is right there next to the pullups, they will buy it.” He also sees opportunity in reusable underwear, which can be a dignified alternative.

Lafferty endorses the importance of education and employee training related to incontinence sales. “Most people have no idea what good incontinence care looks like or how to get there,” he says. “Having well-trained employees who can provide that level of expertise will go a long way toward selling more support products, such as skin care, as well as in keeping their customers’ loyalty.”

Rogers sees a need for better skin care related to incontinence, especially if urine salt is left on the skin during changing. He recommends a good wash cream as a way to prevent irritation to the perineal area. He warns against use of protective barrier creams containing large amounts of zinc oxide or petroleum-based products, which he says can work against an incontinence product’s absorbency.

5 Ways to Sell More Incontinence Products

Here are five ways to increase sales of incontinence products, provided by Steve Blazejewski, U.S. president, Medical Supplies, Covidien:

1. Become a trusted partner Work closely with customers to help them understand their options and choose the best incontinence products.
2. Provide alternatives Carry a variety of product types in a range of prices and styles so customers can find what works best in their situation.
3. Offer samples For example, Covidien provides a two-count sample pack to allow a wearer to try various options.
4. Supply educational materials Customers need educational resources — from sizing charts to product brochures to product selection guides — that they can take with them and read on their own.
5. Work with discharge planners Team up with local discharge planners and work together to become a resource for the patient/customer.

Experts Interviewed

• Tom Bergin, director of marketing, products and insights, SCA’s Personal Care North America division, Philadelphia
• Steve Blazejewski, U.S. president, Medical Supplies, Covidien, Mansfield, Mass.
• Moshe Klerer, CEO, K2 Health Products, Brooklyn, N.Y.
• Dan Lafferty, director of marketing, alternate channels, for SCA’s Personal Care North America division, Philadelphia
• Mark Rogers, director of Internet sales, Medical West Healthcare, St. Louis, Mo.
• Jennifer Weathers, DMEPOS coordinator for Ken Glover Drug, Dora, Ala.