As the aging population grows, manufacturers say you can convert incontinence customers to your HME business — and they'll like buying from you better.
by Denise H. McClinton
May 1, 2009

A growing senior citizen population and Americans' increasing
lifespan are driving growth in the incontinence products market.
Add in new materials and more product styles, and the market is
ripe for continued growth. But are home medical equipment providers
getting their share? Can HME companies compete with drugstores and
grocers in providing incontinence products? Experts in the sector
say yes.

Incontinence is experienced by 25 million adult Americans with
75 to 80 percent of them women. Incontinence, according to IRI
data, was a $639 million market in 2008.

"I expect the incontinence market to grow significantly along
with the growth of the senior market, at a higher rate of 5 percent
annually, based on the proportion of woman living longer and the
continued overall increase in longevity," says Peter Kaplan,
category manager for incontinence and diabetes for Invacare Supply

"The 65-plus market is expected to grow from 12.4 percent of the
population to 19.6 percent by 2030. This translates into growth
from approximately 35 million seniors to an estimated 71 million,
with those 80-plus growing from 9.3 million in 2000 to 19.5 million
in 2030," he adds. "The explosive growth of the senior market is
the result of baby boomers living longer, eating healthier and
pursuing more active lifestyles as well as improved medical

Daniel Lafferty, marketing home care director for SCA Personal Care
North America
, says incontinence product sales are continuing
to increase by as much as 8 percent each year.

"The channel is still broken up into private pay/cash and
Medicaid reimbursement. This split remains nearly 90 percent
Medicaid reimbursement today, depending on how you choose to define
the market," says Lafferty. "The cash side of the business is
growing as business owners recognize that the reimbursed portion of
the market is competitive and margins are extremely low."

The aging of America is directly related to the market for
incontinence products, not only on the growth of sales but also on
product design and consumer preferences.

"The new wave of aging Americans is used to being pampered. They
are very proud of their dignity and they want solutions to help
them manage and retain it," says Stuart Simonovits, COO of K2 Health
. "Another two issues that we need to consider are the
economy and sustainability. Obviously, the economic climate is
affecting many retirees, and aside from quality, they are looking
for ideas to help them save money. The other issue pertains to the
environment. Increasingly, consumers are looking to do their part
to help protect our planet."

Kaplan lists several additional trends affecting the market,

  • A move to gender-specific products, specifically protective

  • Increased interest in breathable briefs for improved air
    circulation, reduced heat buildup and less exposure to plastic that
    can irritate skin;

  • A focus on improved efficacy with target areas and wicking
    material that is more effective at reducing waste exposure to
    patients' skin; and

  • A focus on thinner, lighter weight materials with better
    absorption capacity and improved comfort.

Simonovits also sees an increased interest in gender-specific
products. "The idea is logical, as today's adults are increasingly
looking for more comfortable and dignified products," he says.

But today's customers are "not ready to settle for inferior
products, or even for boring, albeit useful products," he
emphasizes. "They are looking for innovation, and that is what we
as manufacturers need to be providing for them.

"For years, the industry simply recycled products, trotting out
the same unimaginative collection of so-called 'solutions' for
incontinence troubles," Simonovits continues. "That is about to
change. The companies quickest to realize this and change their
approach will survive. The rest will fail."

Better Products, Increased Sales

Over the past decade, products have continued to change through
refinements in engineering and the use of better raw materials.

"Utilizing consumer insights has been key to the change in
product offerings, including the emergence of protective underwear,
or pull-ups … or the new developments of gender-specific
products," says SCA's Lafferty. He notes that SCA, for instance,
has "continued to reach out to our customer and consumer base and
implement change that is tested and asked for to ultimately improve
the care of incontinence sufferers. These products have afforded
individuals to live a higher standard of life and helped both their
professional and unpaid caregivers [with] the opportunity to
provide better care."

Innovation in the use of materials provides numerous benefits
for consumers. Products have improved with the use of lighter
weight, thinner and more effective materials that provide a more
comfortable body-close fit that is far more discreet, adds

"Also, breathable products are becoming far more important,
allowing an improved flow of air to pass through the material to
the skin to reduce heat buildup for improved skin health and less
risk of infection," he says. "Cloth-like material is quickly
replacing plastic back product providing a more comfortable,
less-skin-irritating result while eliminating the crinkling noise
so common to baby diapers for a more discreet and natural

Other design improvements include strategically placed
enhancements at the target point of urine or fecal release that
wick away fluid and/or separate waste from patients' skin, which
reduces the risk of infection and improves comfort. Another
improvement is the use of refastenable tabs for briefs that allow
users to adjust the fit multiple times for a better, closer fit to
improve comfort and reduce leakage, according to Kaplan.

Product innovation also means improving currently available
products, Simonovits points out. "It's not only about new
materials, but using existing ones to help improve products and
packaging, thereby improving the look, feel and, ultimately, sales
of these items," he says.

Growth Offers Opportunity

As the market for incontinence products grows and materials
offer enhanced options for consumers, the opportunities for
providers are expanding as well. But a major obstacle for some HME
companies is the wide availability of these products in drugstores,
grocery stores and mass retailers.

"Incontinence products provide HME providers with a well-rounded
assortment of products that their current patient population is
most likely buying elsewhere," says Kaplan. But he points out that
creating a one-stop shop for current patients' medical needs is far
more convenient for them, especially in the case of mail order
where they can receive all their monthly supplies together in one

"For example, female diabetes patients have a 70 percent higher
risk of incontinence than non-diabetic patients, and HME providers
are likely servicing these patients now," he says. "Also, this is
generally a cash purchase that is not impacted by recent Medicare
reimbursement cuts and can help offset the margin loss from those

"By working with patients to answer questions and ensuring they
have the appropriate incontinence protection that is right for
them, as well as providing accessory products such as skin care,
washcloths, gloves and so forth, HME providers create a nurturing
environment that patients trust and will feel compelled to come
back to."

In addition, home care businesses can provide an extended level
of convenience while further improving their service level with
home delivery of incontinence supplies. A distributor drop-ship
program means providers don't necessarily have to stock additional

In sum, HME providers need to do what they do best, which is to
leverage their smaller size to meet the individual needs of their
consumer base, these experts say.

"Offer home delivery, offer product counseling and offer a wider
range of products," advises Lafferty. Within that product range,
however, he stresses that it is crucial to carry major brands.
"While private-label products offer consumers a price break, brands
drive loyalty," he says.

He also encourages providers to seek assistance from their
vendors. "The market is large enough that medical equipment
providers can compete with retailers if they [have] the right
offering for their customer base," Lafferty says.

In retail, products have to tell a story, notes Simonovits,
emphasizing that packaging and display play an important role in
closing incontinence product sales.

"It's not enough to simply put them in a bag and hang them on a
hook in the store," he says. "Use premium materials and packaging
to help the customer make an informed, educated and, ultimately, an
economically wise decision."

Simonovits acknowledges that national drugstores and mass
merchants are strong competition, but he says HME providers can
certainly play an important role.

"Carrying quality products, especially niche products such as
reusable underwear and reusable bed pads, will enable you to set
yourself apart," he says. "Doing this will provide something for
every type of consumer whether they are looking for quality, cost
effectiveness or sustainability."

Keeping Up with Competition

As the market for incontinence products grows, experts say HME
providers can increase sales by incorporating the following

  • Offer a wide selection of products. Don't forget about add-on
    products, such as skin care products and caregiver supplies.

  • Stock niche products to help differentiate your business.

  • Provide education on the availability of products both to
    current and potential customers.

  • Market products and provide education to caregivers.

  • Offer competitive pricing.

  • Consider Internet sales and/or home delivery in discrete

  • Market to assisted living facilities and home care agencies.

  • Tap into manufacturer support and resources.

Customers Want Privacy When They're Shopping

Kimberly-Clark debuted its new gender-specific Depend products
in March complete with the largest integrated marketing campaign in
the history of the brand. But there are lessons in the rollout that
go beyond the product itself.

Tailored to fit the unique body shapes of men (predominantly
rectangular) and women (who have more variation in shape and size
than men), the newest Depend designs look like regular underwear
and replace the brand's unisex pull-ups.

"This isn't just a product, this is a hero product," says Blake
Boulden, brand manager for Depend. "It allows people to stay
engaged, normalize their life and get back to that person …
they want to be and not have to be limited by what incontinence can
often do to people.

Lafferty, too, believes providers have a significant opportunity
in this area. Yet they must be conscious of pricing and provide a
knowledgeable educational resource for customers.

"The common concern is price, and the reality is that consumers,
especially in this economic climate, will be price-sensitive," he
explains. "Traditional retailers will always be more competitive on
price. That being said, consumers — wearers of products,
their unpaid family caregivers and professional caregivers —
are all starving for information in this category."

Lafferty advises HME providers to become the local "specialists"
in this area and in related fields, such as diabetes and aids to
daily living products. "Customer service will go a long way in this
area to help an overwhelmed and confused customer base get into the
right product at a fair price at the right time," he says.

"A larger product selection than found in traditional retail is
key. For instance, most major retailers are no longer carrying
briefs. This is a huge opportunity to capture this customer

Kaplan agrees. "HME providers can provide a better value by
offering a competitive price combined with a level of service
patients cannot get in a pharmacy, grocery store and certainly not
a mass merchant," he says.

"When you think about the boomers and who that consumer is,"
Boulden continues, "they are getting to the age now where
incontinence is something they are going to have to start thinking
about dealing with, whether it's for themselves or somebody they
are caring for. It's going to take this market to a whole new

But considering baby boomers' lifestyles and expectations, he
adds, "this is a different consumer, and you really need to think
how you are meeting their needs."

Those needs include more than product alone, Boulden says, so
K-C's Depend Underwear for Men and Depend Underwear for Women
feature packaging that can make choosing the right product faster
and easier for shoppers. The company's research indicates that both
users and caregivers can be uncomfortable shopping for incontinence
products, so the new packaging offers a simpler "selection
experience" at stores.

While K-C says its Depend and Poise brands hold a combined
market share of more than 50 percent in the North American adult
incontinence category — which the company estimates at $1.2
billion — "consumers don't want to buy these products in
stores," Boulden says. "They're afraid they'll run into their
neighbor or someone will see it in their cart so they're shopping
early in the morning or late at night. They may make a dry run down
the aisle first to see if anyone is there."

The fact that HME providers can offer customers discreet
shopping is a big advantage over drugstores and groceries. And
because the privacy factor is of such concern, Boulden notes,
Internet sales will also become a much bigger play "as more
Web-savvy consumers who are used to buying online move into the

Experts Interviewed

Daniel Lafferty, marketing home care director, SCA Personal Care
North America, Philadelphia; Peter Kaplan, category manager for
incontinence and diabetes, Invacare Supply Group, Milford, Mass.;
and Stuart Simonovits, COO, K2 Health Products, Brooklyn, N.Y.