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

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.