Through communication and education, HME providers can help customers overcome the stigma of incontinence.

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

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

"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

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

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

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'

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

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.

  • 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.

  • Offer samples
  • For example, Covidien provides a two-count sample pack to allow
    a wearer to try various options.

  • 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.

  • 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,
    • 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,
    • Mark Rogers, director of Internet sales,
      Medical West Healthcare, St. Louis, Mo.
    • Jennifer Weathers, DMEPOS coordinator for Ken
      Glover Drug, Dora, Ala.