Better questions, clearer choices: putting the person at the centre of continence support

Better continence support begins before a product is chosen. It begins with better questions, clearer information and a willingness to keep the person involved.

Continence support is deeply practical. It can involve assessment, treatment, toileting support, daily routines, communication with carers and products where appropriate. In busy care environments, staff need consistency, organisations need reliable systems and individuals need support that can be delivered predictably.

Yet when a continence product forms part of someone’s support, the decision can easily become narrower than the person it is meant to support. What is routinely stocked, familiar to staff or already in place can quietly become the default.

For the individual, that same decision may carry much more meaning. It sits close to privacy, bodily autonomy, everyday routines and independence. It can shape how involved a person feels and whether they understand why a particular approach has been chosen.

The question, then, should be broader than “What do we normally use?” It also needs to be: “What does this person need, what do they understand and what matters to them?”

In Australian aged care, this is not peripheral to quality. The strengthened Aged Care Quality Standards require providers to support older people to exercise choice and to provide timely, accurate, tailored and sufficient information in a way they understand. They also require services to treat individuals with dignity and respect, protect personal privacy and give individuals choice about how and when they receive intimate personal care, which should be carried out sensitively and in private.^{1, 2}

Information is part of person-centred care

Health literacy tends to be discussed in relation to diagnosis, treatment or consent. The underlying principle is just as useful in everyday care decisions. The Australian Commission on Safety and Quality in Health Care describes health literacy as a person’s ability to find, understand and use information to make informed decisions about health and health care.³

That matters in continence support, where people may be navigating unfamiliar language while already uncomfortable discussing the subject at all. A person or carer may be trying to work out what the options mean, how they fit into an existing routine or what they should even be asking.

Clear information should help someone understand the decision in front of them.

This does not mean every person needs an exhaustive explanation of every option. It means the information needs to be relevant enough for the person to take part meaningfully. Daily routine, mobility, dexterity, independence, privacy, personal preferences and who provides assistance may all shape that conversation.

Routine is useful. Automatic decisions are not.

Healthcare and aged-care settings need standard processes. Familiar products and established supply systems can support training, consistency and operational reliability.

The difficulty arises when the system becomes both the starting point and the finishing point of the decision. Person-centred care is not only about how support is delivered. It is also about how the decision is reached. An established approach may keep working well but it should stay open to review as a person’s routine, function, mobility, assistance needs or preferences change. Current aged-care guidance links continence care with dignity, comfort, function and mobility.⁴

A 2026 scoping review of older adults’ perspectives on continence care found that older people reported limited access to information and wanted greater involvement in decisions about their care. It also highlighted the value they placed on self-determination, independence and person-centred support.⁵

The information issue is not new. Australian qualitative research found that people with incontinence and their carers often relied on trial and error and wanted clearer information about the choices available.⁶

Standardisation can support consistency. It should not remove the need for review. Continence support also needs to work within a person’s actual day. Familiarity should not remove the need to ask whether the current approach still reflects the individual.

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Better questions before better choices

A useful continence conversation does not require a professional to become a product expert. It requires curiosity about the person.

Before settling on or continuing a support approach, useful questions might include:

• What matters most to this person in their everyday routine?
• What is working well with the current approach and what is difficult?
• Does the person understand the relevant options and why the current approach has been chosen?
• Are there practical factors to consider, such as dressing, toileting, mobility, dexterity, cognition or the level of assistance required?
• Has anything changed in the person’s needs, preferences or routine that should prompt review?
• Who does the person want involved in these conversations and how would they prefer sensitive care to be discussed?
   

Where cognition or communication affects decision-making, the way a person’s preferences are understood and supported may need to change. That is different from assuming the person should no longer be part of the conversation.¹

None of this is a substitute for continence assessment, treatment, clinical judgement or referral when specialist input is required. Current aged-care guidance similarly places assessment, care planning, review and access to relevant health professionals within continence care.⁴

The point of better questions is not to make every decision longer. It is to make it more intentional.

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Dignity lives in the details

Dignity is sometimes used so broadly in health care that it risks becoming abstract. Continence care makes it concrete.

Australian-led research into dignity-protective continence care identified respect, empathy, trust, privacy, autonomy and communication as central domains of dignified care.⁷ These are not features of a product. They are qualities of the care encounter.

They show up in how a question is asked. Whether privacy is protected. Whether a person is given time to answer. Whether staff assume or ask. Whether a carer speaks about the person rather than with them. Whether a change in preference is treated as an inconvenience or as useful information.

Listening to people talk about continence support, I have been struck by how often the conversation moves beyond supply or routine. It can sit very close to a person’s sense of normality, privacy and control in everyday life.

A familiar approach may be entirely suitable when it has been reviewed with the person and still reflects their needs and preferences.

The difference is not novelty. It is participation.

Reviewing established approaches

For nurses, continence nurses and care managers, keeping the person at the centre may simply mean pausing when circumstances change to check that an established approach still reflects the person’s current needs and preferences.

For organisations, it may mean making sure staff can explain relevant information clearly and know when specialist continence advice may be appropriate.

Continence support is broader than any product. It can involve assessment, treatment, toileting strategies, environmental changes, routines, carers and specialist advice.

The same principle matters during hospitalisation, rehabilitation and transitions of care, when a person’s mobility, function or level of assistance may change quickly. Continence support in these settings should stay attentive to what the person is able to do and what they are working to maintain or regain.⁸

When products form part of that picture, the decision about them still deserves care.

A higher standard for an everyday decision

The current aged-care standards place choice, understandable information, dignity and person-centred care firmly within expectations of quality.^{1, 2} Continence support is one of the places where those principles become intensely practical.

A continence support decision is not only a product decision. It is also a conversation about how a person wants to live, what they understand and what they want to remain able to decide for themselves.

Better continence support begins before a product is chosen. It begins with better questions, clearer information and a willingness to keep the person involved.

That is not a radical change to care. It is a more intentional application of principles healthcare professionals already recognise: dignity, choice and respect for the individual.

*Liz Anieto is founder of Svelte.

^{1. Aged Care Quality and Safety Commission. Choice, independence and quality of life. Accessed 18 August, 2026. https://www.agedcarequality.gov.au/strengthened-quality-standards/individual/choice-independence-and-quality-life}

^{2. Aged Care Quality and Safety Commission. Dignity, respect and privacy. Accessed 18 August, 2026. https://www.agedcarequality.gov.au/strengthened-quality-standards/individual/dignity-respect-and-privacy}

^{3. Australian Commission on Safety and Quality in Health Care. Understanding health information (health literacy). Accessed 18 August, 2026. https://www.safetyandquality.gov.au/our-work/patient-and-consumer-centred-care/health-literacy/national-statement-health-literacy}

^{4. Aged Care Quality and Safety Commission. Safety of clinical care services. Accessed 18 August, 2026. https://www.agedcarequality.gov.au/strengthened-quality-standards/clinical-care/safety-clinical-care-services}

^{5. Silverglow A, Milsom I, Kennedy M, Wijk H, Wagg A. Continence care quality from the perspective of older adults in long-term care or in receipt of home care: a scoping review. BMJ Open. 2026;16(2):e107685. doi: 10.1136/bmjopen-2025-107685}

^{6. Paterson J, Dunn S, Kowanko I, van Loon A, Stein I, Pretty L. Selection of continence products: perspectives of people who have incontinence and their carers. Disabil Rehabil. 2003;25(17):955-963. doi: 10.1080/096382809210142211}

^{7. Ostaszkiewicz J, Dickson-Swift V, Hutchinson A, Wagg A. A concept analysis of dignity-protective continence care for care dependent older people in long-term care settings. BMC Geriatr. 2020;20:266. doi: 10.1186/s12877-020-01673-x}

^{8. Yates A. Preventing deconditioning and incontinence in older people in acute care settings. Nurs Stand. Published online 16 July, 2026. doi: 10.7748/ns.2026.e12750}

Top image credit: iStock.com/skynesher