Like many people with urinary incontinence, Tanya Randall-Tanner was reluctant to get help for her condition. As a child, she had an operation that damaged her bladder, but it was not until she was 16 that she finally visited a urologist who prescribed medication. Even then, another 11 years passed before Randall-Tanner took aggressive steps to solve her problem.

“I was looking for the least invasive option, but ultimately the recommendation was surgery, and it still took me 3 years to go through with the operation,” she says. This time the procedure was a success.

Studies have shown that her response to this situation was not unusual. According to Randall-Tanner, research reveals that the majority of women experiencing urinary incontinence wait 7 to 9 years to get help.

“During those years, I was constantly looking for somebody who could provide information and emotional support, and it finally dawned on me several years ago that I needed to become that person,” Randall-Tanner says.

In 2001, she started her own business—The Center for Continence in Olympia, Wash—a one-stop shop for people experiencing urinary incontinence. It offers everything from one-on-one counseling to online sales of incontinence supplies.

With growing numbers of grocery stores and other retailers offering these products at cheaper prices, the key to success for HME dealers competing in this product niche is to offset the seeming bargains by specializing and offering broader inventories, home delivery, compassionate, knowledgeable staff, and lots of education for customers often too embarrassed to get the help they need.

Talking Incontinence
Initially, Randall-Tanner’s company provided continence counseling for individuals and groups, such as nursing homes and senior citizen centers. She soon realized that it was difficult reaching out to customers who needed her help because they felt embarrassed to admit that they were incontinent. In one of her visits to a nursing home, the geriatric counselor on staff asked her to meet with a patient who did not want to talk about her urinary incontinence even though she was lining her underwear with newspaper.

“The social stigma of urinary incontinence prevents many people from stepping forward to get the help they need,” Randall-Tanner says.

To help individuals who are afraid to speak up, she turned to the Internet as a marketing vehicle. Now through her Web site (www.continencenow.com), she reaches individuals who learn about her services online and can even consult with her in the privacy of their own homes.

Because many customers with incontinence are embarrassed or feel a loss of dignity, Randall-Tanner takes plenty of time discussing various options and stresses that they are not alone with this condition. “Explaining that a large percentage of the population suffers from incontinence tends to put them at ease,” she says.

Privacy a Plus
In addition to offering patients half-hour phone consultations, Randall-Tanner has expanded her business to include online marketing of adult diapers, liners, briefs, skin care products, and devices for strengthening pelvic muscles. Although she only recently launched a Web site for ordering products, Randall-Tanner expects that sales will be strong.

“My customers have told me that they prefer ordering products from home because of the privacy factor, and they also like the convenience of having them delivered,” she says.

Like The Center for Continence, Grand Junction, Colo-based Americare Services also delivers adult diapers and other absorbent products directly to customers’ homes.

“Patients seem to prefer having these products shipped to their homes rather than having to stand in line at the store to buy them,” says Kathy Cserni, who started the company with her daughter 6 years ago.

As a convenience for customers, the products are delivered four times a month, which means they do not have to store a large supply in their homes.

Americare Services has a unique approach to selling incontinence supplies. Its sole market is Medicaid customers. Cserni and her daughter just wanted to start a small business in the health care field. By serving only Medicaid customers, they are able to keep the business relatively small and avoid having to operate a showroom with regular hours.

Since Americare handles only Medicaid contracts, the absorbent products it carries are those approved for reimbursement by Medicaid. “Since some absorbent products cost more than what Medicaid will pay, we have to be careful to carry only those products that are priced right,” Cserni says.

To reach customers, Americare occasionally mails flyers to individuals over a specific age and under a certain income. Cserni also sends letters to urologists and the directors of social service agencies. Word of mouth from Americare’s customer base, however, plays a large role in attracting new customers.

“Many customers like our personalized service so they end up recommending it to friends,” she says.

Americare’s biggest challenge is to stay competitive when other large HME providers are offering the same products. And Americare must also stay on top of its Medicaid reimbursements.

“It can be difficult for small businesses, like ours, if Medicaid gets behind with its payments,” Cserni says. “Our goal is to eventually install an online system so we can receive and record payments more easily.”

Online Entrepreneur
In addition to billing, the Internet can also be a powerful sales tool for incontinence product suppliers. During the first phase of Randall-Tanner’s online marketing campaign, she plans to pay for high ad placements with major search engines, such as Google. She also is working out reciprocal arrangements with other organizations’ Web sites to offer links to her site, and is placing ads in health and wellness magazines

To accommodate a wide variety of customers, including men, Randall-Tanner chose to offer a large selection of products, which most retailers cannot provide. The Center for Continence currently has about 120 types of items available for purchase online. About 75% of these absorbent products have two or three different sizes, and the entire product line represents about 20 different manufacturers.

“I’ve also made a point of carrying everything from budget value-priced items to high-end brands,” Randall-Tanner says. She has even included specialty items such as liners that can be worn with men’s boxer shorts.

Her large selection gives her an advantage over most grocery stores and large pharmacies, which carry only a few different brands of adult diapers, even though there are many different products—both reusable and disposable—that can help customers with urinary incontinence. Occasional or light incontinence patients may obtain adequate protection using only a bladder control pad or shield. Customers who experience light to moderate incontinence may find the use of an absorbent guard acceptable. Those patients experiencing moderate to heavy or heavy to overnight incontinence will require an undergarment, protective underwear, or brief to obtain maximum absorption.

To avoid stocking large inventories, The Center for Continence has agreements with suppliers who ship directly to customers. “All I have to do is provide them with basic shipping information,” Randall-Tanner says. “The only products I ship directly are the pelvic muscle exercisers.”

Because incontinence is a sensitive issue, Randall-Tanner stresses that HME providers, such as herself, also have an advantage over large pharmacies or retailers that do not have employees with the expertise to answer questions and provide emotional support.

“My approach to marketing is to give my customers as much information as possible,” she says. “Once they have this information, they feel more comfortable about their conditions and can usually go ahead and make an appointment with a urologist.”

Based on her personal experience, Randall-Tanner recognizes that many women feel uncomfortable seeking help from a urologist because they fear they will need surgery. “There are many people who can solve their incontinence by simply strengthening their pelvic muscles with Kegel exercises or by taking a medication like Detrol that helps overactive bladders,” she says. “Surgery is not always needed.”

Getting the Word Out
Some HME providers have also found that many caregivers, as well as customers, are not knowledgeable about urinary incontinence products. To solve this problem, Donna Southworth, president of New Boston, Ohio-based Genesis Oxygen and Home Medical, has created gift baskets that contain incontinence supplies as well as other samples. The company’s home health agency nurses distribute them at skilled nursing facilities.

“In many instances, it’s the patient’s children or other relatives that end up making the purchases and they usually know very little about these products,” Southworth says. Gift baskets can display these products in a pleasing, non-threatening way so that the patients and their caregivers actually want to learn more about them.

Like Randall-Tanner and Cserni, Southworth also stresses the importance of having compassionate staff available to talk to customers who need assistance with urinary incontinence products.

“Staff need to be sensitive to the customers’ concerns and they also have to understand the importance of providing adequate education,” Southworth says.

In general, the more information an HME dealer can provide to these customers, the more grateful they will be for their services.

With urinary incontinence affecting more than 25 million Americans, it is no secret that these products represent one of the fastest-growing product lines for HME providers. Those businesses that have successfully carved a niche in this competitive market find that personalized service plays a major role in increasing sales.

“To succeed in this business, you must be knowledgeable and understand your patients’ needs, carry a variety of lines, and provide personalized service that is not available in large retail chains,” Randall-Tanner says.

By providing her one-stop shop for urinary incontinence, Randall-Tanner has found that she has the ability to assist people who desperately need help. “I’m trying to reach people before they lose the active quality of their lives,” she says. “I regret all the years I was somewhat inactive due to incontinence, and now that I know what it is like to live a normal life, I want to help others achieve this goal.”

Carol Daus is a contributing writer for Dealer/Provider.