Gloria Gerard, RN, ET, CWOCN (left), uses a private consultation room to field sensitive questions.

Demand for incontinence products and services is rising thanks to an aging population and to the fact that more people than ever are undergoing various types of treatment—such as drug therapy and prostate surgery—that can induce loss of control over bladder function.

Accordingly, there has never been a better time for HMEs to increase revenue and bolster profitability by entering this arena or building on an already established presence. Incontinence merchandise you can carry runs the gamut from undergarments and liners to drip collectors, waterproof chairs, and bed pads; from catheters to pelvic muscle toning weights, stain cleansers, and more.

Fashion Sense
A recent positive development that makes offering incontinence goods a more appealing proposition has been the arrival of stylish absorbent (and reusable) underwear, which helps erase the stigma that discourages some potential wearers from buying the product. No longer do certain of these garments resemble adult-sized baby diapers. Men’s protective underwear, for instance, now looks convincingly like conventional male briefs, says Gloria Gerard, RN, ET, CWOCN, who manages the incontinence, wound care, ostomy, and sequential compression pump programs for Wisconsin-based Home Care Medical (HCM) Inc, with retail outlets in and around Milwaukee.

Women’s incontinence underwear has gone through a similar transformation. Not quite what you’d find in the Victoria’s Secret catalog, they are nevertheless distinctively feminine and accented with delicate touches women can appreciate, such as frilly lace and bows.

Because incontinence items in general are selling more briskly these days, competition at the retail level is heating up. Even supermarkets, convenience stores, and discount mass merchandisers offer incontinence supplies—but, fortunately for HMEs, their selections are severely limited. “The problem for supermarkets is that they can’t devote very much shelf space to these items,” says Gerard. An HME dealer, in contrast, can offer as many choices as there are brands under the sun because they can special order, something that is not readily done over at Wal-Mart, Costco, Safeway, or Winn-Dixie.

What is the bad news? The list price on many disposable incontinence undergarments has risen appreciably of late due to increases in manufacturer costs for raw materials and labor. Some makers have tried to hold the line on prices by cutting back on the quality of their wares. But the effect of that action has been to flood the market with ill-fitting and poorly absorbent products, says Gerard.

The higher prices and lower quality of some disposables prompted HCM—where incontinence supplies have long been a staple of the product mix—to respond by adding lines of reusable goods. Unit for unit, reusable incontinence undergarments are more expensive than disposables, but because they can be washed and worn over and over, reusables save significant sums in the long run. “Reusables also provide a way to differentiate your incontinence offerings from those of your supermarket competitors because reusables typically are not carried by them,” says Gerard.

Better Days on the horizon?
Gerard makes the important point that, contrary to common assumptions, old age is not a cause of incontinence. “Incontinence is the result of something that’s gone wrong within the body,” she explains. “Aging merely triggers changes that sometimes lead to an incontinence-producing bodily malfunction. But there are many other reasons for a malfunction of the body that have nothing to do with being elderly.”

Consequently, you find intermittent catheters used most often not by geriatrics but by spinal cord injury patients, who tend to be on the younger side of the age divide. Young or old, the most oft-purchased incontinence products are absorbent undergarments. The quantity that an individual is apt to use in the span of a month varies with his condition. For example, a person taking diuretics will use many more disposable briefs over the course of 30 days than will a patient of similar health status who is not on that type of medication, says Gerard. “This is one of the reasons inventory control is such a challenge,” she adds. “It’s hard to predict utilization.”

There is also the challenge of reimbursement. Most third-party payors will not cut checks for undergarments. (For HCM, the exception to that rule is its state’s Medicaid program, which allows a patient 300 briefs per month.) “I don’t see payors changing their position on this,” Gerard says. “Too many consumers have the potential for someday needing these items.”

Coupled with the increasing expense of undergarments, it could be economic suicide for payors, private companies in particular, to start covering them. “What nearly all payors do cover are incontinence-related catheters—Foleys, intermittent, and external—including the supplies associated with them,” she observes.

Although incontinence is considered a nursing speciality, it does offer at least some opportunity for integration with physical therapy. Gerard indicates there are instances where incontinence can interfere with the progress of a physical therapy patient. For example, a patient worried about whether he will wet himself during therapy may not be able to put his heart into the exercises. In fact, he might be so embarrassed about that possibility that he gives up on therapy entirely. Thus, in such instances, dealing with incontinence before the patient begins physical therapy can be crucial to the success of the rehab effort.

Speaking of nurses, a traditional source of referrals for HME incontinence products and services is wound ostomy continence nurses at hospitals and in other provider settings, Gerard notes. Thus, if you have on staff certified clinical specialists in incontinence that you can assign to oversee or help operate your program, you will find that those referring nurses will be much more eager to send you their patients.

As to marketing, a lot of the heavy lifting (building general awareness of incontinence) is done for you already by vendors and the supermarkets that spend millions of dollars on consumer-oriented advertising. However, you will still see that it is necessary to lay out a few dollars of your own to let the world know that you are the real go-to place for incontinence products.

Get Your Feet Wet
Yes, incontinence products and services can become an important contributor to your revenue stream and profitability. Still, the extent to which that materializes will depend on many variables, not the least of which is the future of the incontinence market itself. As Gerard opines, the market could turn out to be less robust than expected due to several factors. One is the possibility that potential consumers of incontinence products and services might not be directed by their doctors, nurses, therapists, and case managers to use them—and without being guided (or prodded) toward those goods and services, consumers may shy away from them.

Another chilling factor might be cost—certainly a concern since consumers must pay for undergarments and the like out of pocket. Future demand could also be dampened by newly developing surgical and pharmacologic interventions aimed at helping patients achieve partial or total continence on their own. “Only time will tell which way the market will go,” Gerard says.

For its part, HCM is betting that incontinence products and services will continue to be strong sellers as the years go by. Following its lead might just be a winning strategy for you as well.

Rich Smith is a contributing writer for Dealer/Provider.