More than 70% of people in aged care experience some form of incontinence, yet Australian guidance makes clear that it isn't an inevitable part of ageing and may improve or resolve with professional advice and person-centred care, according to the Aged Care Quality and Safety Commission's continence guidance. That's a reason to ask for assessment, not just a more absorbent pad.
When a parent or partner starts struggling with toileting, families often concentrate on managing the next accident. Aged care nursing services should look beyond that immediate problem to understand what's changed, what support is missing and what matters to the person receiving care.
Table of Contents
- Why Aged Care Nursing Services Matter Today
- Who Provides Nursing Services in Aged Care
- Clinical Nursing and Minimum Care Time
- Continence Care as a Structured Nursing Process
- Wound Management and Skin Integrity
- Medication Administration and Safe Practice
- Choosing How to Access Nursing Support
- Your Next Step Toward a Nursing Assessment
Why Aged Care Nursing Services Matter Today
A continence product can protect clothing. It can't explain why someone who previously managed the toilet now needs help, or why they're avoiding outings because they're worried about leakage.
That distinction matters. Nursing care starts with understanding the person, rather than assuming that increasing dependence is something everyone must accept.
Support should protect everyday choices
Consider a hypothetical parent who stops attending afternoon activities because they're anxious about reaching the toilet. A useful nursing conversation would explore the difficulty behind that decision: reaching the bathroom, managing clothing, asking for assistance or recognising when to go.
The aim isn't merely to keep the chair dry. It's to help that person participate in daily life with as much confidence and independence as possible.
A useful starting question: What has become harder for this person, and what would they like to be able to do again?
For families caring at home, practical organisation matters alongside clinical support. The Patients Guide offers a resource to help families build daily routines for parent care, which can be used alongside advice suited to the person's health and abilities.
Know what you're asking nursing care to achieve
A family can make the first conversation more useful by describing the effect on daily life, not just naming a symptom.
- Comfort: Explain whether the person feels wet, sore, embarrassed or reluctant to accept help.
- Independence: Describe tasks they could previously manage and now find difficult.
- Personal priorities: Ask whether their main concern is sleeping comfortably, attending activities or using the toilet privately.
You don't need to arrive with a diagnosis. Your role is to describe what you've noticed and help the older person express what they want. The nurse's role is to turn those concerns into questions that can be assessed, acted on and reviewed.
Who Provides Nursing Services in Aged Care
Families often meet several workers wearing similar uniforms, but their responsibilities aren't interchangeable. Understanding their roles helps you direct a concern to someone who can act on it.
The 2023 Aged Care Provider Workforce Survey estimated 549,000 employees across aged care programs, including 414,000 direct-care staff, or 75%; residential aged care included approximately 36,900 registered nurses, 17,000 enrolled nurses, and a personal-care workforce accounting for 72% of direct-care employees, as reported in the Australian Institute of Health and Welfare's aged care workforce overview.
Understand the different responsibilities
Think of the team as a hospital ward crew adapted to someone's everyday living environment. Different workers contribute different skills, but they need to share observations and follow a coordinated plan.
The diagram below shows how those contributions fit together.
- Registered nurses: Lead clinical assessment and care planning, evaluate changes and coordinate further clinical review.
- Enrolled nurses: Contribute nursing care within their scope and supervision arrangements.
- Personal care workers: Assist with daily activities and pass on observations about changes in comfort, function or behaviour.
- Allied health professionals: Contribute specialised support for needs such as movement, equipment and everyday function.
- Family and carers: Share the person's history, preferences and usual abilities, with their consent.
Ask who owns the next action
A personal care worker may notice that someone needs more toileting assistance. That observation becomes more useful when a nurse reviews it, decides what assessment is needed and explains the next step.
Rather than asking only whether someone has been told, ask who is responsible for following up. You should be able to identify the nurse coordinating the concern and the person who will update the family.
Continuity matters because familiar workers can describe what's different from the person's usual pattern. Where staff change, clear handover notes should help the next worker understand both the care instructions and the reason behind them.
Families shouldn't have to carry messages between every member of the team. Ask how information reaches the people providing care across different shifts.
Clinical Nursing and Minimum Care Time
Clinical nursing exists to interpret health changes and organise a response. Completing a task is only part of the job; the nurse also needs to consider whether the person's condition or care plan has changed.
For example, repeated difficulty reaching the toilet calls for more than recording that assistance was provided. A useful clinical response considers what needs reviewing and who should be involved.
Understand the care-minute benchmark
From 1 October 2023, residential aged-care homes were required to provide an average of 200 direct-care minutes per resident per day, including 40 registered-nurse minutes; the first quarter after implementation recorded 201.93 total minutes and 38.76 registered-nurse minutes, while registered nurses were onsite 98.79% of the time, approximately 23 hours and 42 minutes daily, according to the AIHW aged care overview.
These are historical implementation figures, not a statement of today's requirements or the performance of an individual home. Ask a prospective provider to explain its current obligations and recent staffing information.
The distinction between total care time and registered-nurse time is important. The reported total exceeded the original overall benchmark, while the registered-nurse component fell below its benchmark.
Staffing averages help you ask questions. They don't tell you whether a particular person's concern was assessed promptly.
Connect staffing information to daily care
An average across residents isn't a promise that everyone receives an identical block of individual attention. Similarly, an onsite nurse isn't continuously at every resident's bedside.
Ask the home to explain how its staffing arrangements translate into help when your relative needs it.
- Clinical access: How does a resident request nursing review, including overnight?
- Changing needs: Who reassesses someone whose mobility, toileting or comfort has deteriorated?
- Coverage arrangements: What happens if the usual registered nurse isn't available?
- Communication: How are changes handed over, and when will the resident or nominated contact receive an update?
Don't stop at whether a care plan exists. Ask how workers know the current instructions, how nurses check whether those instructions still suit the person, and what happens when the plan isn't achieving its goals.
Continence Care as a Structured Nursing Process
Consider a hypothetical resident who has started wetting their clothing before lunch. Previously, they reached the toilet with a little assistance. The family asks whether a different pad would solve the problem.
The nurse needs a clearer picture before recommending a response. Recording the changed pattern is part of that work.
Find the reason before choosing the response
Under the strengthened clinical-care requirements, providers must assess contributing factors, develop person-centred, evidence-based continence plans, provide safe toileting assistance and review dignity, comfort, function and mobility, as outlined in the Commission's clinical-care safety requirements.
In this example, the assessment would explore what's different. Is the resident waiting longer for help? Are they having difficulty walking or managing clothing? Have bowel patterns, medicines, cognition or urinary symptoms changed?
These are assessment questions, not diagnoses. A new continence problem shouldn't automatically be labelled an infection, and a familiar problem shouldn't automatically be dismissed as routine.
The response should follow the findings. If access is the difficulty, the plan might address assistance and the bathroom environment. If the history raises concern about an underlying illness, the nurse should arrange appropriate medical review rather than relying on containment alone.
Make the plan usable
A useful plan connects findings, goals, actions and review. It should identify who will help, what assistance is needed, what workers should monitor and when the nurse will reassess.
- Personalised toileting: Base assistance on the person's pattern and preferences rather than staff convenience.
- Functional support: Specify help with movement, clothing and toilet access.
- Meaningful monitoring: Record toileting success, leakage, skin condition, falls or near-falls, and the person's comfort.
- Escalation: Explain which changes require nursing or GP review.
The accompanying video provides another format for considering continence support.
In the hypothetical example, success wouldn't be measured only by whether clothing stayed dry. The resident's ability to reach the toilet safely and feel comfortable accepting assistance would also matter.
Products belong within the plan, not in place of assessment. The same approach should respect communication needs, cultural preferences and the person's consent throughout care.
Wound Management and Skin Integrity
Skin care exists to preserve comfort and protect tissue, not to keep someone looking clean. Think of skin as a protective raincoat: when an area becomes damaged, it needs attention rather than being covered and forgotten.
Continence-related skin care is part of the clinical responsibilities described above. Families should expect a clear explanation of what staff have observed, what they're doing and how they will judge whether it's helping.
Start with a clear description
If you notice soreness, broken skin or a dressing that doesn't seem to be managing the problem, ask for nursing review. Describe the location and what the person has said about pain or discomfort rather than trying to name the wound yourself.
A practical review should establish what needs documenting and whether further examination is required.
- Appearance and location: Ask staff to record where the problem is and what they observe.
- Comfort: Include pain, tenderness or distress during personal care.
- Care instructions: Clarify the agreed skin-care or dressing approach and who will carry it out.
- Follow-up: Identify when the nurse will review the area and what changes should trigger earlier contact.
Look for a review process, not just a dressing
A dressing is a treatment tool, not a complete explanation. Ask what the team is trying to achieve and how they will compare the skin's condition over time.
If the area isn't improving, the care discussion should move beyond repeating the same task. Ask whether the assessment needs revisiting, whether the care instructions remain suitable and whether a doctor or another clinician should review the problem.
Practical rule: A skin-care plan should explain what to do if the area becomes more painful, more damaged or otherwise concerning.
Don't wait for a routine meeting if the person seems acutely unwell or the skin problem is rapidly worsening. Seek prompt clinical advice, and don't attempt a new wound treatment based solely on a photograph or a product recommendation.
Medication Administration and Safe Practice
Medication administration is a clinical safety responsibility, not a delivery round. The important question isn't only whether a medicine was given, but whether staff followed the authorised instructions and recognised concerns requiring review.
A traffic-controller analogy helps: the team needs clear directions, an accurate record and a way to stop and clarify uncertainty. Families shouldn't be expected to resolve conflicting medicine instructions themselves.
Make uncertainty visible
A hospital discharge, a changed prescription or an unclear medicine list is a reason to ask who has checked the current instructions. Don't assume that every document held by the family, provider and GP says the same thing.
For medicines administered by staff, ask the provider to explain its checking, recording and escalation arrangements. If the person declines a medicine or has trouble taking it, ask how that information is documented and communicated.
| Family concern | A useful question |
|---|---|
| Different medicine lists | Which list is current, and who confirmed it? |
| A recent prescription change | What changed, and who has updated the care instructions? |
| Difficulty taking a medicine | Who should review how it is given? |
| New symptoms | Has the nurse passed this change to the prescriber or pharmacist? |
Ask for review rather than changing treatment
If a change in toileting, alertness or movement follows a medicine change, tell the nurse and prescriber about the timing. That observation can inform review, but it doesn't establish that the medicine caused the problem.
Don't stop, reduce or rearrange prescribed medicines without appropriate clinical advice. Instead, ask for an explanation you can understand and a clear record of any authorised changes.
At a care-planning conversation, useful questions include:
- Purpose: What is each medicine intended to treat?
- Monitoring: What concerns should staff or family report?
- Responsibility: Who contacts the GP or pharmacist when clarification is needed?
- Review: When should the medicine list next be reconsidered?
You don't need to know every medicine name before raising a concern. Bring the information you have, describe what you've observed and ask the clinical team to reconcile any gaps.
Choosing How to Access Nursing Support
The most suitable access route depends on what needs assessing, how unwell the person is and what support is available locally. Distance matters, but it shouldn't be the only factor deciding whether an assessment happens in person or remotely.
The Australian Government reports that a Virtual Nursing in Aged Care pilot began in March 2025 across 30 residential aged-care homes, including homes facing workforce shortages or serving rural, remote, First Nations and culturally diverse communities, and is scheduled to run until 2027, according to its aged care data and digital strategy progress report.
Access Routes for Aged Care Nursing Support
| Access Route | Best Suited For | What to Prepare |
|---|---|---|
| In-person nursing through an aged care provider | Concerns requiring direct observation, hands-on care or assessment in the person's environment | Current care instructions, relevant records and a description of what's changed |
| Virtual or telehealth nursing | History-taking, discussion and suitable reviews when remote assessment can answer the clinical question | A private space, suitable technology, records and an agreed support person if wanted |
| GP-led referral for specialist nursing | Concerns involving possible underlying illness or a need for coordinated medical and nursing review | Symptom history, medicine information and previous assessment reports |
These routes can work together. A remote consultation may help clarify the history, while a local clinician completes the physical assessment that can't be done adequately over video.
Check the limits before booking
Ask the service what it can assess remotely and what would require an in-person visit. A camera view shouldn't be treated as a substitute for every skin examination, physical examination or bladder and bowel review.
For someone living remotely, clarify who will implement recommendations locally. An assessment is less useful if nobody has agreed to organise equipment, support toileting or report changes.
- Privacy and consent: Confirm who will attend, what information will be shared and whether the person agrees.
- Communication: Request an interpreter or suitable communication support where needed.
- Local follow-through: Identify the worker or clinician responsible for carrying out the plan.
- Escalation: Ask what happens if the remote nurse identifies a concern requiring examination.
A continence assessment service is one option alongside the existing provider and GP. Before booking, ask about availability, costs, documentation and whether the proposed appointment format suits the person's needs; don't assume a pilot or specialist service is automatically accessible.
Your Next Step Toward a Nursing Assessment
Your immediate decision doesn't have to be which product to buy or which long-term service to choose. Start by deciding who can assess the concern and how to give them a useful account of what's happening.
If the person is already receiving aged care, contact the nurse coordinating their care. Otherwise, speak with their GP or an appropriate nursing assessment service about the next available route.
Prepare a practical assessment pack
Gather what you already have. Don't delay asking for help because your records aren't perfect.
- Current medicines: Bring the latest available list and flag anything you're unsure about.
- Recent changes: Note differences in toileting, movement, skin, comfort or general wellbeing.
- Previous information: Include relevant care plans, assessment reports and discharge paperwork.
- Support contacts: Identify current carers, workers and clinicians who may contribute information.
- The person's priorities: Record what they'd most like help to improve.
Make a clear request
Explain the change in plain language. For example, you might say that your parent now needs help reaching the toilet and that you'd like a clinical assessment rather than only advice about pads.
Ask what the assessment will involve, whether it needs to happen in person and what written recommendations you'll receive. Before the conversation ends, confirm who will act on those recommendations and when progress will be reviewed.
Keep the older person involved wherever possible. Ask whom they want present and what they're comfortable discussing, rather than assuming the family should answer every question.
Take one concrete action today: contact the provider nurse, GP or continence assessment service and request an assessment of the specific change you've noticed.
Nursing Assessment Australia offers continence nursing assessments for aged care clients and NDIS participants, providing an option when bladder or bowel concerns need closer assessment. Visit Nursing Assessment Australia to explore its assessment services and practical articles, and ask which appointment format is appropriate for your circumstances.