incontinence – With All Due Respect

I’m closing out 2025 with a review of the most popular articles I’ve posted on this blog since its inception in January 2017. With All Due Respect has a limited audience of just over one hundred followers, composed chiefly of friends, former colleagues, and a few strangers who have found me through internet searches. It’s intriguing what people find interesting.

LOOKING BACK …

…at my stats over the last nine years, the most popular post, the one with over 1.5K hits, surprisingly is Nursing Homes: Clothing and Incontinence. It has topped the list of most-read annually for the life of the blog, including in 2025. Indeed, five of the top fifteen articles are related to aging, senior health care, and nursing homes. Is this surprising? Is aging of concern just for my peers, or more generally these days?

This article on incontinence and the treatment of patient clothing in nursing facilities gets at the very heart of human dignity and the respect or lack thereof that we demonstrate toward one another. Incontinence is often viewed by those who are gradually losing control over their lives and their bodies as the last frontier, the most humiliating, debasing loss. I’m not surprised that search engines have brought readers to my humble blog post.

I imagine a reader, perhaps a daughter, exhausted by months or years of care for her elderly parents, seeking advice on what to expect if she gives in and places one or both in a nursing facility. What would upset Mom most, she wonders. What would Dad hate the most about it? Sitting in a urine puddle in a bed or wheelchair, she suspects. So, she searches the internet to find out how nursing homes manage incontinent patients. Up pops my post, and she is mesmerized and appalled.

Little has changed in nursing facilities in the nine years since I wrote that article. The better-funded and staffed ones do a more acceptable job of managing incontinence and clothing care. However, the direction of senior health care funding in this country does not bode well for the future of even these places. The general societal attitude toward the elderly has not improved appreciably, though end-of-life care through hospice and Death with Dignity legislation have advanced the quality of life approaching death for many.

Curiously, my second-most popular blog post is The Waterwheel, with 803 hits. It quotes well-known and beloved poet Rumi’s wisdom and was written just a few days after the start of the COVID pandemic. Its message of taking up and letting go, embracing and relinquishing, is just as personally, socially, and politically relevant now as it was in March 2020. I suspect most readers find it by googling “Rumi” or, perhaps, “letting go,” a frequent theme in my writing.

The Anatomy of Respect, with 617 hits, comes in third. It goes to the heart and root of this blog over the last nine years by emphasizing the role of listening deeply to understand and develop respect. I have tried to link each essay, poem, and story in the blog to the theme of respect and have encouraged my readers to share their experiences and reflections in response. Truthfully, only a few readers have done so.

The most extensive dialogue with a reader occurred when a self-described, deeply conservative Republican, then Trump supporter, businessman, and father, Ryan, challenged me to engage in conversation about our differences after I posted the next-most-popular article (with 323 hits), Deep Listening, in December 2020. Our exchange of philosophical, political, and religious ideas, recorded in the comments following the Deep Listening article, began in February 2021. It ended in July 2022 when his family and business life became too busy and complicated for him to continue writing. It was fascinating and encouraging to see how much we had in common. Also, it was extremely challenging to be open-minded and respectful when we differed.

Often, at the beginning of a new year, I launch a new theme with the intention of focusing my writing on a particular aspect of respect throughout the year. It’s not always apparent how the theme relates to my overall subject. For instance, Practicing for the Big Let Go, begun in January 2024, initiated my reflections on letting go in everyday situations as a way of preparing for our final surrender at the time of death. What does this have to do with respect? Letting go involves engaging with the fundamental truth of impermanence—constant change. It requires respect for oneself, others, the flow of events, and our nature as human beings.

LOOKING FORWARD

As 2026 looms on the horizon, and I take stock of the world around me, close to home and farther away, I find it disingenuous to wish an uncomplicated and joyful “Happy New Year” to my friends. I wonder which aspect of respect we will encounter, reflect on, and perhaps write about in the coming year. As I grow older, my journey toward self-awareness takes me into more vulnerable, authentic, and intuitive territory. As I approach the culmination of life, I’m confronted by my affinity, even my oneness, with those whose ideas and actions I find disturbing or even abhorrent. Painful as it sometimes is, I sense my kinship and interdependence with everyone and everything. Thich Nhat Hanh called this “interbeing.” Acknowledging our interbeing, my three-fold aim to do no harm, help everyone, and embrace life just as it is, is a perennial and unrelenting challenge.

So, instead of “Happy New Year,” here’s my wish for us all. May we seek to respect one another, and may we meet next year’s opportunities to do so with courage, accept their invitation with curiosity, and respond with compassion.

Some problems seem absolutely intractable. Two such closely related problems in nursing homes are incontinence and care of patient clothing.

Appearance is, for many of us, closely associated with our sense of personal dignity. Some control over how we look and what we wear seems vital to maintaining a sense of identity, of personhood, particularly in American culture. Situations in which people are forced to wear clothing they have not chosen (e.g., prisons, hospitals) make them feel objectified and de-humanized.

My mother-in-law was a fastidious person. Over the years, as she aged, she cultivated a tailored, simple, neat and soft style in her dress, both at home and in public. She had few clothes, but they were of moderately good quality, always clean and well pressed. Her attire expressed her identity and her sense of self-worth. Before she died at the age of 92 she spent two years in a nursing home. I believe that part of her rapid deterioration there was due to her inability to take pride in or have control over her appearance.

While patients are encouraged to bring and wear their personal clothing (each piece labeled with their name) to the nursing facility, this attempt to make them feel more “at home” breaks down very quickly. Nursing home laundries are notorious for losing or destroying clothing, partly due to the pervasive problem of patient incontinence.

For various reasons, many nursing home patients are incontinent. Those who do not suffer from lack of control physically, may do so psychologically. Some have lost sensation and are unable to determine when they need to eliminate. Many are completely dependent upon nursing assistants (NAs) to help them with toileting. Since the NAs are burdened with heavy patient care loads, the patient may have to wait for very long periods of time between trips to the bathroom. After numerous frustrating attempts to maintain continence, many simply give up, relinquish this relic of their dignity and succumb to incontinence. At the end of the day, or perhaps several times during the day, patients’ soiled clothing is removed and tossed in a laundry hamper, where it may sit for hours or even days before being collected for laundering. No matter how hot the water, how strong the detergent, the odor never really washes out. Inevitably, clothing breaks down quickly and the patient’s wardrobe becomes gradually smaller. [An aside: some families, like mine, frustrated with inadequate clothing care in the nursing home, resolve to collect their loved one’s soiled clothing several times a week and launder it at home. Smaller, less powerful washers and dryers are even less effective in removing offending odors and many families give up after just a few attempts.]

Dwindling patient wardrobes are also due to lack of care in returning clothing to the proper rooms. When I visited my mother-in-law, she was often dressed in ill-fitting clothing that was not her own. A peek into her closet would show that perhaps half of the items there had someone else’s name on them, and many of her favorite pieces had disappeared permanently. The clothing was poorly hung or stuffed, unfolded, in drawers. Though I have been able to understand the nature of many operational problems in nursing homes, I have not been able to figure out why clearly labeled clothing does not make it into the correct patient’s closet. I speculate that lack of care or concern, low job performance standards, and a failure to understand the importance of appearance for one’s physical and psychological well-being might be some causes of the problem. There is so much work to do in a nursing home. Caring for the appearance of a patient may be quite low on the priority scale.

Is the problem really intractable? With a different mindset – one of honoring dignity and expressing respect – would it be possible to recognize the importance of answering call bells quickly, taking patients promptly to the bathroom, soaking soiled laundry immediately, hanging clean clothing neatly on appropriate hangers, folding items carefully, reading name tags and returning clothes to their owners. Would it be possible, with such a mindset, to dress patients in their own clothing, comb their hair, and wheel them out into their world as their best and most respectable selves?