Continence is an Occupational Issue.

If you asked most community Occupational Therapists whether they work in continence care, many would probably say no.

Yet ask the same OT, whether they assess toileting, falls risk, bathroom access, mobility, transfers, cognition, dressing, routines, environmental barriers, assistive technology, caregiver education or home modifications, and the answer would almost certainly be yes.

We are already working in continence care, we just don't call it that.

The harsh reality of the reforms

Many community OTs are facing the challenge right now - changes to the stream of referrals due to system changes such as a separation of funding pathways. While it was clear in the HCP program, that most OTs just received referrals for AT or HM, in the current system, that is not only glaringly more obvious but it's actually become an access issue. OTs are being asked to 'do as much as they can for as low as they can offer'. The reality is that care partners are trying to manage clinical risk and mostly only connect OT to AT or HM approvals.

There is a clear need to go back to basics - comprehensive and holistic assessments that inform evidence-based interventions beyond AT and/or HM.

Stats from a 2024 report, found that Incontinence affects 2 in 10 older adults receiving home care. That's 20% of your workload that probably could benefit from exploring their incontinence beyond a management approach! And OTs are best placed to do that work.

Continence is far more than bladder function

When people hear the word "continence", they often think of bladder exercises, medications or continence pads. These interventions are important, but they only tell part of the story.

Continence affects where people go.

It affects whether they leave the house.

It affects whether they sleep through the night.

It affects whether they accept home care services.

It affects confidence, identity, relationships, falls risk and ultimately whether someone can continue living safely at home.

Those are occupational outcomes.

As Occupational Therapists, we don't need to become experts in diagnosing every type of urinary incontinence. But we do need to understanding different types of incontinence to unpack how it affects occupational performance.

The question isn't "What type of incontinence?"

It's "What happens because of it?"

• Does urgency stop someone attending a social group?

• Has fear of leakage led to social isolation?

• Is nocturia contributing to repeated falls?

• Is arthritis preventing clothing management?

• Is dementia affecting recognition of bladder cues?

• Has Parkinson's disease slowed transfers just enough that the person can't reach the toilet in time?

• These are occupational questions.

• And they deserve occupational solutions.

The missing piece in many reports

Too often, reports simply state:

"Client experiences urinary incontinence."

That tells a provider almost nothing.

Instead, imagine writing:

The client experiences urinary urgency resulting in delayed access to the toilet due to impaired mobility, poor bathroom layout and reduced standing balance. This has resulted in increased falls risk, reduced community participation, interrupted sleep and greater reliance on informal carers. Occupational Therapy intervention will focus on environmental modification, task adaptation, equipment prescription, behavioural strategies, caregiver education and collaborative management with the GP and continence service.

Which report better demonstrates clinical reasoning?

Which one justifies intervention?

Which one clearly explains why Occupational Therapy is essential?

Support at Home is changing expectations

The new Support at Home program places greater emphasis on restorative care, independence and helping older people remain safely at home.

The strengthened Aged Care Quality Standards also require providers to partner with older people to identify needs, minimise risks and maintain independence and quality of life.

Continence sits at the centre of all of these priorities.

Poorly managed continence contributes to falls, skin damage, urinary tract infections, carer burden, hospital admissions and premature residential aged care placement.

Good continence management supports independence, dignity and participation.

Occupational Therapy has a unique contribution because we bridge the gap between medical management and everyday function.

We need to stop thinking in silos

Continence care is not owned by one profession.

GPs investigate medical causes.

Continence nurses provide specialist assessment and management.

Physiotherapists address pelvic floor rehabilitation.

Dietitians manage nutrition and constipation.

Occupational Therapists optimise occupational performance.

None of these roles replace each other.

The best outcomes occur when they work together.

OTs should feel confident recognising when symptoms suggest stress, urge, overflow, functional or mixed incontinence, not because we diagnose them, but because recognising the presentation helps us understand when referral is needed and how occupational performance may be affected.

Occupational Therapy brings something different

Uniquely explores:

• Can the person physically get there?

• Can they transfer safely?

• Can they remove their clothing in time?

• Can they recognise bladder cues?

• Can they navigate their home at night?

• Does their environment support success?

• Can they maintain dignity while participating in the occupations that matter?

• Those questions are uniquely occupational.

• And they matter just as much as bladder physiology.

Speaking the language providers understand

Providers aren't looking for reports full of continence terminology.

They're looking for reports that explain:

• Why the person is at risk.

• What functional consequences exist.

• What Occupational Therapy will do.

• How recommendations improve independence.

• Why funding is clinically justified.

  
  

When Occupational Therapists frame continence through the lens of occupational performance, recommendations become easier to justify because they are directly linked to safety, participation and quality of life.

A challenge to the profession

If continence only appears in your reports when recommending a raised toilet seat, we're missing the bigger picture.

Continence isn't a bathroom issue.

It's a participation issue.

It's a falls issue.

It's a caregiver issue.

It's a dignity issue.

Most importantly, it's an occupational issue.

As Support at Home evolves, Occupational Therapists have an opportunity to redefine their role, not by taking over continence management, but by confidently articulating how occupational performance, environmental design and functional independence are fundamental to good continence outcomes.

The question is no longer whether Occupational Therapy has a role in continence care.

If you are curious about working to your full scope in Continence Care?

Join our upcoming webinar on Fri 3rd July 2026 12:00PM AEST

What this session covers:

• How continence fits within Support at Home and OT scope

• Linking continence issues to function, falls risk, skin integrity, and care needs

• Identifying red flags, risk factors, and common presentations in older adults

• Practical OT interventions:

  • Behavioural strategies and habit retraining

  • Environmental modifications and task simplification

  • Assistive Technology and equipment prescription

  • Education that actually changes outcomes (not just information-giving)

• Working effectively within the multidisciplinary team, including when to refer vs when to lead

• Documenting and justifying your recommendations defensibly

  
  

 What you’ll walk away with:

• A clearer understanding of where continence sits in your OT role under Support at Home

• Practical strategies you can implement immediately in assessments and interventions

• Stronger clinical reasoning to justify your recommendations

• Greater confidence navigating the overlap between OT, nursing, and other disciplines