However, there is a stealthy robber of your revenue and from a certain perspective, you did say yes. While we all know (and occasionally need to be reminded) of the clever cost-cutting measures like recycling, electrical use, and various other annoying attempts to drive us further insane, that's not what I am talking about.

In the article titled “ A Win-Win Situation” , we talked about the prospect of your facility supplying incontinence products to your residents. We established that, not only would this create a previously unrecognized revenue source, it would also save the family members supplying those products tons of money. Many of you already supply these products to your residents and this article may help you reclaim quite a bit of lost revenue. For those of you who do not currently provide these products to your residents, I strongly urge you to read the article.

The premise for this cost savings is quite simple. Many of your residents may not be wearing the correct size of adult incontinence briefs or disposable protective underwear (often called pull-ups). Doesn't exactly sound like a financial catastrophe, does it? In truth, improper sizing can result in thousands of your profit dollars going into the wrong pockets. Over 90% of the facilities I have gone into (both long term care and assisted living) have more than half of their residents in incorrectly-sized briefs or pull-ups. The reason why is ridiculously easy to correct, and equally difficult to sustain. The larger sizes are easier to put on. It's as simple as that.

To fully understand this, let's review the recommended waist ranges on, for example, briefs.

The most common sizing mistake I see is when a resident is wearing a large brief when he or she could have fit into a medium. There are certainly more dramatic sizing errors than this, but I'll err on the conservative side to make this point. Before I explain the economics of this mistake, just think about it for a moment. A medium brief usually offers a waist range of 32” – 44”. A 44” waist is not exactly skinny.

Aren't a large number of your residents able to fit into this category?

For the sake of the argument, let's look at both the medium and the slightly bigger regular size. Between these two sizes, a waist range of 32” – 48” is covered. In most cases, this would describe the majority of your residents. However, take a look at what sizes you are currently using. Are the majority of the briefs you purchase either a medium or a regular? If you are answering a sheepish “no” to this, read on. If you answered “yes”, then you may fall into the minority of facilities that are able to keep a handle on sizing.

I'm going to assume a cost of $30 per case of incontinence briefs.
If you are paying substantially more than that then you should shop around.
At $30/case, the following math prevails:

Brief Size	Number of Briefs/Case	Cost per Brief
Small	96	$0.31
Medium	96	$0.31
Regular	80	$0.38
Large	72	$0.42
X Large	60	$0.50
XX Large	48	$0.63

As you can see, the larger the brief, the higher the per-unit cost is due to the lower case counts. Now you are getting a glimpse of the potential cost savings. Looking at one resident, incorrectly-sized in a size large instead of medium, you can see how these costs avalanche over the course of a year.

*Calculations based on $30/case cost and 6 briefs/resident/day.

Only you can decide how many of your residents might fit a similar model. As an example, if only 10 of your residents were incorrectly-sized between medium to large, it would translate to $2,281.25 per year in lost revenue. Unfortunately, this is just the tip of the lost profit iceberg. It's a big, cold iceberg with no Starbucks on it. Here are some of the other effects of an improperly-sized brief:

• Increased soiled linen due to leakage. This combines the lovely financial donations you will be making via inflated laundry costs (i.e. water, detergent, electricity or higher bills if you outsource laundry) and extra labor to change beds, in some cases wash laundry, distribute clean linens, make clean beds, etc. 
• Increased resident laundry bills: Same as above but to a slightly lesser degree.
• Increased skin breakdown: Yes Virginia, if they are in the wrong size brief, the brief won't perform as well and their skin will get wet. Wet skin is one of the leading causes of skin breakdown.

Skin breakdown leads to, if you are lucky, rashes and blistering that will respond to treatment (ointments, bandaging, etc.) If you are unlucky, it festers often into pressure ulcers (bed sores) that are a whole new world of wound care. One nasty pressure ulcer can take $30,000.00 to cure. Guess what? All of these things cost more money. Guess what else?

The state loves to walk into your facility and find residents with pressure ulcers.

It's a very quiet robber of your profits. For those of you that have never actually put a brief on a resident, I encourage you to try it. While I imagine this represents a small minority of readers, it's worth mentioning that it looks much easier than it is. Some of your residents are able to apply their own briefs while others require assistance. In some cases, those who require assistance are not always cooperative with the effort. In all honesty, if I were not so acutely aware of the negative impacts of an incorrectly-sized brief, I'd be tempted to put on a larger size myself if the resident was a bit combative.

Most of you are pretty familiar with the different methods of sizing. The typical method is to measure from one hipbone to the other, double that measurement, and add 2 inches. The preferred method at the places I have gone to where the failure to size correctly is rampant is to “eyeball” it. I can't tell you how many times I have heard “oh, he looks like a large.” Not coincidentally, it is often at those places that I hear:

“How can we become more profitable?”

The solution to all of this is really ridiculously easy: Simply size your residents in the appropriate size brief or pull-up. However, the task of keeping them in that size when there are various caregivers involved can be a bit daunting. There is a natural tendency to slide back towards those larger sizes over time. There are a variety of ways to keep your staff on target with sizing. One of the better methods I've seen is to use a color-coded sticker system. It's very easy to use and extremely cheap to implement. Here's a quick look at how something like this works:

1. Size the resident correctly.
2. Since each different size brief is a different color, select a sticker that reflects the color (size) of brief that your resident should be wearing.
3. Place this sticker in a discreet location within the resident's room.
4. Instruct your staff to consult the sticker PRIOR to placing a brief or pull-up on the resident.

This system will work but is only as good as the level of accountability there is within your facility for your staff to follow instructions. It sounds simple, but we all know how chaotic things get. Sometimes it seems like such a small sin to bend the rules once because the day is so crazy. That, my friends, is the first foot on the slippery slope of watching your sizing program go down the proverbial toilet.

I mentioned a recent article where incontinence products were also discussed.
Click here to read “A Win-Win Situation”.