In general, adult briefs or other continence products should be changed at least 5 to 10 times per day, depending on the resident’s needs and how often they are soiled.
Residents with incontinence must receive timely and attentive care throughout the day to prevent serious health risks and preserve their dignity.
Most long-term care facilities aim to check and change incontinence products every 2 to 3 hours during the day and at least once overnight.
If your loved one’s diaper isn’t being changed, they may be suffering from nursing home neglect. Signs that a family member isn’t getting the care they need include diaper rash, skin infections, urinary tract infections (UTIs), bedsores, and other serious health issues.
If you believe your loved one may be suffering from abuse or neglect in a care facility, get a free case review right now to see how we can help your family.
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Nursing Home Diaper Policy by State
Nursing home diaper policies can vary by state due to differences in regulations, licensing requirements, and enforcement practices.
While there are federal guidelines that apply to all Medicare- and Medicaid-certified nursing homes, each state has its own health department or regulatory body that may impose additional or more specific rules.
Key areas where diaper policies may differ by state include:
- Assessment requirements: States may set specific timelines for how often residents must be evaluated for incontinence and individualized toileting plans.
- Reimbursement policies: Medicaid coverage of incontinence supplies may differ, which can affect what products are used and how often.
- Resident dignity rules: States may interpret and enforce dignity requirements differently. Some states strictly limit the use of adult diapers unless no alternatives are viable.
- Staffing standards: States with higher staffing requirements may better support alternatives to nursing home diaper changes, like timed toileting assistance. Understaffed nursing homes tend to have higher rates of abuse and neglect, affecting the care a resident receives.
- Use of incontinence products: The use of adult diapers may be based on medical necessity or convenience, depending on the individual resident.
States including California, New York, and Illinois have stronger enforcement and clearer patient rights frameworks, which can influence how incontinence care is approached. Other states may have less strict policies, giving facilities more discretion.
If you’re evaluating a facility or comparing state practices, it’s useful to review that state’s nursing home regulations, speak with the long-term care ombudsman, or consult the state’s department of health or aging services.
What If a Resident’s Diaper Isn’t Changed?
When residents are left in soiled diapers for extended periods, their skin and immune systems become especially vulnerable. Prolonged exposure to urine and feces creates an ideal environment for infections and other painful conditions.
Over time, this kind of nursing home neglect can cause a resident’s physical and emotional health to decline significantly.
Injuries and complications that may result include:
- Dehydration or malnutrition: Some residents may stop eating or drinking to avoid the embarrassment of accidents, which can lead to other serious health issues.
- Emotional distress and loss of dignity: Feeling wet, dirty, or ignored can lead to anxiety, depression, or social withdrawal.
- Sepsis: In severe cases, untreated infections can spread into the bloodstream and become life-threatening.
- Skin infection and pressure sores: Constant moisture can damage skin and lead to open wounds, especially in immobile residents.
- Urinary tract infections (UTIs): Bacteria from soiled garments can easily enter the urinary tract, causing painful and sometimes recurring infections.
- Yeast infections and rashes: Damp, warm environments promote fungal growth and skin irritation.
Worse, in some cases, residents may not even need a diaper. Staff may be too busy to provide regular toileting assistance and instead rely on diapers for convenience.
“There are some of those who use a diaper that still can tell when they have to go to the toilet to pee, but I have experienced that [they are told] ‘but you can just pee in the diaper,'” said one nursing home staff member.
Residents have a right to good hygiene, dignity, and patient care. Failing to change a resident’s diaper is not only harmful, it may be considered nursing home abuse or neglect — and you have the right to take action.
Nursing Home Diaper Stories
In November 2024, the operators of four New York nursing homes affiliated with Centers Health Care agreed to a $45 million settlement following allegations of severe neglect and mistreatment of residents.
New York Attorney General Letitia James filed a lawsuit, accusing the operators of using Medicaid and Medicare funds for their own personal enrichment, which led to insufficient staffing and substandard living conditions.
“Centers’ owners operated the nursing homes with insufficient staffing so that they could pocket tens of millions of taxpayer dollars meant for resident care,” explained James.
The settlement included $35 million for improved staffing and resident care, with $8.75 million returning to Medicaid and Medicare. Independent monitors were appointed to oversee reforms in the facilities.
Get Help for Your Loved One in a Nursing Home
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