Diapers: They’re not just for babies

I received a call a few days ago from a woman looking for some source of assistance for her brother who suffered from incontinence and had to wear what are commonly known as adult diapers.  Our posts on this blog have tended to address the diaper need that affects babies and their families; however, many adults, particularly seniors living on limited incomes, suffer from incontinence.  Many of these people have difficulty affording adult incontinence supplies and diapers.  And their lives, and those of their families and loved ones, are adversely affected by the lack of access to incontinence supplies.

Urinary incontinence affects approximately 13 million persons in the United States, with as many as 25 million experiencing transient or ongoing incontinence.  Most of these people are older adults, many of whom may be living on limited incomes with limited buying power once medical expenses are factored in.  In addition, many disabled people are obliged to wear diapers for a variety of reasons, incontinence and inability to use a bathroom unaided among the most common.

Often, people dealing with incontinence problems are among those who have the fewest resources.  According to the Cornell University Online Resource for U.S. Disability Statistics in 2009, an estimated 26.4% percent of the population between 21 and 64 with a disability had incomes below the poverty line.  These numbers only include people with disabilities who are living independently, either alone or with family – not those who are institutionalized and have greater access to care.  According to the U.S. Census Current Population Survey in 2010 9% of adults 65 and older lived below the federal poverty line. However, using the U.S. Census Bureau’s alternative measurement of poverty, as many as 16.1% of U.S. seniors are living in poverty once medical care and other costs of living are factored in.  Elderly Americans spend on average 19% of their total income on out-of-pocket medical expenses annually. Out-of-pocket expenses include health insurance premiums, medical copayments, and prescriptions.  Once those costs are paid, however, many seniors are unable to pay for critical services.

Many insurance programs and Medicare programs will not pay for adult diapers, particularly if the incontinence is not diagnosed as a separate medical condition.  Even when it is identified as a separate condition, some state run Medicare will not pay for diapers even if they pay for other supplies.  (You can find your state’s coverage by using this link and finding Urological supplies.)

It is estimated that by 2015 one in four Americans will be over the age of 65. At a time when communities need to be building infrastructure and planning to care for our increasing aging populations, services are instead being reduced for even the lowest-income seniors.

In “A Report to the Community,” the Community Needs Assessment Process 2006–2009 Area Plan on Aging report, Pima Council on Aging, an Arizona Senior Service Agency, identified as major problem areas for their community “lack of sufficient income to meet basic needs; lack of transportation and affordable health care, including dental care; need for in-home support, including home maintenance and repair; isolation and need for advocacy. The overriding concern of seniors is to find ways in which to continue living in their own homes for as long as possible.”  According to the National Association for Continence, incontinence is the second leading reasons for institutionalization of the elderly in nursing homes and 53% of homebound older persons are incontinent.

Many diaper banks provide incontinence supplies for adults.  The supplies distributed by local diaper banks through their partner organizations are part of a larger continuum of services that not only supports older adults in remaining in their own homes, but also contributes to their dignity and quality of life. If not for a diaper bank’s monthly incontinent supply donations to their partner agencies many local community’s elderly would be unable to leave their homes to due to fear of embarrassment, and would live in compromised comfort even while at home.  Many diaper banks provide monthly incontinent supply donations to their partner agencies because the local community’s disabled would suffer decreased quality of life, ranging from constant discomfort due to accidents to being unable to leave their homes.

Adult incontinent supplies are not donated as often as baby diapers and cost a great deal more.  As a result, diaper banks sometimes have trouble maintaining a reliable supply of adult diapers.   Consider donating to your local diaper bank to help them acquire the incontinence supplies that could make a meaningful improvement in the quality of life for a disabled person or an older person.  If you do not have a diaper bank nearby, consider donating to the National Diaper Bank Network.

Why Diapers? Some Facts That Might Surprise You

Diapers are a basic need for children in the United States, as essential to their health and well-being as food, shelter and a parent’s love.  Unlike other necessities such as food and heat, diapers are not recognized as a basic need by the federal government, and so no provision is made to help families acquire diapers.  Federal anti-poverty programs such as Food Stamps (now called the Supplemental Nutrition Assistance Program or SNAP) do not cover diapers, leaving poor families without the means to properly diaper their children.

 

Families from a range of incomes struggle to afford diapers, including both families who fall below the federal guideline of poverty ($22,350 for a family of four) and families with incomes above the federal poverty guideline but who are still considered low-income.  Research suggests that families earning twice the federal poverty guideline still struggle to meet their basic needs, making the poverty level figures cited in this plan a very conservative estimate of the universe of people struggling to meet their diaper needs.

 

Families unable to afford diapers are forced to choose between a range of undesirable alternatives that can severely impact the health and well-being of both the child and the rest of the household.  According to a study by Ravers and Letourneau, 34% of families surveyed had cut back on basics such as food, utilities or child care in order to purchase diapers for their children.[1]  Other families reported leaving their children in soiled diapers for a longer period of time than they otherwise would have.  Some families even resort to cleaning out or drying soiled diapers and reusing them in order to meet their diaper needs.

 

The lack of diapers also limits families’ child care options.  Most licensed child care programs do not accept children who are not sent with an adequate supply of disposable diapers and do not accept alternatives such as cloth diapers.  When parents run out of diapers, they are forced to withdraw their children from child care, hindering their ability to work or attend school.

 

Twenty-two percent of all children under five years of age in the United States live in poverty, ranging as high as 34% in Mississippi to 12% in Maryland.[2]  In the U.S. territory of Puerto Rico, as many as 57% of children under five live in poverty.  This poverty is most pronounced in households headed by single mothers, where 54% of children under five live in poverty, compared to only 27% of children under of five in single father households and 10% of children under five in households with two married parents.[3]

 

In absolute terms, 4.4 million children under five live in poverty[4], of which roughly 2.6 million are children who wear diapers (0-36 months).  At a rate of six diapers per day per child, diaper wearing children in poverty in the United States require more than 5.8 billion diapers annually to keep them clean, dry and healthy.


An inadequate supply of diapers can have severe repercussions for the health and economic and emotional well-being of the child, parent and rest of the household.  Most immediately, an inadequate supply of diapers forces many parents to leave their child in a soiled diaper longer than is appropriate, which frequently leads to diaper rash, and may cause staph infections and urinary tract infections.  Uncomfortable babies also experience irritability, prolonged crying and poor sleep.  These consequences, in turn, erode mother-child attachment and may lead to lower levels of self-esteem and even depression for parents who are not able to provide the diapers their children need.  In many cases, these outcomes result in neglect[5] and abuse of the child.

 

The inability to enroll children in child care due to lack of diapers threatens parents’ economic and educational opportunities.  Without proper child care, parents cannot work to support their families and cannot attend the schooling that will help them provide a firmer economic base for their family.

 

Moreover, the unplanned removal of the child from child care when diapers run out may itself cause harm to the child’s well-being.  Adams and Rohacek report that instability in child care arrangements has been linked to a range of negative outcomes in children, including problems with relationship attachment, social competence, behavior, cognitive ability, language development, school adjustment and overall well-being.[6]

 

In cases where parents cut back on other expenses to afford diapers, families suffer due to a lack of other necessities.  Cutting back on clothing, heat or prescription drugs can negatively affect family members’ health and emotional well-being.


[1] Ibid.

[2] U.S. Census Bureau, American Community Survey 2005-2009.

[3] Ibid.

[4] Ibid.

[5] Laura Frame, Parent-Child Relationships in Conditions of Urban Poverty: Protection, Care, and Neglect of Infants and Toddlers, Center for Social Service Research, School of Social Work, U.C. Berkeley, 2001, p.4.

[6] Gina Adams and Monica Rohacek, Child Care Instability: Definitions, Context, and Policy Implications, Urban Institute, 2010, p.6.

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