EAUN edition - No place to go: Homelessness & Incontinence

0:00Welcome to this EAUN edition of the EAU podcast, no place to go, homeless and incontinent. In this episode, we are delighted to be joined by Eva Wallace and Anne Marie Kelly. Together, they explore the often overlooked connection between homelessness and incontinence, letting light on a condition that too often remains hidden. Join us for this insightful conversation. Hello everybody, and delighted to be here today with Anne Marie Kelly from the HSC. She's the clinical nurse specialist on continents in the Dublin area. My name is Eva Wallace and I'm chair of the Special Interest Group of the EAUN. Today we're going to talk about a hidden condition in the hidden population, so we'll be talking about incontinence and the homeless and we're finding a child that's really isn't easy for them. I'd like you to think really, imagine experiencing urgency and incontinence when you don't have a home,

1:03no access to a pipe of bathroom, clean clothes, somewhere to wash, or even a reliable toilet to use. How difficult would that be and how difficult is that for the homeless? Or Eva, it's a phenomenon problem. It's much more than a health condition. It affects the person's whole wellbeing. It strips away their dignity. As you could imagine, it impacts on their hygiene needs, it interrupts their sleep, their psychological wellbeing, and a lot of people become isolated simply by being incontinent. And the ability to access services in further person that's living in homelessness is exacerbated if you have incontinence. Trying to access emergency accommodation, centers, and even healthcare because you have incontinence and homeless, it's very dramatic on the person's quality of life. Yeah, I suppose really is healthcare questions we need to really look beyond the bladder and the bowel. And we need to look and see the whole person and ask the right question. Absolutely, Eva. And it seems to be a lack of proactive strategies to address bladder and bowel dysfunction

2:04for people living in homelessness today. What really does a person need to manage safely and with dignity? Have the homeless person? Or dignity is key in relation to helping the homeless person. And it can't be solved in one conversation, but we can address some of the needs and get the message out to health professionals what can be done for people living in homelessness that experience bladder and bowel dysfunction. Yeah, particularly has no address and and concerns should not depend on having a front door. We should be able to, ehm, sport homeless people within their own areas. Absolutely. And by simple things like having access to toilets, we think ourselves that is a basic human need. But for people living in homelessness, there's very few public toilets if you think of their year living yourself and in the city's budget visit. I suppose if you're going into the likes of a fast food restaurant, some places like that, when they get to know you, they might turn you away. Oh, absolutely. People are often turned away if they're homeless.

3:05And sometimes homeless people are being financially asked to use public toilets to pay and in some countries down to it's happening. So accessibility to toilets is one of the key factors that we must look at, but it's not the only factor. If the person does get a toilet successfully, then you have to look at issues in relation to privacy, to pass urine or pass a bowel motion. And safety is e. A lot of homeless women are very fearful of using public toilets in the night time if they're lucky enough to have access to toilets. And then if the person uses a toilet, are they able to access the simple things like washing your hands, taking a shower, so that the person doesn't smell of the order of urine or thesis? I suppose confidence products are not a problem. Where do they get them? What do they do? And how do they dispose of stuff them? And is when another issue is storage, if they are looking enough to get continents where products could you imagine? Where does the person, this homeless, store the continents where products? And then if they use continents where products, where do they dispose of them?

4:06They have to be disposed properly. And if they have an underlying health condition, then even constipation, that will make the bladder and bandage function. I suppose for a lot of these people, they might not have their own GPs, and their own local doctors are that, and they're actually depending on, you know, getting maybe their clothes and that, you know, we have charged. I know there are big wash machines and that now that people can use, but sometimes they have no place to store anything, so it's actually there to take everything with them. Yeah, and even accessing, you know, hot meals and drinks. A lot of the homeless people would experience and express that they cut back on what they're eating and drinking for fear that they would have an incontinence episode. And the shame of being incontinence, the shame of being homeless, but then incontinence and wholeness is phenomenon. I suppose if we look at some of these might have a lot of medical issues with substance abuse and maybe cognitive difficulties, that would also add to their dilemma. Yeah, and they may get a very strong urge to go to the toilet.

5:09They may not be incontinent, but the urge may be so strong that they may not be able to find a toilet and then they may have an incontinent episode. As healthcare workers as nurses really, we ask everybody about their bladder and bowelheads because problems are very common. And if you look at all the comorbidities, like, you know, conscience classes every border really, how would you ask questions of these patients, you know, like they're very vulnerable to start, as we said, no, it would have to be very delicate. Absolutely. And build a relationship with the person. Compassion is key and putting the person first, rather than just looking at homelessness and incontinence, look at the person first and teach, I suppose approach that person with dignity, compassion, and to be able to talk to that person in a private setting, not where there's other people and listening to what you're going to discuss. I suppose really dignity before diagnosis. Absolutely. You actually would have to take that first really, wouldn't you? Yeah, and you'd have to be very gentle.

6:11And once you have that relationship built up, then you can approach your continent's assessment in a compassionate manner. And it might be just simply gently exploring the issue with them in a non-judgmental manner. In content really, it's not a personal failure, it really can affect on their on-met needs. Absolutely. You know, so within that then, how would we actually approach us? I suppose maybe the best way to ask them to rather than say, and what's wrong with you, what matters to you, what would make managing your bladder about easier for you today? Really, we need to be able to give more holistic care. Absolutely. And to explore it in a very gentle manner initially, why, what do you find a, is challenging to you, are difficult for you to use a toilet. Our toilets are accessible for you during the day or the night. And do you have access to washing facilities or access to your continent's wear products, or even have you discussed it with anyone before? Is this the first time that you ever communicated

7:13that you have a bladder a bowel? Yeah. I suppose really about experiencing homelessness and confidence issues really isn't about being able to control the bladder a bowel. It's about having somewhere safe, five, or an accessible tool. And just practicant. The urge to act manifesto are loving within the EU, trying to make continents assessment available for everybody, regardless of their abilities or disabilities. And I suppose from our point of view, it's time to really break this silence, start the conversation, to make leather health a priority. And ask them what matters to you here and now today, in relation to the bladder dysfunction or the bowel dysfunction. It's not only urinary continents, also a lot of these people may have issues in relation to a fecaning continent. Yeah. And really it's not about continent shouldn't be dealt with only when you have fun talk. You know, it really is for everybody across all disciplines, really, across average or just barges and everything. And within Europe, I presume that there will be

8:15a lot of issues in every country in relation to homes. The Disney Arts and Only Ireland or Dublin or any of the major cities in Ireland. I suppose we should sign off on that really. And I suppose the final thing to say, thank you, Anne-Marie, would be in Cancun. But you listen, advocate and educate. Then we need to take incontinence out centre front, not silent hidden condition. And really, the challenges and stigma we have to work with them together. And we need to make our patients lives. We have that. Thank you very much. Thank you for this insightful episode. We are sure our listeners enjoyed it. To keep up with the latest EAU podcasts and stay informed on the urological advancements, be sure to subscribe to our EAU podcast channel on your favourite podcast app. Until next time, keep learning and stay inspired.