Understanding High-Intensity Bowel Care

Everybody has different needs, whether they’re living with a disability or not. Some individuals may suffer from simple shocks, others may face complex health issues, while some others suffer from multiple high-intensity care needs. For this reason, everyone should be cared for according to their condition. 

High-intensity bowel care is a specialised form of health support. It is required by people who have difficulty managing their bowels independently. This care procedure involves procedures that must be done with respect, dignity, and honour.

High-intensity bowel care is not just about a process or routine; it is a core care pattern to stay healthy. Especially for people living with complex neurological or physical injuries.

What is High-Intensity Bowel Care?

High-Intensity Bowel Care is the special care required by people living with complex bowel problems. They find it difficult to manage their bowels, owing to physical or neurological health conditions. 

The care support they receive is called Complex Bowel Care. It is beyond hygiene support and basic toiletting. Some medical procedures that high-intensity bowel care might require include:

1. Manual evacuation

When an individual has little to no bowel sensation, manual evacuation is recommended. It is the physical removal of stool from the rectum. 

2. Enema

Also called “suppository administration”. An enema involves injecting fluid or inserting medication into the rectum to trigger bowel movements.

3. Stoma care

This involves caring for a surgical opening on the abdomen. 

4. Digital stimulation

Using the finger to stimulate the rectum in a bid to trigger bowel activity.

Managing Bowel Plans

Apart from the different bowel care listed above, monitoring and managing bowel plans can serve the same purposes. This involves tracking bowel activity, responding to bowel changes, and ensuring adequate preventive measures are followed.

Who Needs High-Intensity Bowel Care?

1. People living with spinal cord injuries. For instance, they may have lost control of the muscles around their bowels.
2. People with neurological disabilities.
3. Older people with an advanced stage of fragility who are living with age-related conditions.
4. Older people with impairments that make using the toilet properly difficult. 
5. People with a history of gastrointestinal disease, such as bowel cancer.
6. People who are just recovering from abdominal surgeries that require ongoing clinical intervention, e.g, colostomies.
7. People living with acute intellectual disabilities, like motor neuron disease, cerebral palsy, and so on.

It is worth knowing that High-Intensity Bowel Care is not only about physical support. It also revolves around maintaining a healthy bowel function. Likewise, it involves preventing infections, maintaining clinical standards, and preserving the client’s dignity. 

Individuals who require NDIS support should maintain proper documentation. Their disabilities will be funded through the NDIS’s core or capacity building support category.

High-Intensity Bowel Care and the NDIS

The National Disability Insurance Scheme (NDIS) has different categories of care depending on their severity. But they classify Bowel Care as Complex Care/High-Intensity Care due to the risks involved in its procedure. Another reason is that many of the procedures have to be carried out by health professionals.

This might seem simple and easy on paper, but extremely complex in reality. If the necessary care actions are not taken, it could lead to serious complications and life-threatening conditions. Hence, right from the planning to funding stage, the NDIS prioritises them.

The NDIS has three major classes of support for people living with disabilities. They classify High-Intensity Bowel Care under “Core Supports”. More specifically, under “Assistance with Daily Living”. 

Only specialised persons are cleared to administer High-Intensity Bowel Care. However, support workers and carers who are trained and have passed assessments can also administer bowel care.

Nurses or Support Workers, Whom Should I Prioritise in Bowel Care?

Whether to prioritise nurses or support workers in bowel care depends on the level of bowel care needed. They perform different functions. 

Nurses are mostly involved at the initial stage. They oversee the initial assessments, develop care routines, and assist in managing complications. Nurses are also helpful in bowel care in cases of high medical risks (bowel bleeding, infections, etc.).

Carers and Support workers, on the other hand, bank on the routines and other care protocols set by the nurses. They handle the moderate tasks. Most times, their task is a follow-up to what the nurses have done. However, before that, they must have completed some recognised support training and demonstrate competency in some procedures.

Overall, NDIS funding helps to reflect this balance. While nurses provide key support, trained carers do the follow-up. This synergy helps to create a balance and encourages clinical safety. It is also cost-effective and favourable in a long-term setting.

Ensuring Safety and Dignity in High-Intensity Bowel Care

Bowel care is personal and very secret. Complex Bowel care is a procedure that requires careful and thorough implementation, which only disciplined carers can handle.

Most families often find it hard to work with carers and create a balance between safety and dignity because of how personal it is. It is important to ensure the individual feels respected while maintaining clinical standards.

Here are some ways to help families and carers ensure clients’ autonomy and maintain standards.  

Championing Independence

It is important to always encourage autonomy at the slightest chance possible. Even in situations that require full support, allow them to participate in their care. However, this does not mean saddling them with complex tasks. 

Let them decide their preferred time of day for care. Allow them to use their preferred products. For some individuals, asking simple questions is enough. For instance, you can say, “Would you like to start now, or in ten minutes?”.

These little inclusive acts can help them to build confidence, promote a strong sense of control, and reduce stress.

Reducing Trauma and Anxiety in Clients

The importance of having a relaxed psyche before care administration cannot be overstated. A peaceful mind is a healing mind. Unfortunately, previous bad experiences might induce trauma in some patients.

Previous unpleasant moments in institutionalised care can also contribute to discomfort or sudden loss of independence in some patients. The thought of having bowel care in the home might make them feel anxious.

To combat this, keep routines predictable. Carers should talk with the client before proceeding to core treatment. This is not where to show your flexibility. Stick to the sequence for a while. This will help the client ease up and feel more relaxed.

Speak to them in a calm tone. Offer reassurances, and do not rush through processes. Let them know what to expect. That way, you are helping them fight trauma and making them feel relieved.

Infection Prevention and Safety Practices

Good hygiene is the first defence strategy against infections. High-Intensity Bowel Care often involves coming in contact with liquid and bodily fluids. It also involves using medical equipment like catheters, oedema kits, stoma bags, etc.

To minimise the risks of improper handling of care items and unsafe disposal of equipment and care items, thorough washing of the hands is compulsory before and after routines. Surfaces should be cleaned and disinfected. Solid waste materials should be discarded properly and in line with Australia’s healthcare guidelines.

Respect Privacy

That they need support does not mean they forfeit their right to privacy. They may be vulnerable, but that should not take away their autonomy. Always ensure to seek their consent before taking any step, verbal or written.

It's as simple as saying, “We’re about to carry out a manual evacuation procedure on your bowels. Are you ready?”. Even if it's a procedure they’ve had done a thousand times before, always ask for permission.

Also, close all openings in the house. Close every door and curtain, or reduce exposure by only uncovering the area that requires treatment. 

In cases where the client has difficulty in communication, use gestures, picture boards, or cues to communicate with them.

Quick Tips for Families and Carers About Navigating High-Intensity Bowel Care

It is not easy to support a loved one who needs High-intensity bowel care.  The task might seem hard at the initial phase. However, it gets better with time, especially if you have a reliable support like the carers from Support Network to guide you. 

Knowing hacks and tips on how to manage it can be relieving. It saves family members from doing the right thing at the wrong time. It also makes it easy to balance dignity, safety, and promote independence with ease. 

Here are some practical tips that can help you navigate Bowel Care with ease. These tips will also ensure that your loved one and the carer are respected, honoured, and supported efficiently.

Know the Care Routine

Learning the care routine should be the first item on your agenda. Ensure everyone involved in the care plan understands what is expected of them and when. Walk the new carer through the routine several times and review medications from time to time.

Knowing the care routine ensures you know when your loved one is not receiving quality care. It prevents health complications and facilitates open discussion.

Involve the Right People

After knowing the care routine, the next thing is to involve the right people. People who know things better than you do. Safety is best guaranteed when the right people are in place. Some of the right people you should involve include:

• Registered Nurses: They are needed for their clinical oversight. They are also trained in handling advanced tasks like monitoring bowel health and stoma changes. 
• Trained Carers: They have the right competencies in high-intensity supports.
• Other Family Members: The impact of supportive family members cannot be underrated. They can assist you in providing insights about routines and preferences. They keep the home together. 

Encourage Open Communication

No one has their privacy invaded as much as a person undergoing bowel care, especially high-intensity bowel care. Even if the procedure isn’t new, they’re never 100 percent sure at all times. It’s worse with the family of the person who has to watch the carer do their job.

As a carer, always loop the family of the patient in. As the patient’s loved one, if you notice the carer trying out a new method, be calm and ask questions in a polite manner. That the carer is doing it differently does not mean they are doing it wrong. Also, motivate the carer to always take you and other family members through new procedures.

Open communication prevents a lot of small issues from upsetting a well-curated care plan. Use simple language. Do not use curse words. Give constructive, not destructive criticisms. For example, instead of saying “You did not do it right,” say, “It looks like you missed a step.”

Create a Daily Routine and Stick to it

Consistency achieves the best result. Always have a written list of things you want to achieve. Or a care schedule, to ensure you are on the same page as the carer and your support provider. 

High-Intensity Bowel Care is a procedure that involves many steps, so many that it is easy to skip or forget some. Creating an itinerary reduces the chances of missing a step or forgetting to perform a particular task. 

You can have a checklist that lists key tasks. For example, enema preparation, stoma cleaning, applying lubricants, etc. 

If multiple family members are involved in the care procedure, a visual chart might be helpful. Apart from ensuring you do not skip a task, it also prevents repeating a task. Creating a daily routine is an assurance that proper care is delivered.

Install Proper Hygiene and Storage of Equipment 

Part of doing things the right way is maintaining hygiene. You do not want to add infections to the bowel issues your loved one is having. All tools, supplies, and equipment should be stored in a clean, dry, and easy-to-access place. 

Delicate items like needles, disposable pads, syringes, creams, etc., should be disposed of or put away properly. Ensure all bottles and containers are labelled correctly to prevent the misuse of drugs. 

Encourage other family members and the carers to wash their hands regularly. Everyone coming near your loved one should be in their protective gear to reduce the rate of infection. Poor hygiene is unpleasant. It could also be the source of another ailment for your loved one. 

Push for Specific Training and Consistency in Care

High-Intensity Bowel Care is too delicate a disability to be always changing carers. You need someone who will be around for a while. There is a need for consistent support workers. During your NDIS planning, emphasise the quality of carer you want and their level of experience. 

Request an NDIS funding package that covers high-intensity training and makes provisions for an overnight care worker. Request for continuity in your choice of carer or any carer they provide you with. Constantly changing carers is not ideal.

Be specific with your asks. It matters a lot. You can say something like “My daughter needs consistent bowel care from expert workers who are familiar with high-intensity bowel care. Can we allocate funding that ensures we have a full-time team and support their upskilling?”

It is not too big to ask; just ensure you submit all the necessary documents that support your claim.

Keep Proper Records

Documentation is something you probably do not want to miss out on. It is crucial. Maintain a log of everything that happens, from bowel movements to the equipment used, to the time the carer arrived and left. 

These records are vital. They can be helpful during NDIS review meetings and interviews. They can also be helpful when liaising with health professionals. If something happens during care, proper records can be used to trace the effect and suggest a possible line of action.

Do Not Act Alone - Seek Help

One mistake many people make is thinking they can manage their loved one’s high-intensity bowel care without external help. This is not so. Request help from the appropriate quarters if you ever feel choked with care tasks.  

Reach out to your NDIS Support Coordinator, and they will link you with a reliable support provider like Support Network. Regardless of what you need help with, speak up. And whether it is to complete some paperwork, review your plan, or find the right carer, Support Network is there to assist you.

Don’t Sideline Your Loved One - Their Opinion Matters

Beyond the physical support you want to provide, their mental readiness carries weight too. Involve the care receiver in all of your planning. Let them partake in their care. Ask them questions, seek their counsel. It makes them feel seen and heard.

This not only builds their confidence. It also reinstates the fact that you are not taking away their autonomy. High-Intensity Bowel Care does not have to be a passive experience. Let everyone involved express themselves without hindrance.

Other Random Tips that Can Help

• Put all equipment away neatly. And store in a sanitised, cool, and dry place, away from contaminants.
• Use the ideal personal protective equipment
• Do not render the patients useless. Let them participate in simple tasks like handing over the wash cloth. 
• Never discuss their condition with a third party.
• Know when to stop. Respect their stress signal when they show signs of discomfort during a procedure.

Frequently Asked Questions

Does the NDIS plan cover High-intensity bowel care?

Yes, it does. The NDIS plan covers High-intensity bowel care. 

How Do I Know if my Loved One Qualifies for High-intensity bowel care Under the NDIS?

Once they start experiencing frequent bowel issues and have issues managing them independently, then it is high time you considered them for care. Just ensure to provide clear evidence for diagnosing it, and you are set. This may be a report from a specialist, continence nurse, or GPs. The report should state the level of support needed. During the design of the care plan, important aspects of the care routine should be emphasised. You should discuss daily challenges, the risks involved, and how support would improve safety. 

Can a Support Worker Perform High-Intensity Bowel Tasks?

Only experienced and trained support workers should be trusted with performing High-intensity bowel care procedures. To be qualified for this, the carer must have been trained by a nurse and passed their assessment. This is to ensure that every task is done by the best hands.

Does my Loved One with Complex Bowel Care Need a Special Nurse?

This may not be necessary. A trusted carer from reliable providers like Support Network will do. That is why you should ensure that the carer is highly trained and has experience caring for people living with High-intensity bowel care. This promotes continuity in care, and it is also cost-effective. However, if there is a decline or complications, let a nurse step in. Your NDIS plan should be able to accommodate provision for this based on assessment needs.

What does a Regular NDIS support for Bowel Care look like?

If you submit the right document and your request gets approved, your support plan will include;

• Funding to train carer for bowel procedures
• Supervision support by registered nurses when needed
• Equipment and supplies that are necessary for safe bowel management

Conclusion

High-Intensity Bowel Care can be hard. But with the right people, it can be a walk in the park. Knowing the right things and when to do them can make Bowel care easy to administer.

Family members, nurses, and carers all have a role to play. While at this, the impact of trusted and reliable support providers like Support Network should not be underestimated. Reach out to them if you are considering NDIS support for your or your loved one’s High-Intensity Bowel Care.