Domain 3 of 12

Continence

Bladder and bowel function, catheter and stoma care, and skin-integrity impact.

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What this domain measures

The Continence domain captures bladder and bowel function — including catheter management, stoma care, and bowel-management regimes. Continence routinely interacts with Skin & Tissue Viability (incontinence-associated dermatitis, pressure damage) and Mobility (toileting transfers). The Continence descriptor table has 4 levels — no Severe, no Priority — so the scoring fight is typically Moderate vs High.

How it's scored (Annex C wording)

DST scoring levels for the Continence domain, with verbatim Annex C descriptors.
Level	DST descriptor
No needs	Continent of urine and faeces.
Low	Continence care is routine on a day-to-day basis; Incontinence of urine managed through, for example, medication, regular toileting, use of penile sheaths, etc. AND is able to maintain full control over bowel movements or has a stable stoma, or may have occasional faecal incontinence/constipation.
Moderate	Continence care is routine but requires monitoring to minimise risks, for example those associated with urinary catheters, double incontinence, chronic urinary tract infections and/or the management of constipation or other bowel problems.
High	Continence care is problematic and requires timely and skilled intervention, beyond routine care (for example frequent bladder wash outs/irrigation, manual evacuations, frequent re-catheterisation).

Evidence that moves the score up

Continence assessment by a district nurse or continence specialist
Pad change frequency log — number per 24 hours, soiling pattern, skin-condition notes at change
Catheter care records — type, change frequency, bypassing or blockage incidents, urinary tract infection history
Stoma care records and any complications (retraction, prolapse, parastomal skin damage)
Bowel management regime — manual evacuation, suppositories, rectal medication, frequency
Tissue viability nurse referrals and notes on incontinence-associated dermatitis
Hospital admissions for catheter-related UTI or bowel obstruction
Care plan section describing dignity-preserving toileting routine and the staff time it consumes

How ICBs commonly under-score this domain

Pattern: Assessor scored Low because incontinence is 'managed' by routine pad changes.

Rebuttal: Routine pad changes are the intervention, not the absence of need. The Moderate descriptor turns on continence care requiring monitoring to minimise risks — including urinary catheters, double incontinence, recurrent UTIs, or bowel-management issues. Per paras 162–166, score the present-day need.

Source: para 162-166 + DST Annex C Continence Moderate descriptor

Pattern: Assessor scored Moderate where catheter requires regular trained-nurse intervention for bypassing or blockage.

Rebuttal: The High descriptor turns on continence care being problematic and requiring timely and skilled intervention beyond routine care — frequent bladder wash outs/irrigation, manual evacuations, or frequent re-catheterisation are the named examples. Routine trained-nurse response to catheter bypass/blockage meets that test.

Source: DST Annex C Continence High descriptor

Pattern: Assessor scored Moderate where bowel management requires manual evacuation by trained staff.

Rebuttal: Manual evacuation is one of the High descriptor's named examples of timely and skilled intervention beyond routine care. Bowel-management regimes requiring manual evacuation meet the High descriptor.

Source: DST Annex C Continence High descriptor

4-line rebuttal template

I disagree with the [LEVEL] score for Continence. The evidence shows [SPECIFIC PATTERN — catheter complications / bowel regime / skin breakdown] which meets the [HIGHER LEVEL] descriptor. On [DATE/PERIOD], the continence regime involved [DESCRIBE: pad change frequency, catheter bypass/blockage events, manual evacuation, skin damage, trained-staff time]. Per the well-managed needs principle (National Framework paras 162–166), the current regime is the intervention, not the absence of need. If [SUPPORT] were withdrawn, the present-day risk would be [DESCRIBE: dermatitis, UTI, bowel obstruction, dignity harm]. I therefore request the Continence domain be re-scored to [HIGHER LEVEL] with reference to the [SPECIFIC EVIDENCE: continence assessment, catheter chart, bowel chart, tissue viability notes].

Continence rarely secures eligibility on its own

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