This letter outlines the requirements of nursing homes and healthcare facilities to ensure that residents who are continent of bladder and bowel on admission receive services and assistance to maintain continence, unless their clinical condition is or becomes such that continence is not possible to maintain. It also states that for a resident with urinary incontinence, the facility must assess for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catheterization is necessary. For a resident with fecal incontinence, the facility must ensure that the resident receives appropriate treatment and services to restore as much normal bowel function as possible. Nursing homes and healthcare facilities must assess each resident at admission regarding continence status and whenever there is a change in urinary tract function, such as if a resident is admitted who is continent of urine, and subsequently becomes incontinent. They must also identify and consider factors that affect continence, such as medications, patterns of fluid intake, physical and cognitive capabilities, and environmental factors. This letter requires nursing homes and healthcare facilities to provide appropriate care and services to prevent urinary tract infections and restore normal bladder and bowel functions to the extent possible.

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