Mr Kwan Kwong Mun, 76, is embarrassed every time a nurse has to change his diapers.
"They see my 'everything' and there is no dignity in that. It can also get very hot and uncomfortable when I wear diapers," he said in Mandarin.
Like many seniors in hospitals and nursing homes in Singapore, he uses diapers - five years in his case - due to a medical condition and the lack of mobility.
A small group of nursing homes is now pioneering an "anti-diaper" policy, especially for the elderly who are assessed to be able to live without them. Nursing homes in other countries such as Japan have already taken a similar stance.
The aim is to empower residents, offering them dignity and quality of life, as well as reduce incidences of urinary tract infections, bed sores or discomfort from prolonged use of diapers.
In April last year, NTUC Health piloted a "return to continence" programme for 41 residents at its Jurong West nursing home. So far, 34 of them have been weaned off diapers.
Initially, the nurses had a hard time trying to convince the residents to go without diapers. Many lacked confidence or feared the embarrassment of soiling themselves. Some also did not wish to trouble the nurses unnecessarily.
Mr Gurcharan Singh, 73, for instance, was initially very hesitant but changed his mind after hearing fellow residents share their experiences on how they did it during "graduation ceremonies" in the wards, where certificates and prizes are presented to the older people who managed to wean themselves off diapers.
Mr Singh said: "I decided to try it as it can be itchy and warm when wearing diapers."
STRENGTH TRAINING NEEDED
This is a multi-pronged approach that includes putting residents on a strength-training programme.... This will strengthen their muscles and ability to walk to the bathroom. We will place a commode next to their beds at night to encourage them to be independent.
MADAM LOW MUI LANG, executive director of The Salvation Army Peacehaven nursing home.
Ms Janice Tan, head of the residential care division at NTUC Health, said: "Without diapers, residents were observed to be happier and more confident. They also had more self-esteem and dignity, and felt more comfortable."
On average, it takes about one to two months for residents to adjust and make the transition to live without diapers.
Mr Singh, for instance, has an enlarged prostate and needed a diaper change every two hours a day. His spinal cord has degenerated to the extent that he is not able to walk.
Recognising his fear, nurses allowed him initially to continue wearing diapers while using a urine bottle. He soon realised he was able to keep his diapers dry and, after one month, had the confidence to stop wearing them.
As part of NTUC Health's pilot programme, nurses would record each resident's preferred timing for a toilet break and remind him repeatedly, so that he gets used to the idea of going regularly. Changes may also be made to the resident's diet, exercise routine and medication.
Mr Kwan, for example, has Parkinson's disease and it has affected his mobility.
Nurses worked with the physiotherapists to strengthen his leg muscles so that he would be able to reach the toilet in time. The dosage and timing of his medication were also tweaked so that its muscle relaxant effect would enable him to walk better to the toilet.
Residents are also encouraged not to take caffeine at night so that they do not need to go to the toilet too often.
Other nursing homes in Singapore are also recognising the value of an "anti-diaper" policy.
"This is a multi-pronged approach that includes putting residents on a strength-training programme... this will strengthen their muscles and ability to walk to the bathroom. We will place a commode next to their beds at night to encourage them to be independent," said Madam Low Mui Lang, executive director of The Salvation Army Peacehaven nursing home.
"We recognise that some residents are concerned that they may be incontinent and end up embarrassing themselves. We will let them use incontinent pads, not diapers, to give them the confidence that they can go to the toilet in time without wetting themselves," added Madam Low.
Jade Circle, a nursing home project by Peacehaven and two other foundations due to open at the end of the year, will adopt such a policy.
In 2014, Bright Hill Evergreen Home did a small study on reducing the usage of diapers for incontinent residents.
One benefit, it found, was the cost savings that resulted from the reduced use of diapers.
NTUC Health, however, said its pilot project was not aimed at reducing cost. In fact, it said there was a need for more manpower as staff members had to remind residents without diapers to go to the toilet, keep an eye on them when they do so and clean up after them should they soil themselves.
NTUC Health intends to roll out the pilot programme to its two other nursing homes by the end of the year.