The slight nursing home resident is giving way to the obese senior, hampered by diabetes, disability and other weight-related ailments. Facilities that have long cared for older adults are increasingly overwhelmed and unprepared to care for this new group of morbidly heavy patients.
The population is shifting faster than the ability of nursing homes to deal with obese patients," said Cheryl Phillips, a senior vice president at LeadingAge, an association of nonprofit providers of services for older adults. Nursing homes don't have adequate staff, adequate equipment or adequate knowledge."
The percentage of patients entering American nursing homes that are moderate and severely obese with a body mass index of 35 or greater has risen sharply, to nearly 25 percent in 2010 from 14.7 percent in 2000, according to a recent study, and many signs suggest the upward trend is continuing.
As the demand from severely obese patients surges, nursing home administrators cannot afford to care for the patients, because Medicaid, which covers more than 60 percent of all nursing home residents, does not reimburse for specialized equipment required: motorized lifts; larger wheelchairs, bedside commodes and shower chairs; and longer intramuscular needles and blood pressure cuffs. The devices are expensive: $10,000 for a mechanical lift, for instance, and $5,000 for an extra-wide bed.
It's really not a moneymaker," said Aundrea Fuller, an owner of Generations of Red Bay, the private, for-profit facility that cares 10 obese patients. Ms. Fuller's decision to open the unit, which frequently has a waiting list, it is a personal mission to aid obese people, that are often ostracized and forgotten.
There is no national census of available beds in American nursing homes for patients weighing more than 350 pounds, the maximum weight a standard hospital bed can handle. But industry groups and researchers say facilities rarely accept more than a few markedly obese patients.
Genesis HealthCare, one of the nation's largest nursing-home chains, recently closed its much lauded bariatric care program. Nursing experts considered it a model for safe handling of obese patients. One or two places that have tried to do it recognize the economics just don't work," said Dr. David Gifford, the senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group.
As a result, nursing homes across the country are routinely declining referrals from hospitals seeking to transfer obese patients, creating dilemmas for hospital staff members tasked with safely discharging patients ready to leave.
The problem is especially acute in the South, where obesity rates first skyrocketed decades ago and extreme obesity a 40 B.M.I. and above continues to rise.
This is definitely not grandmother's elderly population," said Julie Locher, a medical sociologist at the University of Alabama at Birmingham. This is a totally different cohort that is aging now."
In neighboring Mississippi, where 29 percent of people 65 and over are obese, nursing homes that accept heavy residents are few and far between, said Sandra Terra, an administrator at the University of Mississippi Medical Center in Jackson. Ninety percent of the nursing facilities routinely discharges patients won't have anything to do with obese patients" Sandra said.
The delays are exasperating and commonplace. It's not uncommon to make 30 or 40 referrals to finally find a placement," said Barbara Miller, the director of case management at the University of Arkansas for Medical Sciences, an academic health center with a hospital and clinics in Little Rock.
Whether routine denials violate anti-discrimination laws is unclear, especially because the degree to which obesity is a legally protected disability remains unsettled. Industry specialists argue the law is unambiguous. But some experts argue that severely obese patients with significant physical impairments could challenge denials. There are other reasons nursing homes are wary, including the inability to transport such patients to the emergency room, the possibility of staff injuries and higher workers' compensation costs, and the feasibility of remodeling older buildings with wider door frames and special plumbing to accommodate sturdier toilets. Nursing home administrators have to accommodate a number of younger obese patients with serious health problems unable to live alone.
Hospitals have become increasingly inventive, with some offering donations of specialized beds, mattresses and lifts to nursing homes considering admission of an obese patient. The expectation has been that the patient will get back up and go home again," said Ms. Phillips of LeadingAge. But there are a group of patients that this is not going to happen. And losing weight at this point in life is not a viable option."
Visit [www.biomazinghcg.com/nursing-homes-deal-obese-patient](http://www.biomazinghcg.com/nursing-homes-deal-obese-patients)s for more info.
