High obesity rates are straining nursing homes ability to care for their residents. Patients that are severely or morbidly obese require specialized tools and attention with which most nursing homes are not equipped. This problem affects both new and old nursing home facilities which have not adapted to the new landscape.
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The familiar imagery of old age was a frail and slight nursing home resident. However, that common assumption is giving way to residents who are hampered by obesity. The percentage of people entering nursing homes who are moderate to severely obese has increased from 14.7 percent in 2000 to almost 25 percent.
It is estimated that by 2040, more than 82 million Americans will be 65 or older. Moreover, it is expected that 38 percent of Americans over 60 are obese while one in 20 adults is rated extremely obese.
A person is assessed as moderate to severely obese if their body mass index (“BMI”) is 35 or greater. BMI is a measurement tool that estimates body fat content by dividing a person’s weight (mass) by their height. The BMI assumes that people of a particular height should weight a certain amount.
Problems with Providing Care
Patients who are moderate to severely obese require specialized care to address their attendant medical issues, and they need specialized equipment to help nurses provide care.
Many nursing homes report that they are overwhelmed by the number of obese residents and are unable to provide many of them with the necessary level of care.
For example, a morbidly obese resident requires a team of nurses and a mechanical lift to leave his bed. The mechanical lift is an expensive and specialized tool that many nursing homes cannot afford. Moreover, even those nursing homes that can afford the mechanical lift, they do not own enough to equip 25 percent of their beds with them.
Furthermore, even for the nursing homes that do offer mechanical lifts, nurses are at higher risk of injury. Nurses that care for obese patients report higher rates of back injuries and therefore increase costs on nursing homes.
Even nursing homes that receive subsidies from Medicare and Medicaid cannot afford the specialized equipment to care for obese residents. Medicaid, which provides funding for 60 percent of all nursing home residents, does not reimburse nursing home for the specialized equipment to care for obese patients. For instance, obese residents need:
- Larger wheelchairs;
- Longer needles and blood pressure cuffs;
- Mechanical lifts;
- Extra wide beds;
- Reinforced shower chairs; and
- Bedside commodes.
These specialized tools are expensive; the average mechanical lift costs around $10,000 while larger beds cost $5,000.
The American population is shifting faster than nursing homes can adapt.
Moreover, obese patients require additional specialized medical care. For example, obese patients are unable to leave their beds which then requires nurses to shift them every few hours to avoid the development of pressure ulcers which can lead to serious complications.
Furthermore, obese residents require additional medication to address weight-related ailments like diabetes. Many of these residents require a level of care that most nursing home staff are ill-prepared to offer.
Nursing homes are also wary because they may lack the ability to quickly move these patients to a hospital should an emergency arise. Their inability to quickly move them to a hospital increases their liability and insurance costs.
Nursing Homes Decline Care
Due to the high costs associated with caring for obese residents, very few nursing homes are equipped to care for obese residents, especially residents that exceed 350 pounds. While there is no national census on the total number of beds, most industry experts do not believe nursing homes accept more than a mere handful.
Moreover, even the nursing homes that did offer care are shutting down their specialized facilities. For example, Genesis HealthCare, one of the largest nursing home chains recently closed its bariatric care program. Most nursing experts considered their system the model for safely providing care for obese patients. The cost of caring for obese patients exceeds the ability of nursing homes to provide services at an affordable rate.
Furthermore, even the nursing homes that continue to offer care are turning away obese patients. Hospitals
As a result, nursing homes across the country routinely deny referrals from hospitals for obese patients. The effect is to push the problem onto hospitals which are not designed for nor equipped to provide long-term care.
Americans with Disabilities Violations
Some industry experts argue that routinely denying obese patients could be a violation of the Americans with Disabilities Act (“ADA”). However, the issue of obesity and its attendant healthcare problems qualifying as a disability under the ADA is an unsettled area of law.