Nursing Homes Overwhelmed by Rising Obesity Rates

According to an article in The New York Times, obese seniors suffering from diabetes, disability, and other weight-related ailments are increasingly overwhelming older adult care facilities, which are not prepared or equipped to care for this new group (https://nyti.ms/1UqBJy5).

Cheryl Philips, a senior vice president of LeadingAge, an association of nonprofit providers of services for older adults, told The New York Times, “The population is shifting faster than the ability of nursing homes to deal with them….We don’t have adequate staff. We don’t have adequate equipment. We don’t have adequate knowledge.”

According to a recent study in Research in Gerontological Nursing (2015:8(4);173-178), the percentage of those entering American nursing homes who are moderately and severely obese—with a body mass index of 35 or greater—has risen sharply, from 14.7% in 2000 to nearly 25% in 2010; and many signs suggest the trend is continuing.

As the number of severely obese patients surges, nursing home administrators say they cannot afford to care for these patients. Medicaid, which covers more than 60% of all nursing home residents, does not reimburse them for the specialized equipment required, such as motorized lifts; larger wheelchairs, bedside commodes and shower chairs; and longer intramuscular needles and blood pressure cuffs. And the devices are expensive; for example, a mechanical lift costs ~$10,000, and an extra-wide bed costs ~$5,000. 

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 those ready to leave. The reluctance to accept hospital referrals, especially when physical therapy or wound care is needed, comes down to practical matters: how many staff members it will take to turn the patient; the location of the wound; and how long physical therapy will take. But staffing is the most common barrier to accepting referrals, due to the monumental staff coordination and time required to help obese residents with daily needs. 

The paucity of available beds has meant that obese patients can languish in hospitals—at great expense to Medicare, private insurance companies, and hospitals. “We’ve had patients in the hospital for several months,” said Lynn Crawford, the medical director of the University of Alabama at Birmingham Hospital-Highlands geriatric unit—an observation echoed by other hospitals and national industry groups.

By 2040, more than 82 million people will be aged 65 years and older, twice as many as in 2000. At the same time, adult obesity has continued to increase—38% of Americans aged 60 years and older are obese—and 1 in 20 adults is considered extremely obese. As tens of millions of these obese Americans age, “it’s going to be exponentially worse,” says Crawford.—Amanda Del Signore