Annals of Long Term Care

Older obese adults are more likely to report fair to poor health as compared to those of normal weight. Excessive weight in residents of LTC facilities will have profound effects on care delivery and resource utilization. Model programs for bariatric and obese resident care do exist in some LTC facilities; however, universally agreed upon standards for education, staffing, and resources have not yet been established, and financial costs associated with providing bariatric care are not readily apparent. This article describes the challenges of caring for obese individuals residing in LTC facilities and includes strategies for addressing the specific clinical needs of this population. Experiences from the Genesis HealthCare Corporation are highlighted. (Annals of Long-Term Care: Clinical Care and Aging 2009;17[7]:17-21)

Introduction

The United States is currently in the midst of an obesity epidemic affecting all segments of the healthcare system, including long-term care (LTC) residents, their caregivers, and associated financing and delivery systems.1,2 A recent study of U.S. LTC facilities indicates that the percentage of newly admitted, obese residents has risen 15-25% over a 10-year period (between 1992-2002); nearly one-third of these obese individuals were under age 65.3 Older obese adults are more likely to report fair to poor health as compared to those of normal weight,4 and for middle-aged individuals, obesity is a risk factor for predicting future nursing home (NH) admission.5

Although the impact of a changing LTC resident population has not been fully appreciated, it is anticipated that excessive resident weight will have profound effects on care delivery and resource utilization. Few publications describe how LTC corporations have responded to these challenges. Clinical reviews and anecdotal reports to some degree have outlined specific aspects of care that require additional staff education, including issues around sensitivity to the needs of obese residents and their rights, skin, hygiene and wound care, mobilization complicated by excessive weight, and promotion of self-care. 6-9 Model programs for bariatric and obese resident care do exist in some LTC facilities10; however, universally agreed upon standards for education, staffing, and resources have not yet been established, and financial costs associated with providing bariatric care are not readily apparent.

A critical review of the literature has identified important gaps in research and clinical care of obese NH residents, such as the lack of evidence-based guidelines and “best practices” to support protocols and models of care.11 To address these gaps and elucidate the complexity of care for obese residents, we present a model recently instituted by Genesis HealthCare Corporation (GHC). Recommendations are proposed for integrating care strategies and preparing staff to provide optimal care to obese residents.

GHC Experience

Drawing on experiences from GHC, one of the nation’s largest LTC providers with more than 225 skilled nursing and assisted living facilities in 13 states, it is possible to better understand the problem of obesity in the LTC setting. Each year, GHC facilities admit obese and morbidly obese individuals who require either long-term placement or extended recovery periods to regain independence and return home. The Figure depicts weight categories for all obese and morbidly obese residents admitted to GHC facilities during a 6-month period (N = 87). Although ages range from 20 to 90 years, most (n = 69) are between 41 and 70 years of age and, as in other published reports,12 are generally younger than the “typical” newly admitted nonobese GHC resident (average age, 76 yr).