Barriers in Transitioning Patients With Severe Obesity From Hospitals to Nursing Homes

Abstract

This cross-sectional, descriptive study explored perspectives of discharge planners regarding transitions of hospitalized patients who are severely obese seeking discharge to a nursing home. Attention has been focused on care transitions regarding high hospital readmission rates, yet specific needs of patients who are severely obese have been largely overlooked. Ninety-seven (response rate 39.8%) discharge planners returned surveys addressing frequency of, and issues encountered when arranging placements. Community and hospital characteristics were also collected. One-third of the respondents from Pennsylvania and Arkansas reported inability to transfer patients; barriers included reimbursement, staffing, and equipment. Respondents perceiving nursing homes to have equipment concerns were nearly seven times more likely to report patient size as a barrier (p = 0.001). Given increasing obesity rates, healthcare delivery systems must be prepared to provide necessary resources and all levels of care, including transitions for hospitalized patients who are severely obese needing nursing home care post-discharge.

Obesity and intensive staffing needs of nursing home residents

“…In a recent survey of nursing homes administrators, 31% of respondents reported that staffing was not adequate to care for morbidly obese residents (defined in this study as residents weighing 325 pounds or more), and a survey of hospital discharge planners found that 60% of respondents thought that nursing homes had staffing concerns regarding admission of someone with a BMI of 35 or more. 31,32 While this difference between available workforce and assistance needed may have be compensated for by new methods or technology, it is most likely that staff are using a greater proportion of time and energy caring for the intensive needs of residents with obesity. Resident obesity is leading to a serious workforce issue.…”

“…31 Among hospital discharge administrators, 72% of respondents reported perceived nursing home concerns regarding equipment necessary for care for residents with a BMI of 35 or more. 32 Such equipment is expensive to purchase or lease, and it may be difficult to justify for nursing homes with lower numbers of residents with obesity, leading nursing homes with less equipment, staffing, or volume to refuse admission to these prospective residents. Indeed, one third of hospital discharge planners reported that nursing homes often or always refuse admission to these residents.…”

“…Indeed, one third of hospital discharge planners reported that nursing homes often or always refuse admission to these residents. 32 Specialized equipment for obesity care has a narrow range of uses, unlike the utility of higher staffing rates which can be utilized in many ways, making these expenses difficult to justify for lower volume facilities.…”

The care of older adults with extreme obesity in nursing homes: A collective case study

“…In situations where power failures may occur, facilities must consider the needs of people reliant on electric devices and have adequate arrangements for backup power(40–42). Additionally, it has been suggested that consideration needs to be given to factoring in the predicted longer evacuation time of larger and older adults(43). Based on our findings, it is imperative that homes develop emergency management plans and procedures that consider the weight and size of residents.…”

Addressing a Major Health Problem From an Array of Perspectives

“…Given that African Americans have the highest prevalence of obesity, it is important to examine what strategies are effective for this group. Transitioning patients with severe obesity from the hospital to a nursing home has its challenges, which is addressed by Bradway, Felix, Whitfield, and Li (2017). Petit Francis, Spaulding, Turkson-Ocran, and Allen (2017) conduct a systematic review to determine whether nurse-delivered weight management interventions improve weight outcomes, which is a unique perspective because weight loss studies are most commonly conducted by behavioral scientists.…”