Higher Level of Obesity Is Associated with Intensive Personal Care Assistance in the Nursing Home

Abstract

Objectives: To examine whether higher obesity level was associated with extensive staffing assistance (from 2 or more persons) for completing activities of daily living (ADL) among older nursing home residents. Design: Retrospective cross-sectional study. Setting: US government–certfied nursing homes. Participants: Medicare beneficiaries residing in a nursing home on April 1, 2015. Exclusion criteria were age less than 65 years and body mass index (BMI) below 18.5 (underweight). Measures: Residents were divided by obesity level according to established BMI cutoffs, as follows: nonobese (BMI = 18.5–29.9) or mild (BMI = 30.0–34.9), moderate (BMI = 35.0–39.9), or severe (BMI ≥40) obesity. Level of staffing assistance for completing each of 10 ADL (bed mobility, transfer, walking in room, walking in corridor, on- and off-unit locomotion, dressing, eating, toileting, and personal hygiene) was dichotomized as below 2 and 2 or more. Robust Poisson regression was used to test whether obesity conferred excess risk for needing 2 or more staff to complete each ADL. Adjusted models included individual-level covariates and nursing home fixed effects. Results: A total of 1,063,383 nursing home residents were identified, including 309,263 (29.0%) with obesity. Adjusted relative risks (95% confidence intervals) for 2-person assistance with bed mobility associated with mild, moderate, and severe obesity were 1.17 (1.15, 1.18), 1.28 (1.25, 1.31), and 1.40 (1.36, 1.43), respectively. Adjusted relative risks for 2-person assistance with transferring associated with mild, moderate, and severe obesity were 1.15 (1.13, 1.17), 1.24 (1.22, 1.27), and 1.36 (1.33, 1.39), respectively. Obesity was associated with 2-person assistance for all other ADL except for eating. Conclusions: Higher obesity level was significantly associated with assistance from 2 or more staff for completing 9 of 10 ADL. Given increasing obesity rates in nursing homes, payment mechanisms that do not adjust for obesity or comprehensively account for excess ADL assistance may need revision to prevent adverse impacts on the long-term care system.

The relationship between patient obesity and nursing workload: An integrative review

“…Similar findings are indicated with nursing home staff workload: nursing home residents with obesity required increased assistance from two or more residential staff for the activities of daily living with bed mobility, transfers, walking in rooms and corridors, locomotion inside and outside, dressing, toileting and personal hygiene (Felix, 2008). Subsequent research across USA governmentcertificated nursing homes indicated an increasing correlation between the need for extensive staffing assistance and the resident's severity across mild (BMI 30-34.9), moderate (BMI 35-39.9) and severe (BMI ≥40) obesity categories (Kosar et al, 2018).…”

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

“…When applying these standards to future bariatric residents it is expected that staffing ratios or staff time allocation needs to be considerably higher. As older people's BMI increases caregivers need more time than when they perform the same task with non-obese residents (31,(45)(46)(47). Kosar et al(47) examined whether different levels of obesity was associated with higher staffing needs for completing activities of daily living (ADL) amongst care home residents.…”

Care home staff's experiences and views of supporting the dietary management and choices of older residents with obesity

“…Also, management of RWO requires more intensive assistance with personal care from staff (Harris, Engberg, & Castle, 2018;Kosar, Thomas, Gozalo, & Mor, 2018) and may increase the risk of work-related injury (Bradway, DiResta, Fleshner, & Polomano, 2008). Felix et al (2016) suggest that these factors are barriers to care home admission for RWO, which result in longer or inappropriate hospital stays.…”

“…There is a lack of specialist equipment, resources and training to enable staff to provide effective care (Bradway, Miller, Heivly, & Fleshner, 2010; Dimant, 2005; Felix et al., 2016; Marihart, Brunt, & Geraci, 2015). Also, management of RWO requires more intensive assistance with personal care from staff (Harris, Engberg, & Castle, 2018; Kosar, Thomas, Gozalo, & Mor, 2018) and may increase the risk of work‐related injury (Bradway, DiResta, Fleshner, & Polomano, 2008). Felix et al.…”