RED BAY, Ala. – At 72, her gray hair closely shorn, her days occupied by sewing and television, Wanda Chism seems every bit a typical nursing home patient – but for her size.
Chism is severely obese, unable to leave her bed without a mechanical lift and a team of nurses. She has not walked in years. Her life is circumscribed by the walls of her room.
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(HealthNewsDigest.com) – Obesity is redrawing the common imagery of old age: The slight nursing home resident is giving way to the obese senior, hampered by diabetes, disability and other weight-related ailments. Facilities that have long cared for older adults are increasingly overwhelmed – and unprepared – to care for this new group of morbidly heavy patients.
“The population is shifting faster than the ability of nursing homes to deal with them,” said Cheryl Phillips, a senior vice president at LeadingAge, an association of nonprofit providers of services for older adults. “We don’t have adequate staff. We don’t have adequate equipment. We don’t have adequate knowledge.”
The percentage of those entering American nursing homes who are moderate and severely obese – with a body mass index of 35 or greater – has risen sharply, to nearly 25 percent in 2010 from 14.7 percent in 2000, according to a recent study, and many signs suggest the upward trend is continuing.
But as demand from severely obese patients surges, nursing home administrators say they cannot afford to care for them, because Medicaid, which covers more than 60 percent of all nursing home residents, does not reimburse them for the specialized equipment required: motorized lifts; larger wheelchairs, bedside commodes and shower chairs; and longer intramuscular needles and blood pressure cuffs. The devices are expensive: $10,000 for a mechanical lift, for instance, and $5,000 for an extra-wide bed.
“It’s really not a moneymaker,” said Aundrea Fuller, co-owner of Generations of Red Bay, the private, for-profit facility that cares for Chism in a specially outfitted wing that can accommodate 10 obese patients. Fuller’s decision to open the unit, which frequently has a waiting list, fulfills her personal mission to aid obese people, who are often ostracized and forgotten. But it makes little business sense.
“You’ve got to do it because you have a heart for it,” she said.
Wanda Chism, left, talking to Pam Bates, an administrator at Generations of Red Bay. Ms. Chism cannot walk on her own, and patients like her need to be repositioned every few hours to avoid dangerous pressure ulcers. (Photo by Joe Buglewicz for The New York Times)
There is no national census of available beds in American nursing homes for those weighing more than 350 pounds, the maximum weight a standard hospital bed can handle. But industry groups and researchers say facilities rarely accept more than a few markedly obese patients.
Genesis HealthCare, one of the nation’s largest nursing-home chains, recently closed itsmuch-lauded bariatric care program. Nursing experts considered it a model for safe handling of obese patients.
“One or two places that have tried to do it recognize the economics just don’t work,” said Dr. David Gifford, the senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group.
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 problem is especially acute in the South, where obesity rates first skyrocketed decades ago and extreme obesity – a 40 B.M.I. and above – continues to rise.
“This is definitely not my grandmother’s elderly population,” said Julie Locher, a medical sociologist at the University of Alabama at Birmingham. “This is a totally different cohort that is aging now.”
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