When Finding Post-Acute Care, Obesity Is a Problem, Study Finds

As obesity rates increase, health systems will have to take charge of finding places to discharge the largest patients to avoid penalties from Medicare, authors of a new study find.

Transitions in care are already one of the most challenging and expensive parts of healthcare and an area of increased scrutiny for Medicare. While new payments models are finding ways to better coordinate care, prevent readmission, and reduce costs, a new study finds there’s a group of patients who have been overlooked: obese patients.

Elderly, obese patients who have chronic conditions need their own care models to avoid complications that happen for a frustrating reason: often, when they are ready to leave the hospital, there’s no place for them to go, according to the study by Penn Nursing and the University of Arkansas published in the Western Journal of Nursing Research.

Obese patients, especially the severely obese, require special equipment. Larger beds, toilets, and blood pressure cuffs—and extra staffing to properly lift patients—all add to costs. Because of this, obese patients may linger in the hospital for weeks or months while discharge staff try to find a placement. Even when they are transferred, patients might not have all their needs met: a patient in Illinois had to sue to get a large dialysis chair in a nursing home.

Researchers surveyed discharge staff from hospitals in both states; Arkansas has one of the nation’s highest obesity rates at 35.7%, while Pennsylvania’s rate is 30.3%, according to the CDC. If these trends continue, health systems must solve the problem of discharging obese patients, or they will pay penalties for poor outcomes, the researchers conclude.

In the study, a third of the respondents reported being unable to transfer obese patients, for reasons that included reimbursement, staffing, and lack of equipment. Respondents who said that nursing homes lacked the right equipment to care for obese patients were 7 times more likely to say the patient’s size was a barrier to admitting the person.

“Given increasing obesity rates, healthcare delivery systems must be prepared to provide necessary resources at all levels of care, including transitions for hospitalized patients who are severely obese needed nursing home care post-discharge,” the researchers wrote.

"Understanding the unique nursing and transitional care needs of patients who are severely obese and optimizing their transitional care experiences is an increasingly relevant area of study,” Christine K. Bradway, PhD, RN, CRNP, FAAN, associate professor of Gerontological Nursing, and the study’s lead author, said in a statement.

Reference

Bradway CK, Felix HC, Whitfield T. Barriers in transitioning patients with severe obesity from hospitals to nursing homes. West J Nurs Res. 2017; 39(3):1151-1168. https://doi.org/10.1177/0193945916683682.