Establishing a Bariatric Unit in a Post-Acute Setting
Sylvia Bennett-Josephson, RN
5/28/2024
Establishing a bariatric unit in a post-acute care setting is challenging in many ways. Obesity is an ever-increasing concern in health care. In 2022 it was estimated that adults with a body mass index (BMI) of above 30 (indicating obesity) is now one in every eight persons. Each facility will face unique challenges when establishing a bariatric unit.
Bariatric individuals are of varying sizes and needs. Two individuals who weigh above 500 pounds may have very different requirements. In order to appropriately assess the needs of each individual, the gold standard approach is a face-to-face assessment. If your facility is unable to visit the individual personally, an online interview with assistance from the transferring facility might be useful.
This article will seek to identify equipment needs both individually and facilitywide.
Individual Considerations
How tall is the individual being considered for admission? A 5-foot, 400-pound individual needs very different equipment from a 6-foot, 400-pound individual. Ideally you will be able to work with a physical therapist and/or an occupational therapist to identify the type and size of equipment needed to assist this individual.
Just as height and weight are considerations, measurements are another concern. If the individual carries more weight in one section of their body, will your gowns fit? What about the non-skid socks; will those work for the larger resident? The width of the wheelchair the resident will need should also be considered. The width/length of the bed mattress will also need to be assessed and don’t forget sheets for the bed and mattress pads as well.
As you can see each individual need will require review. Here is a table with some suggestions to review prior to accepting a person for admission.
Individual equipment considerations:
| Wheelchair | Seat width.
Chair height.
Weight limit.
| | | Lift | Weight limit.
Sling size.
Ability to bear any weight.
Ability to sit upright.
Moving the lift with the resident in the lift.
Number of staff needed to assist with transfer. | Prior
to admission, identify how the resident currently transfers from one
surface to another. Remember that the resident may experience an
unexpected decline and transfer ability will decrease. | | Bed | Width.
Weight limits.
Side rails for turning (Are they sturdy? Can they withstand weight?).
Bed linens (size and sturdiness).
Length of bed.
Gap measurement. | Residents with excess body mass can impact the way the mattress fits the bed creating challenges in gap management. | | Bedside Commode | Weight restrictions.
Size. | Many bedside commodes will not support over 350 pounds. | | Incontinence Products | Size.
Width.
| Briefs that do not fit well may increase pressure wounds or other skin breakdown. | | Chairs (dining room and in room) | Width.
If resident will sit in wheelchair during meals, is the table adjustable for height?
| Consider resident social needs and dignity when examining seating options. | Therapy Equipment
(walkers,
parallel bars,
exercise equipment)
| Weight restrictions.
Width.
Sturdiness.
Height.
Ability to individualize fit. | | Bathroom/
Toilet
| Size of toilet.
Height of toilet.
Weight restriction of toilet/shower bench.
Room to navigate wheelchair in bathroom.
| A wheelchair-dependent resident will need a larger bathroom in order to move about.
|
|
Bariatric Unit Considerations
Staffing may
be your number one priority. Do you have enough staff? Bariatric
residents require more staff even for simple tasks such as putting on
and taking off clothes. It is estimated that staff needs increase by
more than 30 percent for each bariatric resident. The resident may also
require additional staff to accompany them to appointments or
activities. Staff education will be needed to address topics such as
turning, using lifts, and safe transfer of residents.
Each facility will need to complete individual assessments of the area projected to house bariatric residents.
Facility assessment considerations:
| Entrance and Exit Areas | Width of opening.
Consistency of flooring grade (Are that dips or gaps that could be hazardous?).
| Can a large stretcher or wheelchair fit through?
Is the grade too steep to push a heavy resident up?
Is the path to the area wide enough?
|
| Common Areas | Room to move wheelchair about.
Are the entry doors wide enough?
Are chairs and benches wide enough?
Is there a weight restriction for chairs and benches?
| Will the unit have its own common areas, or will these be shared with other units?
Will larger wheelchairs and other equipment cause the common areas to be overcrowded?
|
| Dining Rooms | Can tables accommodate a larger chair?
Chairs that can support larger weight restrictions.
Table height can be adjusted if the resident remains in wheelchair.
| |
| Shower Rooms/Bathing Facilities | Equipment to support weight restrictions is available.
Room to move larger wheelchair/lift is available.
Larger linens and gowns are available.
| |
| Resident Room | Space for equipment is available. | Many residents will require private rooms related to the size/number of pieces of equipment required. |
| Outdoor Spaces | Is the sidewalk wide enough?
Can walking paths support the weight of larger chairs?
Seating is available.
| You may need to color code or otherwise indicate seating and equipment that is safe for use by bariatric residents. |
Emergency Actions
(evacuation and/or
sheltering in place)
| Can residents be moved quickly.
Emergency personnel response plan.
| If residents are not on the ground floor, how will they be moved to a place of safety?
Involve your emergency response team in the planning.
|
| Specialized Needs | Dietary support.
Physical/occupational therapy.
Psychiatric visits.
Wound care.
Outpatient virtual visits.
Activities.
Respiratory therapy.
| Many bariatric residents are younger than the general population and have different needs. |
As you can see, establishing a unit devoted to bariatric care can be a daunting task. Each area must be carefully and thoroughly evaluated. Staff who will regularly work on this unit should be involved in the assessment process as they may note other concerns. The need for such units is great. However, the challenge of establishing and maintaining such units is equally challenging.
References
• Dockrell S, Hurley G. Moving and handling care of bariatric patients: a survey of clinical nurse managers. J Res Nurs. 2021 Jun;26(3):194-204. doi: 10.1177/1744987120970623. Epub 2020 Dec 14. PMID: 35251242; PMCID: PMC8895002.
• Elrazek AE, Elbanna AE, Bilasy SE. Medical management of patients after bariatric surgery: Principles and guidelines. World J Gastrointest Surg. 2014 Nov 27;6(11):220-8. doi: 10.4240/wjgs.v6.i11.220. PMID: 25429323; PMCID: PMC4241489.
• Harris JA, Castle NG. Obesity and Nursing Home Care in the United States: A Systematic Review. Gerontologist. 2019 May 17;59(3):e196-e206. doi: 10.1093/geront/gnx128. PMID: 29253135; PMCID: PMC6524472.
• Adult Obesity Prevalence Maps | Overweight & Obesity | CDC
• One in eight people are now living with obesity (who.int)
• Harris JA, Castle NG. Obesity and Nursing Home Care in the United States: A Systematic Review. Gerontologist. 2019 May 17;59(3):e196-e206. doi: 10.1093/geront/gnx128. PMID: 29253135; PMCID: PMC6524472.
Sylvia Bennett-Josephson, RN, BSN, CDONA, CDP, CDDACT, IP-BC, FACDONA, CO-Q, has been a registered nurse for over 38 years and a director of nursing in long term care for over 30 years. Bennett-Josephson is a fellow of the National Association of Directors of Nursing Administration and is certified as a dementia practitioner and a certified Alzheimer’s disease and dementia care trainer by the National Council of Dementia Practitioners. She is certified as an infection preventionist and as a compliance officer. She also serves as a health care specialist with Med Net Consults and maintains an educational website, SJJ Education.