The Challenge of Severe Obesity in Nursing Homes from the Perspective of Administrators

Introduction/Objective: This study provides input from nursing home administrators on their challenges (financial, quality, staffing) in caring for severely obese residents. In addition, we report on how changes due to the COVID-19 pandemic have affected care for people with obesity in nursing homes (NHs). Caring for those with severe obesity is a major challenge in NHs and creates several dilemmas related to appropriate nursing care, equipment choice, and potential excess resident care costs. Little is known about how facilities respond to these dilemmas while maintaining the quality of care. Design/Methodology: We fielded a mailed survey to a random sample of US NH administrators from May to October 2021 and received 81 responses. The survey covered admissions, staffing, quality issues, policies/procedures, and finances for a theoretical severely obese resident, weighing ≥ 300 lbs. and needing assistance with ambulation and transfers. A $19 gift card was provided with each survey. Results: Before the COVID-19 pandemic, 76% said it was somewhat likely or likely that they would accept this resident, whereas afterwards, only 60% said they would accept them. Most respondents reported they address the equipment needs (69%) and supply needs (70%) of residents with obesity well or extremely well; whereas, only 48% felt their facility addresses the CNA/aide staffing needs well or extremely well, and similarly for facility space needs (45%). For staffing, less than half (45%) agreed it was easy to have enough staff available for obese residents on day shifts, with even lower staff adequacy on evening (24%) and night shifts (18%). 86% and 90% of respondents believed severe obesity was associated with higher costs for short-stay and long-stay residents, respectively. Only 22% and 21% of respondents believed that severe obesity led to higher patient-driven payment model reimbursement for short-stay and long-stay residents, respectively. Finally, 68%, 58%, and 44% of respondents felt that severe obesity affects the quality outcomes related to discharge to community, hospital readmissions, and inspection deficiencies, respectively. Conclusion/Discussion: NH administrators reported that the COVID-19 pandemic made them less likely to admit obese residents with mobility limitations. For admitted residents, there are serious concerns related to staffing adequacy, especially non-day shifts, and the potential to affect key overall NH quality metrics. Disclosures: This research is funded by the US Agency for Healthcare Research and Quality.