Caring for residents with severe obesity contributes to higher costs for nursing homes in terms of increased staffing, specialized equipment and other expenses, new research has found. Even worse for providers, current reimbursement models are inadequate to cover the increased costs, the researchers said.
“Our conclusions were that there were numerous and difficult challenges for nursing homes in caring for people with severe obesity,” study leader and senior author John A Harris, MD, MSc, told McKnight’s Long-Term Care News Wednesday. “The solutions really center around reimbursement.”
Harris, an assistant professor of Obstetrics, Gynecology and Reproductive Services at the University of Pittsburgh School of Medicine, and fellow researchers conducted telephone interviews of 71 nursing home staff and leaders from around the country from 2019 to 2022 to learn about challenges associated with caring for people with severe obesity, or those with a body mass index of 40 or higher.
Their study, “Paying a Heavy Price: Costs of Care for People with Severe Obesity in Nursing Homes,” appeared online in a recent edition of The Gerontologist.
Additional staffing and equipment costs
One of the most common concerns of interviewees was the need for additional staffing to care for severely obese residents and their associated costs.
One administrator told the researchers that when their facility had four or more severely obese residents it was “nearly impossible” to provide adequate care for them, especially during lightly staffed shifts.
“Regardless of the number of additional staff required, there was consensus across participants from all groups that, for large, nonambulatory and relatively immobile residents, assistance with activities of daily living, such as transfers, transportation, and daily evaluations, required more staff than a typical resident,” study authors noted.
Many activities, such as bathing and skin examinations, also require significantly more time, interviewees pointed out to investigators.
The result, researchers say, is increased staffing costs for the facilities and a greater workload for existing staff.
“Staff clearly reported a lot more work for direct patient care for people with severe obesity, and all this extra work resulted in increased burnout, turnover, lower morale and a greater possibility of injuries,” Harris explained.
Residents who are severely obese also may require additional or specialized equipment, such as a bariatric bed, special mattress and chairs, and a wheelchair or lift with a higher maximum weight limit, the researchers found. The facilities often must rent or purchase that equipment at significant additional cost, study participants pointed out.
Harris noted the greater costs also can have a negative impact on the overall quality of care severely obese residents receive. For example, 30% of nursing home directors from Pennsylvania and Arkansas who were surveyed reported finances as a serious concern when admitting residents with obesity.
“These residents are at risk of not being accepted into nursing homes because of their size, and when they are accepted, there’s a risk they will be accepted to lower quality nursing homes,” Harris said. “They may end up feeling more isolated in nursing homes, are less mobile and feel less comfortable being out in public places.”
Inadequate pay
The study authors cited a lack of adequate reimbursement as a major issue in caring for residents with severe obesity.
Harris said the research did not quantify the total costs of caring for these residents, but study participants overwhelmingly agreed that reimbursement levels for those patients were wholly inadequate.
One corporate nursing home leader, for example, told researchers Medicare pays up to $750 for specialty equipment and extra staffing, but if that patient is on Medicaid, the facility gets reimbursed only $150.
Harris said that many of the respondents expressed hope that the Centers for Medicare & Medicaid Services’ Patient Driven Payment Model would do a better job of taking obesity into account as a risk factor and providing more appropriate reimbursement for these patients.
“Obesity kind of affects every part of long-term care, so having reimbursement models that have a higher score for obesity as a comorbidity, those are things to move toward solutions in the future,” he said.
He added that the research did not address in detail the issue of weight management and whether dietary or nutritional changes for severely obese residents would help improve health outcomes and reduce costs. He said it’s often difficult to change the dietary habits of older adults and to aggressively manage diets without negatively impacting resident satisfaction, but added the issue is certainly worth further study.
Harris noted that the researchers developed a nursing home obesity toolkit with tips for staffing and other recommendations to help promote better care, better outcomes and lower costs for residents with obesity.
The research team included investigators from the University of Pittsburgh, West Virginia University, the University of Texas at San Antonio, the University of Maryland, and the University of Pennsylvania. Their research was part of a larger federally funded study on obesity in nursing homes supported by the US Agency for Healthcare Research and Quality.
