Exploring Resource Barriers to Providing Care for Residents with Severe Obesity in US Nursing Homes

Document Type

Conference Session

Publication Date

7-22-2023

Abstract

Purpose: Growing obesity rates poses variety of challenges such as nursing and medical care in the U.S. nursing home (NH). Previous studies have investigated the amount of time needed to care of residents with obesity. However, limited information available about the costs of care and resources for staff and facilities that care for severe obese NH residents. Therefore, the purpose of this qualitative study is to explore the cost and resource obstacles, related challenges, and responses of stakeholders in U.S. NHs when providing care for residents with severe obesity.

Methods: A qualitative study using one-on-one semi-structured interviews collected data from staff at 80 US NHs between 2019 to 2022. Participants included administrators, corporate leaders, directors of nursing, medical providers, registered nurses, care aides, ancillary staff, and others. Each interview had open-ended questions such as admission considerations, equipment needs, staffing issues, and facility limitations. Each interview lasted between 30 to 45 minutes. Interviews were audio recorded and then transcribed verbatim. Atlas.TI qualitative analysis software was used to code the interview data. Three coders analyzed data using a grounded theory approach, with the senior author (J.H.) acting as an arbitrator in coding disagreements. Codes were evaluated using the constant comparison method to identify common themes throughout the transcripts.

Results: Seventy-one participants were included in this study, 74% were female, ages ranged from 18 to 75 years old, with the most common age group being 35-44 years of age. The most common worker stakeholder type was nurse aides (n=28; 39%), followed by nurses (n=14; 20%), then administrators (n=12; 17%). Four main themes were identified: staff scarcity, expensive equipment, inadequate reimbursement, and strategic planning.

Participants described “staff scarcity” by reporting that residents with obesity need more time with more staff, but staffing is limited due to cost constraints or the inability to hire and retain staff.

Participants expressed “expensive equipment” by reporting how renting is not a financially wise decision with the reimbursement policies due to residents who are obese requiring different equipment than most other residents.

Participants explained “inadequate reimbursement” by reporting how NHs will often lose money when providing care for residents with obesity, as the costs of equipment, staffing, and the standard nursing home overhead charges exceed the reimbursement amount.

Participants refer to “strategic planning” by stating extreme frustration and hopelessness about taking care of residents with severe obesity in NHs. They indicated the need for urgency due to the shifting nursing home resident demographics. As the impact of obesity on nursing homes grows, we noted that certain facilities were preparing to be able to provide appropriate care.

Conclusion: Providing care for residents with obesity poses significant resource barriers to underfunded and understaffed US NHs. NH funding models do not account for the obesity-related differences required to adequately care for these residents. As the proportion of the US NH population with obesity continues to grow, solutions to these challenges should be investigated and given priority.

Publisher

Sigma Theta Tau International Honor Society of Nursing

Conference/Symposium

34th International Nursing Research Congress

City/State

Abu Dhabi, United Arab Emirates

Department

College of Business and Management

Comments

Join Sigma in Abu Dhabi, United Arab Emirates, to connect and engage with over 800 nurse researchers, students, clinicians, and leaders who are focused on evidence-based research.

Congress Theme: Connect Nursing Globally Through Research and Evidence Dissemination

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