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Designing Space for the Bariatric Resident

November 1, 2004
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For weight-challenged residents and their caregivers, specific design suggestions for resident rooms and accommodations by Marylou Muir, RN, OHN, and Linda L. Haney, RN, MPH, COHN-S, CSP
        Obesity has dramatically increased in the United States during the last decade, and there are indications that it is beginning to increase significantly in other developed nations, as well. This increase is occurring in all states, in both sexes, and across age groups, races, and educational levels.1,2 The impact of this trend is being felt by virtually every segment of our society, including long-term care facilities, which are starting to see an increased demand for accepting and accommodating bariatric residents.

Long-term care facilities need to rethink the space required to provide quality care for bariatric residents because of the high risk of injury to both residents and staff during these residents' care. Most existing architectural designs, furnishings, and equipment can accommodate residents weighing as much as 350 pounds, but for larger residents, as well as for the staff who care for them, standard-size resident rooms are a barrier to care and safety. This article focuses on the space and equipment requirements for providing care to residents weighing 350 to 1,000 pounds.

Planning Care
Process mapping is an effective care-planning tool for facilities providing care for bariatric residents. By mapping a resident's care needs from admission through discharge or death, and by considering each part of the facility that might be used during the resident's stay, the planner can identify space and capacity problems that may be encountered.

Potential problems include insufficient door widths to allow the bariatric resident access into the building, inadequate space for turning a stretcher (if needed) in the halls, and lack of access to or inadequate space within the resident room and bathroom, the shower/bathing room, the activities room or lounge, elevators, the facility van, etc.

Staff will need written protocols for handling the bariatric resident through each phase of the process. In addition, the facility will need to coordinate with the local hospital to ensure that it can provide care for the facility's bariatric residents requiring hospitalization.

Planning to ensure adequate space for bariatric residents can have a positive effect on their care. The following cascade of events occurs when residents have enough space in which to be properly cared for and mobilized:

  • Heart/lung capacity and blood circulation increase when residents are up and moving; their hearts beat faster, increasing the amount of oxygen that reaches their tissues and organs.
  • The risk of pneumonia, thrombosis, and other illnesses is reduced as a result of the increased heart/lung capacity and blood circulation.
  • Residents' quality of life is improved.

For providing care to bariatric residents, having adequate space and equipment means:

  • Reduced need to assist residents;
  • Fewer strain-related injuries and increased staff productivity;
  • Lower staff turnover rates;
  • Reduced costs of delivering care; and
  • Enhanced quality of nursing care.

Special Needs
If room furnishings are not large enough or if caregivers cannot get appropriately sized equipment into the resident's room and/or gain adequate access to the resident's bed, then care suffers. The facility may also be in jeopardy of regulatory noncompliance.

Care needs. Care may be provided to residents:

  • Within the confines of bed (for those with virtually no mobility). This includes lifting, turning, boosting, and feeding them, as well as applying dressings and assisting with hygiene.
  • Around the bed and beyond, into other areas of the facility (for residents who are mobile with assistance and who range from being only somewhat independent to somewhat dependent). In bariatric resident rooms, there needs to be enough space to accommodate several pieces of equipment and up to six healthcare workers simultaneously for resident handling and various care tasks.

Care may also include assisting the resident with mobility tasks such as:

  • Transfers from bed to chair/wheelchair/commode/stretcher and back;
  • Transfers from bed to shower chair or stretcher and back;
  • Transfers from bed to toilet and back; and
  • Ambulation assistance-i.e., helping with sitting, standing, or walking.

The appropriate equipment and methods used for transfers depend upon:

  • Resident's weight and height;
  • Resident's ability to bear weight and assist;
  • Resident's trunk and upper-extremity strength;
  • Whether resident has an infectious disease that might require isolation;
  • Resident's cognition level or presence of dementia;
  • Resident's cooperativeness; and
  • Medical complications that might affect resident's mobility-e.g., the presence of various tubes, the existence of pressure ulcers, whether the resident has undergone amputations, etc.

Furniture needs. The type of furniture needed in the resident's room is the basic facility-provided or resident-owned furniture, albeit larger and with an increased weight capacity. The absolute minimum space designed to meet these needs adds an additional 5 feet to the width of the standard room. Additional space may be needed depending upon the resident's personal effects and furniture.