Designing Space for the Bariatric Resident
|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.
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:
For providing care to bariatric residents, having adequate space and equipment means:
Care needs. Care may be provided to residents:
Care may also include assisting the resident with mobility tasks such as:
The appropriate equipment and methods used for transfers depend upon:
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.
Bariatric chairs have expanded widths-up to 36 inches-as do other pieces of bariatric furniture and equipment. The beds available for bariatric residents range up to 54 inches wide and 88 inches long when overhead bars are included (because the bars are attached to the outside surface of the headboard). Obviously, adequate space must be allowed to accommodate these items.
The minimum width for doors should be 60 inches, because the doorway into the room must accommodate the bed width and the widest piece of equipment. A split door that can be expanded to that width should be considered.
Equipment needs. The table provides a list of equipment/furnishings that are needed for the bariatric resident.
Essential equipment for mobility includes an extra-capacity ceiling lift and/or a floor lift, in addition to an extra-capacity SARA, depending upon the resident's mobility.
There is increasing interest in ceiling-track systems that can save space and increase safety for both bariatric residents and their caregivers. All facilities being newly constructed or with resident rooms that are being significantly renovated should seriously consider ceiling lifts, because the expense of installing tracks in the ceiling is often less during construction than when retrofitting a room after construction is complete.
Some facilities have beds that convert to chairs. These may reduce the amount of space required, by eliminating the task of transferring a resident from the bed to a separate chair. Physical loads for caregivers transporting residents to a chair or to the bathroom are sometimes prohibitive, but a powered commode chair or a powered mobile lift (the latter is in development) could make this activity possible in the future.
Space needs. Most residents of long-term care facilities need some type of assistance. From the caregiver's perspective, the space provided in resident rooms designed for bariatric residents must allow for proper ergonomic postures during nursing care activities to minimize musculoskeletal injuries. Therefore, the room should be at least 13 feet, 3 inches wide by 15 feet long.
Mobility tasks for the bariatric resident, with varying space requirements, will usually be performed with equipment and three to four caregivers, depending on the resident's ability to assist. Options for transferring bariatric residents are:
Example of space needs. The care plan for a 600-pound, non-weight-bearing resident includes the need to perform a lateral transfer from the bed to a stretcher for showering, either with a ceiling lift and three caregivers or with a friction-reducing sheet and six caregivers. To turn lift equipment 360 degrees requires a 5-foot radius of floor space between the equipment and the walls. Ideally, there should also be 5 feet of space on either side of the bed, although a minimum of 39 inches is required to allow nurses to position their stance and move safely and ergonomically during resident-handling maneuvers.
|Bariatric: Definition of Terms|
The word bariatrics is derived from the Greek word baros, meaning "weight." Whether someone is simply overweight or falls into the bariatric category is determined by the individual's body mass index (BMI), which is a calculation of body weight adjusted for height. The BMI can be calculated with a basic formula, using either pounds and feet/inches, or kilograms and meters/centimeters. A simple, government-sponsored BMI calculator, along with other useful information, is available at www.consumer.gov/weightloss/ (click on the "BMI Chart" button and go to the bottom of the page to find the calculator).
An individual is considered to meet the bariatric criteria if he or she is overweight by more than 100 pounds, has a BMI of 40 or greater, or weighs more than 300 pounds (137 kg).3,4
Toileting space and equipment in standard bathrooms are not designed to manage residents weighing more than 350 pounds or those with wider bodies. Designers need to take into consideration the bathroom space needs not only of the bariatric resident, but also for special equipment and at least two caregivers. The activities that may take place in the bathroom include:
Which method should be used depends upon the resident's ability to assist and ambulate. If it is determined that caregivers can safely transport the resident (with assistance), then the resident will be able to access the bathroom facility. If the resident cannot assist or the caregivers cannot safely transport the resident without risk of injury to the resident or themselves, then the resident may be toileted at the bedside using a commode chair.
Most toilets are not designed to accommodate the bariatric resident. Toilets that are floor mounted are preferable to those that are wall mounted, because they are more sturdy, but even they have their limits. If an oversized toilet is available then it should be purchased. However, if the toilet cannot accommodate the resident's size and weight, then an extra-capacity commode chair will need to be used over the toilet or at the bedside.
There also must be space for folding support handles used to assist the resident in standing, without impeding the access of mobility equipment. Additional space is also needed so that the caregiver can assist the resident with hygiene care after the resident uses the toilet. The space we recommend is 31 inches on either side of a floor-mounted toilet. This will allow enough space from the walls to accommodate an oversize commode chair.
The toilet should be placed 8 inches from the wall. Since hygiene care in this small area is difficult, a built-in shower hose and wet area built into the design would be extremely helpful for those residents who are able to stand. This design currently needs to be studied and problems identified before be-ing adopted, but it appears promising.
The ideal room configuration has a bathroom attached to the bedroom area.
Depending on the size and weight of bariatric residents and their general health and mobility, it is possible that, for some, bathing in a tub would be unsafe or inappropriate. Currently available tubs are not designed to accommodate a resident who weighs more than 500 pounds; therefore, showering may be a safer and more acceptable practice. Shower chairs are currently being designed to accommodate the bariatric resident and should be available soon. An ideal design would allow the resident to recline in a comfortable position and be safely transported to the shower area by two caregivers.
For residents who do not meet the weight-limit criteria of shower chairs, reclining bariatric shower stretchers or plastic-covered bariatric transport stretchers should be considered. These residents cannot tolerate lying on their backs, so the reclining feature is important. Otherwise, they should only be showered while lying on one side with their head slightly propped up, if this position can be tolerated. Residents showered while lying on their side should not be turned during this procedure, because of the narrow width of most stretchers.
The shower stretcher is managed in the shower room by two to three caregivers. The shower area must be large enough to allow the caregivers to circulate around the entire stretcher while using the shower hose.
Our recommendation for the combined bathroom and shower area is 106 inches by 177 inches, and the length of the shower hose should be at least 98 inches. This type of bathing, with two or three caregivers, allows access to most body creases and difficult-to-reach areas. The shower door must be wide enough to allow the stretcher to pass through along with the caregivers.
Because of the dramatic rise in obesity, it is likely that the demand for care of bariatric residents in long-term care facilities will likewise increase. These facilities must consider the extra care, equipment, furniture, and space needs of these residents in order to properly provide that care and prevent injury, both to residents and caregivers. Caregivers who have worked with bariatric residents should be involved in the design of these facilities. The recommendations outlined in this article are meant to be used as a guide for designers and space planners and to provide administrators with important information on the relationship between space, equipment, and furnishings for quality care of bariatric residents. The space guidelines described are based on current practices and currently available equipment. Future designs for bariatric equipment may alter space requirements.
Marylou Muir, RN, OHN, has a certificate in Occupational Health Nursing. She is the Coordinator of Injury Prevention and Disability Management for the Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada, and has extensive involvement in nursing management for bariatric patients. Linda L. Haney, RN, MPH, COHN-S, CSP, is the Clinical Director for Diligent Services, a company that focuses on the reduction of injuries in healthcare workers. She develops and provides on-site clinical counseling in healthcare ergonomics to acute and long-term care facilities. For more information, contact her at (715) 842-3563. To comment on this article, please send e-mail to email@example.com. For reprints in quantities of 100 or more, phone (866) 377-6454.
Topics: Articles , Design , Housing