No ‘one size fits’ all in bariatric care

Treatment and care of the obese resident involves compassion, respect, and dignity. Without appropriate supplies and equipment, management of these residents can be frustrating, embarrassing, and an injury risk to both staff and resident. Long-term care facilities face a new challenge as obesity levels in the United States are at an all-time high. A facility that is able to provide quality, cost-effective care for the “bariatric geriatric” population will be the community choice.

One size does not fit all. In addition to right-sized equipment, using appropriate size supplies is critical. Obese residents must be individually assessed to be certain all of their care needs will be met. The facility should have a preadmission assessment process in place to identify the resident who may need oversized equipment and have the room ready upon admission. It is an advantage to both staff and resident to go directly into the right-sized bed instead of changing the equipment later.

A few simple supplies will help both the staff and resident.

Keep a large/extra-large blood pressure cuff in the resident’s drawer to ensure an accurate and consistent reading. The proper fit of the cuff is important and using the same cuff and extremity for blood pressure measurement is critical in obtaining reliable information. The type of blood pressure cuff and extremity should be noted in the care plan.

Gowns must be of sufficient size to provide privacy and dignity. Obese residents are at greater risk of falling if they are trying to hold a gown closed in the back for privacy. A flat sheet can provide additional privacy in bed or during a transfer.

Toileting is a basic need. If the resident is immobile or the doorway to the bathroom is too narrow for the wheelchair, an expanded capacity commode chair placed next to the bed may be the difference between a resident remaining functional and independent or becoming completely dependent on staff. If the resident is fearful that a standard size commode chair will not support his or her weight, the resident may choose to remain safely in bed and become incontinent.

Leasing oversized equipment is certainly an option based on the number and frequency of admissions, however the cost effectiveness of leasing may be negated as demand increases. Your bariatric equipment vendor can assist you with a purchase/rental cost analysis.

Carolyn Brown, MEd, RN, ARM, FCCWS, is the National Director of Clinical Services for RecoverCare. She is a registered nurse and a Fellow of the College of Certified Wound Specialists and has developed and implemented numerous programs addressing the unique challenges and care of the bariatric patient. She can be reached at or (813) 731-2914.

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Long-Term Living 2009 December;58(12):14

Topics: Articles , Clinical