The care of older adults with extreme obesity in nursing homes: A collective case study

Objective: To establish the preparedness of nursing homes to deliver high quality, safe and equitable bariatric care for older adults with extreme obesity. Design and methods: A collective case study approach was used. Data collection included observational and interview data from three nursing homes, and a review of 224,200 resident admissions over a 3-year period in New Zealand. Participants: Twenty eight health care workers from three nursing homes in the North Island of New Zealand. Results: Despite a willingness by healthcare staff to care for older adults with extreme obesity, nursing homes were not well equipped to provide safe equitable care for this resident population. Key areas of concern for nursing homes related to limitations in the infrastructure, and financial barriers relating to government funded contracted care services which incorporated equipment procurement and safe staffing ratios. Conclusion: Nursing homes are unprepared to accommodate the existing and increasing number of older adults with extreme obesity who will require bariatric specific care. Government agencies and policy makers will need to consider the financial implications of the increasing need for bariatric level support within aged care, as well as the impact on individual nursing home resources and quality of care provided. Considerable sector and government attention is needed in relation to infrastructure and funding, to allow for the provision of high quality, safe and equitable care for this population group.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis study was fully funded by a University Research Fund, Victoria University of Wellington, New Zealand.Author DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesNo data is publicly available

https://www.medrxiv.org/content/medrxiv/early/2019/11/29/19013326.full.pdf