LAUSR

The safety of residents of US nursing homes is a national concern. Landmark reports in the 1980s that documented significant harm to residents due to unsafe nursing home care practices and environments led to major regulatory changes that prompted improvements in nursing home care. However, recent annual inspections indicate that deficiencies in care, which resulted in resident harm, persist through today. The 2014 federal report, Adverse Events in Skilled Nursing Facilities, estimated the cost of adverse events in nursing homes to be > $2.8 billion and that two thirds of the adverse events that resulted in harm were preventable.1 Obese persons are an emerging, vulnerable group needing nursing home care. The obesity epidemic has spread across the United States and now affects 1 in 3 adults.2 As the US population ages, obese persons are growing older.3 Obesity has been shown to increase risk of chronic conditions and functional decline, and negatively impacts the ability to perform activities of daily living (ADLs).4,5 Specifically, the chances of not being able to perform ADLs increase 50% for moderately obese men and 100% for moderately obese women, and increase 200% for severely obese men and 400% for severely obese women.6 Dependencies in 3 ADLs has been shown to be among the strongest predictors of nursing home admission.7 Although disability rates among older adults have decreased in recent years, there is now concern that the obesity epidemic will reverse that trend, leading to an increase in nursing home use in the future.6,8 Indeed, significant increases in the proportion of nursing home residents who are obese have been observed. Today, 1 in 4 nursing home residents is morbidly obese (body mass index≥35).9 Obese residents are at risk of injury in nursing homes. Emerging, albeit sparse, research is showing that obesity complicates nursing home care10–13 and presents legitimate resident safety concerns, including risk of pressure ulcers, infections, and falls. A study that examined the association of obesity and pressure ulcers among nursing home residents found that the likelihood of having a pressure ulcer was 18.9% higher among moderately to severely obese residents compared with normal weight residents, and that low numbers of nursing aides in the nursing homes increased the risk of getting pressure ulcers.14 Lack of appropriately sized medical equipment in nursing homes may contribute to the risk of pressure ulcers among obese residents. For example, a General Accounting Office report described the care of an obese resident who had no pressure ulcers at admission, but within 7 days had 4 stage II ulcers and 3 stage I ulcers because of an inappropriately sized bed and mattress that hindered the staff’s ability to turn the resident.15 Treatment of pressure ulcers among obese persons can be particularly problematic as obese persons are at high risk of wound complications including infections, seromas,