After lunch, a nurse rolls a mechanical lift into Nalls’s room. Four aides gently slide a sling underneath him and lift him into bed in a well-rehearsed routine.
Physical ailments are often compounded by obesity’s emotional toll. “Stigma, self-image, and isolation,” said Michael Yao, the chief medical officer at Golden Living, a national nursing-home chain. Residents who are withdrawn or feel shunned need to be reassured, Yao said so they “don’t feel like they’re alone.”
At the Generations of Red Bay facility, nurses reposition obese residents like Nalls, who are unable to move on their own, every few hours to avoid dangerous pressure ulcers. Daily personal needs require monumental coordination. One nurse can help a resident of normal weight dress and sit in a chair within 15 minutes, said Kathy McCurry, the head treatment nurse. “With a bariatric patient, that takes an hour with two certified nursing assistants.”
There are other reasons nursing homes are wary, including the inability to transport such patients to the emergency room, the possibility of staff injuries and higher workers’ compensation costs, and the infeasibility of remodeling older buildings with wider door frames and special plumbing to accommodate sturdier toilets.
The paucity of available beds has meant heavy patients can languish in hospitals, at great expense to Medicare, private insurance companies and the hospitals.
“We’ve had patients in the hospital for several months,” said Lynn Crawford, the medical director of the University of Alabama at Birmingham Hospital-Highlands geriatrics unit—an observation echoed by other hospitals and national industry groups.
Martin Bayne, 65, who has Parkinson’s disease and weighs 370 pounds, found himself stuck in a hospital in Pennsylvania after episodes of congestive heart failure and the flu. “It was hell for me,” he said, lamenting the helplessness and humiliation he felt awaiting placement in a skilled nursing facility.
“There’s a terrible feeling that goes along with knowing that you’re not wanted,” said Bayne, an advocate and blogger on issues of aging. He now lives in a personal-care home in Center Valley, Pennsylvania.
Patients can end up in nursing homes hours away, and across state lines, from their families, compounding a difficult period of their lives. “They are already ill and feeling compromised,” Terra said. “But at some point, we have to say, ‘It has to do with your weight. I can’t find a place for you to go.’”
By 2040, more than 82 million people will be 65 and over, twice as many as in 2000. Adult obesity has continued to increase—38 percent of Americans 60 and older are obese—and one in 20 adults are considered extremely obese.
As tens of millions of these obese Americans age, Crawford said, “it’s going to be exponentially worse.”
Hospitals have become increasingly inventive, with some offering donations of specialized beds, mattresses, and lifts to nursing homes considering admission of an obese patient. “We step in to try to help with that transition,” Bonsi-Wallace said.