Accommodating the bariatric resident: DOJ nursing and rehabilitation center created a new service to solve a big problem. (Feature Article).

Several years ago our director of admissions noted that we were receiving a lot of calls from area hospitals asking if we could help with the rehabilitation of patients that they just couldn't handle. As many nursing facilities know, residents and patients weighing 350 to 750 pounds pose special challenges that most facilities are unequipped to manage. Certainly, when we investigated other facilities in our area, we determined that very little was offered in the way of special accommodations for these individuals. We decided to do something about it.

We hired an architect to determine which of our 220 rooms might be adaptable for special beds and other modifications for extra-heavy patients. It turned out that our facility, which had been constructed in 1972, had several three-bed rooms that could easily accommodate two 54-inch queen-size beds each, with room left over for a more normal-sized resident, if necessary. We chose rooms spread out over five floors of the facility, two rooms to each floor. We did this to minimize the extra effort for staff, because we hired no new staff for this. We did, however, provide staff with special training on appropriately managing these patients, who are often subject to social bias of various kinds. (Some extra training was needed, too, on appropriate patient maneuvering and lift techniques, but this facility has been responsive to OSHA requirements for years.)

The rooms themselves had to be modified, of course. Doorways to the rooms and to the private bathrooms were widened. A special bariatric commode seat was installed over each toilet to help with load-bearing needs. We have a spacious central shower area for all patients; it needed only wider doorways and the installation of bariatric shower chairs to accommodate these patients. Furniture in the rooms, dining area and along the hallways now includes large-sized chairs and lounge chairs that can accommodate individuals weighing up to 1,000 pounds; because foot care is an issue for many of these patients, some of the chairs have built-in elevating footrests.

A great deal more equipment was purchased or modified for our bariatric service. After initially trying to use oversized lift equipment, we found this to be too burdensome and space consuming, and have since acquired more standard-sized lift technology able to accommodate patients weighing up to 850 pounds. We also use electronic bed transfer devices, customized wheelchairs and walkers, specialized orthotics and prosthetics equipment, and customized hand braces and support devices. Also--and this is unique, so far as we know--we have a ventilator support room for bariatric patients who have respiratory-related comorbidities.

Because we had found that no ambulance service in New York was properly equipped to tranport these patients, we had van/ambulettes customized for this purpose, with extra-wide doors on back and extra-large electronic lifts. Our ambulettes transport our patients comfortably to whatever location their healthcare requires.

Although our service is not designed specifically as a weight-loss program, our registered dietitian does specialized meal planning and monitors patients' food intake under the supervision of a physician. One of our patients received considerable local media attention recently when he announced that he had managed to lose more than 400 pounds from a life-threatening 840 pounds during his one-year stay with us.

Since we opened the doors of the Bariatric Program in 1997, we have managed 85 patients. We have plans for growth, and believe that DOJ has a bright future in providing this challenging and much-needed service.

Gary Lipperman is administrator and Gil Preira is executive director of DOJ Nursing and Rehabilitation Center, Bronx, New York. For further information, phone [phone], ext., 241. To comment on this article, please send e-mail to [e-mail].