title: Nursing Home Perspectives on the Admission of Morbidly Obese Patients From Hospitals to Nursing Homes.
abstract: OBJECTIVE
  Care challenges have been described for hospitalized morbidly obese (MO) patients. These challenges likely persist post discharge. As a result, nursing homes (NHs) may be reluctant to admit these patients, potentially leaving them "stranded in hospitals". This study identified issues NHs consider in admission decisions for MO patients transitioning from hospitals.
  
  
  METHODS
  Approved surveys were mailed to nursing directors at federally-certified NHs in Arkansas (n = 234) and Pennsylvania (n = 710) to collect NH experience in the admission of patients weighing ≥ 325 pounds. Analyses included descriptive and inferential statistics to summarize and identify predictors of MO patient admission decisions.
  
  
  RESULTS
  In total, 360 surveys were returned (38.1% response rate). Although two-thirds of respondents reported patient size as an admission barrier, only 6% reported that MO patients were always refused admission. Adjusted analysis showed that NHs with adequate staff were significantly (p = .04) less likely to report obesity as an admission barrier whereas NHs reporting concerns about availability of bariatric equipment were significantly (p < .0001) more likely to report obesity as a barrier.
  
  
  CONCLUSIONS
  Lack of staff and bariatric equipment in NHs appears to negatively affect the transition of MO patients out of the hospital to NHs. Additional research, including examination of current regulations and reimbursement policies, should be undertaken to understand NH staffing and equipment acquisition decisions in light of the current obesity epidemic. Such research has implications for the optimal care of obese individuals during times of transition.
authors.affiliation: Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA felixholly@uams.edu.
authors.forename: Holly C
authors.initials: HC
authors.lastname: Felix
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Bradway
authors.affiliation: Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA.
authors.forename: Mir M
authors.initials: MM
authors.lastname: Ali
authors.affiliation: Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA.
authors.forename: Xiaocong
authors.initials: X
authors.lastname: Li
mesh_terms: D001131:Arkansas; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D006801:Humans; D016015:Logistic Models; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009767:Obesity, Morbid / Q000451:nursing*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010360:Patient Transfer; D010414:Pennsylvania; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: hospital/ambulatory care; nursing homes; obesity; placement issues