A Weighty Issue
In the most recent issue of ADVANCE for Directors in Rehabilitation
(electronic version), Michael Dionne, PT, and Daniel J. Drake, MSN, RN, tackle the topic of treating bariatric patients. Their article "Bariatric Basics" discusses the special considerations and equipment needs of working with this population. They advocate building modifications, bariatric equipment and education for meeting the needs of those patients.
Dionne and Drake have good ideas. Obviously larger equipment is needed to treat heavier patients. Staff needs to be educated on proper use of this equipment and body mechanics for their protection. What Dionne and Drake don't do is look deeper into the problem. I've used bariatric equipment. It takes at least two people to use any of it safely. Having two people available can be a challenge in a cost cutting environment. When trying to save money one of the first things to go is extra staff.
Adequate staffing raises another issue. These patients are difficult to mobilize. It takes at least two therapy personnel to do anything with them. I've had patients that took three or four people to move them. If I'm having trouble getting two people for a transfer, how am I going to get four people for a treatment? Either bariatric patients get limited mobilization or none at all. That does not lead to good outcomes for them.
Even if the equipment is available, there may not be enough of it. I've been involved in the purchasing of bariatric wheelchairs. They're at least twice as expensive as their "average" counterparts. A facility may be willing to buy one or two. The problem with that is the need may be five or six. What results is chair rationing where no one gets what he or she needs. This weekend I worked in a rehab unit that is chronically short of wheelchairs. They don't have a bariatric chair. There is no money in the budget to repair, much less replace, the chairs they do have. A bariatric chair is out of the question.
Staff education is another problem. Many people are reluctant to work with this population, frequently due to fear of injuring themselves. Teaching body mechanics isn't that difficult. Getting individuals to overcome their reluctance to work with bariatric patients is something else. Just because I teach someone how to transfer a bariatric patient doesn't mean the person will actually do it. It's unrealistic to expect PT to take sole responsibility for transferring and moving these patients.
I don't have answers for this. It's a problem that is rapidly growing. As the number of bariatric patients increases, staffing levels will need to be reviewed. Most departments aren't going to be able to absorb the extra staffing demands these patients require. It could come down to a choice. Does a department focus its manpower on treating these patients at the expense of less labor intensive patients? Or, does the department focus on less labor intensive patients at the expense of bariatric patients? I think this will gradually become a real problem. As a therapist there are physical limitations to what I can do by myself. If staffing remains an issue the decision will be made for me.