As American waistlines continue to grow, the health care industry has had to adapt – manufacturing larger medical equipment, for example, and retrofitting rooms to accommodate larger patients.
“Bariatric is kind of the new frontier when it comes to wheelchairs and seating,” said David Kemp, vice president of the Cerebral Palsy Research Foundation’s technical services, which has been making specialized wheelchairs for people for the past 16 years.
To provide the best equipment, Kemp said, providers have to find a balance while sizing wheelchairs.
“If the wheelchair is too small, it can cause pressure issues and sores,” he said. “You have to find the balance between making sure you’re not going to hurt them and them being able to get in and out of functional (spaces).”
Kemp said he knew of one man who couldn’t fit his wheelchair into his home, so he locked it up outside like a bicycle.
“It’s pretty heartbreaking,” he said.
Providers don’t anticipate that the trend toward accommodations for larger and larger patients will stop anytime soon.
According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults are obese and the average body mass index for adults has increased drastically over the last 20 years.
About 29.4 percent of Kansans are obese, according to 2010 CDC data.
Novation, a national health care supply chain, surveyed 178 hospital facilities for a November 2012 bariatric report and found the following:
• 38 percent have seen a slight increase in admissions for morbidly obese patients in the last 18 months.
• 75 percent said their emergency rooms are equipped to handle morbidly obese patients.
• 36 percent said that within the past year, they had renovated facilities to accommodate morbidly obese patients, with a median cost of $50,000 and an average cost of about $1 million.
• Most respondents purchase bariatric equipment, and 48 percent rented or leased beds for morbidly obese patients.
• 78 percent said beds are the highest total cost and/or the greatest increase in bariatric product spending.
Most medical supply companies have products that come in bariatric sizes, and some specialize in just that area.
The larger the equipment, the pricier it can be. Depending on the supplier and the brand, bariatric equipment can cost 20 percent more than standard sizes.
“It’s very lucrative,” said Amanda Page, Wesley Medical Center’s bariatric program coordinator. “If places aren’t making changes to accommodate the population, then they’re making a mistake. Right now, that’s the shift.”
Wesley Medical Center did not provide specific information on how much it has spent on bariatric equipment, but it is looking to upgrade many of its beds to accommodate patients up to 450 pounds, said Matt Leary, chief financial officer.
When you move into the heavy-duty bariatric beds, which are about 40 inches wide by 80 inches long with a weight limit of 600 pounds, the cost can be in the $5,000 range, said Becky Condreay, purchasing manager at Hart Pharmacy and Medical.
“It’s the price of a good used car,” she said.
Although she said the amount of bariatric inventory Hart has sold has increased over the last few years, Condreay couldn’t give a percentage because they don’t track all sales electronically.
At Via Christi Home Health and Home Medical, Joy Scott, executive director, said that in 2011, the group ordered about 125 bariatric beds and wheelchairs. In 2012, that increased to 175.
Over the last 10 years, the industry trend among hospitals has been to retrofit rooms with built-in lift systems, wider doors and more accessible equipment and bathrooms, said Art Huber, vice president of facilities for Via Christi Hospitals.
“There’s a lot that goes into a bariatric room. You think maybe of a big bed and bigger door, but there’s a lot more,” Huber said.
There are two modified rooms at Via Christi Rehabilitation Hospital. The Cancer Institute at St. Francis was designed with six bariatric rooms. And the hospital at St. Teresa has three medical/surgical bariatric rooms and four pre-operation rooms with oversized doors.
Via Christi officials said the cost for a basic room retrofit is from $6,000 to $8,500, not including a sling. They include up to two motorized lifts that can hold up to 500 pounds each. Pricing goes up with add-ons. The built-in lift systems have tracks that can move the patient from the bed to the shower and the toilet.
To accommodate the lift system, the rooms have to have reinforced steel installed into the ceiling.
Via Christi also has mobile lifts that can be moved from room to room but they require more staff to use them and they can’t lift as much weight, Huber said.
Installing lift systems is important for patient and staff safety, Huber said, noting that staff can injure themselves or create risk for a patient who is overweight. That’s among the reasons that Via Christi plans to outfit almost all rooms with the track system going forward.
To avoid some cost, the hospital won’t yet install motors in all of the rooms because motors can be moved from one room to another.
Although the upfront cost to install the lifts is relatively high, Huber said it’s worth it in the long term to help avoid injury and workers compensation claims.
“You can’t afford not to put it in,” he said.
The outfitting for heavier patients extends even to the toilets.
Although most toilets can have a weight limit of 500 pounds, the wall mount itself has a limit of about 300 pounds, according to Via Christi.
Huber said that at a previous job, a toilet in a public restroom shattered, leaving the person in shock among gushing water and porcelain shards.
“Now, wherever I go, I push for floor-mounted toilets,” he said. “One of the scariest things for a person to imagine is sitting on a toilet and having it break off the wall.”
At Wesley, staff are provided training to make sure they know how to use the lifts correctly and to ask for help if needed, Page said.
“We want patients and families to know they don’t need to be fearful of coming here and us not having equipment to take care of them,” Page said. “That’s a true fear for patients. Patients didn’t want to come to the hospital because ‘I was embarrassed,’ or ‘They won’t have a gown to fit me.’ It happens more often than not, and at Wesley, we’re trying to make a culture change.”
“It’s sad somebody wouldn’t want medical treatment because they’re fearful their size would be a barrier to care,” Page said.
In addition to Wesley’s four bariatric surgery suites that were remodeled about five years ago, Page said there are several other areas of the hospital that have been retrofitted to accommodate bariatric patients.
“There’s not really an area of the hospital, except maybe pediatrics, where that hasn’t really been taken into consideration,” Page said. “Even the waiting rooms and chairs can accommodate, not necessarily a patient, but their family.”