Are Aged Care Organisations adequately resourced to safely manage obese and bariatric clients ?Feedback gained from SA Bariatric and Obesity workshops

Hal Robertson. Manual Task Services, Workforce Health, SA Health

Jo Bills. Physiolink

Bariatric definition

Person fits two or more of the following criteria: Weighs 120Kg+ BMI 40+ Hip width >20” (51cm)

The Project

•Sponsored by Employers Mutual Member Benefit Program, 2010

•SA Aged Care Consultative Committee

project

•Hosted by Elanora SYP Homes Inc

To reduce the risk of injury to employees by identifying future risk management strategies for bariatric care in the residential and community aged care sector

To develop resources for management of the bariatric resident/client (Fact Sheets)

Aims of the Project:

Working Party (4)

Literature Review

Workshops -December 2010

(1 metro- Adelaide; 2 country-Mt Gambier and Kadina )

Collation of feedback (questionnaires)

Development of Fact Sheets x 6

Determine participants knowledge and readiness of organisations to manage obese and bariatric clients

Provide basic information on bariatric client management and bariatric issues

Identify AC funding model’s limitations with funding care of B clients

Workshop objectives

Small group discussions to identifythe needs of

◦ The obese client◦ The worker◦ The Aged Care industry

To safely manage larger clients and the current barriers in achieving this

Participant input

Does your organisation … Have guidelines on managing bariatric clients? Hire in bariatric equipment? Have bariatric specific manual handling training? Roster additional staff to manage bariatric client

transfers and hygiene care?

Pre workshop questionnaire

Beds SWL>200kg Pressure care mattresses>150kg Shower chairs and commodes>150kg Wheelchairs>100kg Walking aids>100kg Lifting machines>150kg Weighing scales>150kg

What ‘bariatric’ equipment is available in your workplace

Prompts Access to bariatric resources Improved knowledge about B equipment Improving worker safety with handling larger clients Resources to develop organisational B guidelines Resources to promote sensitivity and dignified care Other reasons

Post workshop questionnaire What they had gained using same prompts

Pre workshop-what attendees hoped to gain

Results- pre questionnaire

Organisations with bariatric policies or Guidelines

0%

10%

20%

30%

40%

50%

Yes No DK N/A DNR

perc

enta

ge o

f res

pons

es

Adelaide

Country (2)

2008 WA Hospital audit-79% of hospital surveyed had B Guidelines. (Paterson)

Organisations that Hire Bariatric Equipment

0%

10%

20%

30%

40%

50%

Yes No DK N/A DNR

Perc

enta

ge o

f res

ponc

es

Adelaide

Country (2)

Organisations that provide Bariatric Specific MHT

0%

10%

20%

30%

40%

50%

60%

70%

Yes No DK N/A DNR

Pe

rce

nta

ge

of

res

po

ns

es

Adelaide

Country (2)

Bariatric patients are involved in between 14%, and 21% of body stressing incidents associated with acute patient care hospitals across metropolitan Adelaide, but make up less than 2% of all

inpatients.

Organisations that provide additional staff for Bariatric Client transfers/hygiene tasks

0%

10%

20%

30%

40%

50%

Yes No DK N/A DNR

Pe

rce

nta

ge

of

res

po

ns

es

Adelaide

Country (2)

Felix (2010) reported a 42% increase in cost (paid time to complete the task) to perform hygiene care on an obese client compared to bathing normal sized clients in USA Nursing Homes

Equipment for bariatric patients present in workplace

0%10%20%30%40%50%60%70%80%

Per

cen

tag

e o

f re

spo

nse

s

Adelaide

Country

2008 WA Hospital audit-Beds (66% had enough), transfer and hygiene aids

(58% had enough). Wheelchairs (57% had enough) (Paterson)

Pre workshop expectations and post workshop satisfaction. Adelaide.

70%

75%

80%

85%

90%

95%

Resourcesabout B care

B equipmentknowledge

Improveworker safety

Devt. BGuidelines

Dignifiedcare

Pre Adelaide

Post Adelaide

Post workshop questionnaire-gains from attending workshop

Pre workshop expectations and post workshop satifaction. Country

88%90%92%94%96%98%

100%102%

Resourcesabout B care

Bequipmentknowledge

Improveworkersafety

Devt. BGuidelines

Dignifiedcare

Pe

rce

nta

ge

of

res

po

ns

es

Pre country

Post country

Post workshop questionnaire-gains from attending workshop

1. Needs & Considerations of Bariatric People in Aged

Care (definition; stats; BMI; general info)

2. Designing a Safe Environment (design guidelines)

3. Weight Bias

4. Needs of Staff (tools, algorithms, wellness)

5. Needs of the AC Industry (lobbying for funding,

planning)

6. Equipment (options, purchasing checklists) All have references and resources.

Bariatric Fact Sheets

https://www.employersmutual.com.au/south-australia/member_incentives_program/index.htm

ACFI does not adequately fund for additional workers, specialised equipment and in some cases increased space required to safely manage bariatric clients

Few ACFs are resourced to manage dependant clients who weigh over 150kg

Community organisations cannot provide more than 2 staff to transfer/provide hygiene care at home, therefore struggle with dependant clients over 100kg

Acute hospitals in Adelaide have difficulty D/Cing dependant patients weighing over 120kg to ACFs

The Reality

Not known Lack of shared weight and BMI dataNeed Influence funding to support safe and dignified

care Industry guidelines E-data base of client weights/BMI

How big is the problem?

Are Aged Care Organisations adequately resourced to safely manage obese and bariatric clients ?

References

•Felix H C, Bradway C, Miller E, Powell L S. Obese Nursing Home residents: a Call to Research Action. JAGS. 2010.58:6. 1196-1197

•Paterson, C. ASSC Survey results. Safe Steps. National Hospital Intervention and Compliancy campaign. Work SafeWA. March 2009. http://www.commerce.wa.gov.au/WorkSafe/Content/Industries/Health_and_community_services/#Manual%20handling

•Link to bariatric fact sheets. https://www.employersmutual.com.au/south-australia/member_incentives_program/index.htm