to refuse to care for bariatric resident?

[Anarchyinateacup]

I work in a home with a resident who has a BMI of nearly 70. They are essentially bed bound due to their weight and require help with all aspects of physical care.Their weight is the main reason for them living in a care setting, and they continue to gain weight. This person has been assessed as needing two carers to complete personal care as they need to be rolled etc. We have access to slide sheets, hoists and other risk assessed equipment as per their care plan.

I've been working with this resident more often recently and I'm physically starting to struggle to care for them without hurting myself, despite following moving and handling as detailed in careplan. They have a bariatric bed which means even further to reach over to roll this person. They fill almost the entire width of the bed.

I'm at the point where I'm on a chiropractic waiting list, painkillers and my GP is referring me for physio and recommended I speak with my manager about the situation to come up with a solution. I'm under 30 and I don't want this to plague the rest of my life like it can do with so many care workers and I do not want to end up with a sickline.

My manager basically said there is nothing more they can do as care plan and risk assessment is all up to date and correct and that we don't have the staff to assist with my idea of 3 carers, 2 to roll and hold the resident whilst 1 carries out care. Many of my colleagues also struggle with this resident but are frightened to cause any "hassle" as care is famous for it's bitchiness etc so I have been the only one to raise the subject with management.

AIBU to ask to be moved to another area of the home, or to remain where I am and continue to care for this resident in other aspects but have another carer assigned to personal care? I really do love and enjoy my job but my health has to come into it somewhere surely?

Speak the patient's gp and flag that there may be inadequate support in place which puts them at risk.

Also report to the Health and Safety executive as well as the cqc. Both have options online or over the phone as an anonymous whistleblowing report, please give details of the risk factors.

This Does matter

Sod that. Why should that fat bugger ruin your life and health? Tell the manager you won’t be assisting them any longer and if they kick up a fuss, resign.

I write SOP/RAM/ expected/unexpected admissions plans for ultra high BMI patients (50 & over).

You need all the risk assessments and also the standard operating procedures for these patients. It may well be that they (the home) are using the plans for BMI>40 which is what most care settings do. We are literally re-writing the book on these patients as a few years ago these were people we saw on TV. Now they are on the wards/in care homes.

As a basic measure you need the turn bed. There are 2 good ones on the market right now and they do full turns. I have found that the users don't like them on full turn as they can make them feel quite nauseated but you can medicate against that and you have to mitigate risk to all staff at some point.

I would also suggest a hovermat and hoverslide. They are amazing and you can do a long time on the mat in an emergency without a turn and keep skin intact.

I do feel for you. I never thought I would care for patients with BMI >70 but here we are.

Sorry I haven't replied individually but thank you all for making me feel a bit less silly about this situation!

I am going to revisit their careplan when I am next on shift and double check dates, last weight logged etc and speak to the staff nurse that is on for their thoughts on the matter. Each shift is overseen by an RGN (not manager or deputy) so should be able to hopefully get a bit better advice or opinion. Will also check our board in work for contact details for Occupational Health etc.

If nothing gained then I will definitely be revisiting GP for sick note or at least for lighter duties as honestly you are all right, I am already injured and this simply cannot go on for my sake or the residents. Their size already puts them at risk of numerous complications never mind a carer accidentally hurting them because they cannot take the strain.

Truthfully I have never seen a person IRL as big as this resident. They are a really lovely person but completely at ease with their size and don't really have any intentions of losing the weight. Visitors bring them snacks and we cannot refuse any of their requests because they have been deemed to have capacity so they will only continue to gain. It's quite a sad situation to think of playing out.

I work in a hospital , which I understand is a totally different setting, but we would be expected to have 3-4 members of staff to roll a person of this size. 2 to wash the front, 3 to roll while the 4th washed and changed the sheets.
Has a moving and handling risk assessment been done?
Sorry I'm not sure how it works in a home setting.

I work with people who weigh less and manual handling is a 3 people task.

Did you get any literature about manual handle when you did the training? It should have also included weight limits.

www.hse.gov.uk/healthservices/moving-handling.htm

www.healthyworkinglives.com/advice/work-equipment/manual-handling This one
Has images about weight limits for certain parts of your body

YANBU - as a care worker you are totally within your rights to refuse care if it will lead to some sort of harm to yourself. Being already injured means as you've said that you are at increased risk whilst caring for this resident which then puts both you and the resident at risk. Their risk assessment should be updated to reflect this. Unfortunately having previously worked in care settings I know your managers reaction, although unreasonable, is not unusual. I reported my last employer to CQC for neglect before I left. I did have to leave as working there was leaving me with really bad mental health due to the (unintended) abuse going on. I really hope you get this sorted - you are not the one in the wrong here!

I opened this thread expecting to tell you you were being U, but no I don’t think you are BU.

In the care plan does it state that you both roll together and then once client is on side one of you goes back round the other side
of the bed to give care. And repeat. That's how I've been told to do it. Is it something you could suggest to be put in the care plan if you don't do it already?

To minimize the damage to your back you shouldn’t be reaching over. So rather than pulling you should be pushing.

Another move we do for some is use the recover move. If the person can bend their knees this helps a lot.

Moving and handling assessments can change. If you are experiencing difficulties with the procedure it HAS to be revisited.

Whoever did the assessment needs to be consulted and a revised plan put in place ASAP.

Things change, carers ability, carers size, size of bed, type of mattress, sheets, clothing, hoist constraints, client health, so many variables.

The procedures recommended should cover all these variables and more. Your safety and the clients safety is paramount.

What’s important is that you have identified a health and safety issue.

I’d ask your manager what the procedure is when additional health and safety issues have been raised and considering your health is suffering as a consequence can this be logged formally.

It sounds as though a professional has made recommendations but not got it quite right.

The correct response should be a review of practice, otherwise they are negligent as you’ve flagged a procedure that’s not working.