Residential homes refusing DM because she's bariatric

[ElphabaTheGreen]

DM is 5ft 1in and 23-25st - not massively 'bariatric' but nevertheless morbidly obese. She's 71 - she's been this size for decades, it's not going to change, with all the will and help in the world.

The difficulty I'm having is she's now requiring residential home placement. She's been turned down by 8 so far because she's a 'health and safety risk' as they wouldn't be able to evacuate her easily in an emergency. She's in a bariatric wheelchair which won't fit through standard doorways, and the vast majority of homes only seem to have bedrooms upstairs and tiny lifts. Other than this, she can actually transfer with supervision only, and only needs assistance of one carer for personal care and toiletting - it's not like she needs hoisting, nor does she have any complex nursing needs. She is firmly 'residential' and not 'nursing'. At a pinch, they could get her onto a standard wheeled shower chair or commode to get her out - her sitting balance is fine and, while not ideal, you do whatever it takes to evacuate someone, as it's hardly a daily occurrence.

She has a social worker who is hopping mad about these repeated refusals, as the same homes have completely bed-bound patients who would be just as difficult to evacuate for different reasons. We also don't know where these places think the magical ideal home is for her - even the more modern ones have standard width doorways on every room and seem to reserve their ground floors for group dining rooms and social areas (which DM would never want to be a part of anyway - she herself has no issues whatsoever with having to remain in one room as she's the original hermit).

Is there any kind of discrimination clause we can invoke if we get yet more refusals? As it stands, we're having to look further and further afield from where we live which is far from desirable as we would struggle to visit her more than once a week. Additionally, if the only home that will accept her happens to charge massive top-up fees, which we cannot afford, it's not like we'll be in a position to look elsewhere. She's medically very healthy - not the slightest hint of diabetes, cardiovascular disease or COPD etc - so we're probably looking at years/decades of placement.

Help? Please?

What a difficult situation to be in. For what it's worth, I used to work in a nursing home that was purpose built and all on one floor. The doorways were wide enough for moving beds in and out of, and wide wheelchairs. The communal areas were all open plan and the entire place was accessible to all. Even the baths and showers were made for larger people, and we had several bed bound larger residents although some did have ceiling hoists. The only thing I would perhaps says is that even moving someone from a bed to a wheelchair etc had to be done by a hoist or stand-aid if the person had limited mobility so there was zero fall risk - and that meant 2 carers each time. I wonder if a residential home would have the staffing levels needed for that, and bathing etc. Care is very much dominated by health and safety these days, and it's more a case of what could happen. From her size alone, residential care may simply not be an option for your mum sadly and I'd have a look around some nursing care facilities so you can see the difference for yourself. Some homes do operate both residential and nursing care, do you have any of these in your area?

Are there any dual registered homes in your area (residential and nursing in one home)?

Two or three of the homes which have turned her down were dual registered. One was even a nursing home only, so we were looking down the barrel of those fees, even though she'd only be funded for residential. They all give the same excuse.

There is no way she needs more than one carer or handing aids to transfer. It would be grossly unfair and detrimental to her health, quite frankly. I'm an occupational therapist myself so would be livid if they suggested any kind of hoisting for 'health and safety' reasons. She can weight bear sufficiently to transfer very safely with supervision only of one person. If she isn't permitted to do that because of her size, I'd seriously consider taking legal action as it could have serious effects on muscle tone and bone density.

I'm so stressed about all this I don't want to put her in a home, she really doesn't want to go into a home, but we have no other option because there is no way to keep her in her maximally adapted granny flat - she needs the 24 hour care. This bullshit is just making it fifty times worse.

Since my OP, I found out she was turned down by another one today, so it's another day of driving around town tomorrow and bursting into tears yet again in another care home manager's office

Does the social worker not have any experience of homes in the area that would be suitable? Or someone from CQC or the local council? What an absolute nightmare for you, I can't imagine how you're feeling. It's hard enough accepting your mum needs to take this step, let alone everything else.

www.stmonicatrust.org.uk/news/2013/02/trust-launches-specialist-bariatric-service

www.carehome.co.uk/news/article.cfm/id/1565071/growing-number-care-homes-bariatric-rooms-obese

I don't know if any of these locations are near you??

We had a baractic lady who was lovely but it did take a lot for the carers when mobilising her and it meant they were thinly spread on the floor. She did get additional equipment specialist hoist and shower chair. Access to the door ways is important when trying to do an emergency evacuation and a lot of care homes have to be properly assess if they can accomdate a resident who requires additional equipment to met their needs.

I'm sorry I can't offer much help but I too am surprised by this.

I used to work in a nursing home where we had bed bound residents attached to peg feeds and one very large gentleman who, I'm sure, would have been heavier than your DM. It would have been nigh on impossible for us to evacuate these or some of our other residents in an emergency situation. I've never heard of weight or BMI being a reason to deny care - in fact, having worked more recently as a community carer, I would have said that most care homes are better equipped with wheelchair accessible doorways, wheelchair/walking frame friendly flooring (ever tried pushing a chair across a badly fitting carpet?) etc. than your average home.

It all sounds crazy to me.

The social worker is ringing the CQC to see if they can advise, thanks Hyacinth, and no, those homes are nowhere near us.

I get that Underthemoonlight, but where else is she supposed to go? Everywhere is the same. And honestly, she needs one carer for transfers and personal care. She can do most of her own wash and dress in sitting. And all of these homes had completely bed-bound patients upstairs who would have needed stretchering downstairs - like I say, they could stick mum on a standard wheeled shower chair or commode with the arms removed at a pinch to get her out.

All they're seeing is her size and leaping to hoisting/extra care needs conclusions. It's bloody infuriating. They don't listen to me, or the OT in the intermediate care facility or the social worker when we tell them how little input she actually needs.

The home has a duty to look at the sustainability / longevity of a placement. OK Mum is mobile and self caring now, what if she's not in 6 months? The sad facts are that when people enter residential they don't usually return home, so are requiring a home for life.
There are so many HCP's on the site I'm sure if you gave us a vague location we could wrack our brains

Santas The bariatric wheelchair won't go through anything other than a double door. A large number of the care homes around us are just old converted houses with no wiggle room to widen doorways. One I visited had a corridor that couldn't even fit a standard ambulance stretcher in to retrieve the remains of one of their deceased (normal weight) residents! How is it even allowable to have poorly mobile people housed in places like that!

I have witnessed residents becoming unable and unwilling to do tasks which were well within their capabilities, very quickly. Shockingly quickly in some cases. Perhaps this is why some homes are reluctant to offer your MIL a place. Nursing and care homes are often run with the legal minimum of staff, particularly at night.

I had to place a bariatric client once-no home would take her for the reasons you describe-fire evacuatoon risk, not big enough for wheelchair, concerns about her future mobility and the carers ability to lift-some I thought were genuine, some I felt were spurious.we eventually got her into respite care until a council property could be adapted for her to move into with care going in.It was a very lengthy process unfortunately.
Is she a self funder or LA funded?

LA funded. It's the 24 hour care she needs to assist with toiletting, mainly, and lower half personal care. 24 hour care never happens in people's own homes - not for the over 65s anyway, and not for those needs. She can't physically get to a toilet anymore and can't manage her own hygiene on a commode and gets up at least twice in the night. She also has continence issues and IBS so can't just hang on for carers four times daily.

I was going to post (as I work in hospitals and am familiar with bariatric equipment being made available on wards when needed) but I see you are an OT and still can't get any further forward! So I just send my sympathies. When Dad was stuck in hospital a year ago and could not go home due to rapid deterioration of his dementia, the CCG stepped in and found a nursing home. It is an awful situation for you (been there with grandpa and with Dad) and hope it gets resolved soon.

My friend is a nursing home manager and struggles to admit bariatric residents. He says they just don't have the facilities - whilst your mum may need very little equipment or assistance now, they have to do long term projections in terms of care required especially in order to secure long term LA funding and satisfy the safety inspections and assessments.

It may be that within 6-12 months your mum requires a bariatric bed, chair, hoist, showering equipment, 2 carers to mobilise etc etc. The home won't necessarily get any extra funding for this and can't afford to buy it themselves. Given the demand for care home/nursing home places it is probably easier for them to decline her and wait for the next enquiry.

It doesn't make it any easier for you or her though. Sympathies to you both.

If she's LA funded then they have a duty of care and a responsibility to find her a place or put care in place on her own home. Over 65's can and do get 24 hour care, though it varies from LA to LA.
Do you know who your older people's services commissioner is? This is an issue for them as they have to commission services to meet people's needs. Their name and contact details should be on your LA website.

Crikey OP! Those buildings don't sound particularly suitable for care homes for anyone!

I'm sure it's a regional thing but most care/nursing homes here are modern buildings - or at least purpose built at some point. That said, the one I worked in was an old Manor House - but had been suitably adapted.

I understand that the homes are taking into account DM's future needs along with her current ones. So are looking at a possible time when she does require lifting etc., but anyone's needs can change after admission.

Somewhere has to be equipped with wider doorways, or double doors. I'm still quite shocked at the problems you are having & really hope SS come up with a good solution very soon. It must be awful for DM to be in a "nowhere will have me" state of limbo.

Thanks nigel. I'll talk to DM's social worker and look into that.

Have you looked at sheltered scheme or is that not suitable? She'd have her own bungalow or gff on a purpose built complex with carers and a warden available 24/7. She'd get to keep some of her independence then too. I suppose the care homes have to think about if she deteriorates and then does need hoists etc if it's not something that they can provide as they can't just kick her out. We had a nightmare with my grandad (in law) because "he wasn't bad enough" but mentally he couldn't look after himself and was getting very confused. We did get there though! Good luck I know how stressful it can be

I know from experience through my job that sheltered schemes are very hit-and-miss and places are like hens' teeth. Wardens are rarely on call for 24 hours, and from what I've gathered, independent toiletting is a must as that's not what wardens or on-site carers in sheltered places are generally there for. If mum could toilet independently, she could come home. She's still working to try and get her mobility back but, for various reasons, I don't have her confidence that that is going to happen.

Her previous set-up was a fully-adapted granny flat in our garden, so she virtually was in 'sheltered' accommodation before this.

I'm residential/nursing home manager.
Unfortunately home managers do not want to take morbidly obese people in. On the surface of it it sounds morally wrong but I think the majority of people don't understand what the care of an obese person entails.
If someone is morbidly obese and can just about transfer to the toilet and can do most things with the aid of a carer I can assure you it won't be long before they are immobile.
Because of the politics of fat, care homes are not given more money for very large people despite the fact it is SO expensive taking care of them. There would be an uproar if people who needed care were classified as too fat to take up a 'normal' place in care. It would be deemed discriminatory, I feel. Unfortunately care homes are private businesses and unless they are financially compensated for their time then they lose money. Obese people generally cost MUCH more money than average sized people.
Nursing/care staff struggle to move the bodies of obese people. It is incredibly hard to clean them (think two staff manually lifting their abdomen up to expose their private area and another staff member to clean it).
Staff regularly feel the physical strain on their bodies after a shift moving an obese people. Trying to push a wheelchair of an obese person (even with a power pack on the back) leaves staff with pain in their shoulders. This is despite the best and latest bariatric equipment (who pays for that?)
When I assess a person to see if they are suitable for my home I would pass on a morbidly obese person. If I accepted them I would lose money and my door would be revolving with staff complaining about their concerns about their physical health. My directors would want to know why I put their home at risk from financial loss and at risk litigation from staff.
I feel very obese people should get more money from the Government for their care to off shot all the risks.
So sorry it is difficult for you to find a placement. It's difficult.

The problem is that relatives and social workers lie through their teeth to get a placement and say care needs are a lot less than they are. Also care needs increase over time and then her weight will be a lot more of an issue.
Suitable care staff are VERY hard to recruit, the care homes I audit pay unqualified staff NMW even for nights and bank holidays

bed bound people are not usually evacuated, they are moved to put more firedoors between them and the fire. Rolled out of bed onto a ski mat on the floor and dragged