Obesity is a growing problem in the U.S., and one that’s affecting seniors more and more. The 2015 Gallup-Healthways State of American Well-Being Index reported that more than 30 percent of elders ages 65-74 and more than 20 percent of those 75 and older reported incidences of obesity. The World Health Organization defines obesity as people having a body mass index (BMI) greater than 30, with those having a BMI greater than 40 considered severely or morbidly obese. “Bariatric” is the term often used to refer to those who are obese, and “morbidly obese” defines those overweight by more than 100-200 pounds or having a body weight greater than 300 pounds.

As the number of overweight adults increases, senior living communities need to be prepared to care for bariatric residents. Seniors who are dealing with obesity report difficulty with depression, functional mobility, and multiple activities of daily living (ADLs), particularly dressing, bathing, walking, and transferring from a seated position to standing. Chronic illnesses, including heart disease, stroke, diabetes, incontinence, osteoarthritis, and certain cancers, are more prevalent among this population. Challenges with mobility also increase with age for those with obesity, with the majority needing assistive devices or wheelchairs. To better support these residents, senior living communities must address a current lack of appropriate care programs, furnishings, and equipment. The following four approaches can help guide designers, architects, and operators to create the right care environment for these individuals and their families.

1. Space planning considerations
Guidelines for facility design and space planning for bariatric residents are available from the American Institute of Architects (AIA), the Veterans Administration (VA), Facility Guidelines Institute, and Bariatric Room Design Advisory Board. Recommendations include that public spaces, dining areas, and resident activity rooms should be designed to allow access for all residents, with corridors at a minimum of 48 inches wide and interior doors at least 42 inches wide. Passageways between furnishings should also be enlarged from a standard 36 inches to 42 inches, to allow adequate space for residents and equipment to pass.

Resident room door openings should be at least 60 inches wide to transport a bariatric bed or stretcher, which can be accomplished by using a bi-fold door, a 45-inch door with a 15-inch second “leaf” opening, a pocket door, or a sliding barn door. Bariatric guidelines from several organizations recommend a minimum 5 feet of clearance around three sides of a bariatric bed for caregivers to provide adequate care and safe handling. Each resident room should also provide a 72-inch turning radius for a bariatric wheelchair.

Bariatric toilet rooms, provided in resident rooms, dining areas, and resident activity zones, should be outfitted with bariatric toilets that are floor mounted, located 24 to 36 inches from the side wall to accommodate a caregiver on each side, and capable of withstanding 700-1,000 pounds. Shower spaces require grab bars with structural steel supports capable of withstanding 500-1,000 pounds of pressure, a hand-held shower nozzle mounted on a side wall, and additional space for caregivers. For bariatric residents with no mobility, a shower area with an extended hand-held shower nozzle and sized to accommodate a bariatric stretcher and two to three caregivers is recommended.

2. Choosing the right furnishings
When choosing bariatric furnishings, designers should look for chairs, benches, and sofas that are similar in style, color, and upholstery to complement other furnishings in a room and not stand out. Steel structures (which can hold 700-1,000 pounds) are essential to providing proper support. Guidelines from AIA and the VA suggest that 10-20 percent of all seating in public areas, such as dining, living, activity areas, waiting areas, and religious spaces, should accommodate bariatric individuals. Since obesity is often genetic, appropriate furnishings may also be needed for family in resident rooms and public areas.

In dining spaces, specifically, bariatric seating should be placed close to the entrance as well as around the room so that residents have a choice in where to sit. It’s important to consider table design, as well. Seniors with mobility issues often use the table as a support when standing up, so it’s critical that a table can support additional weight. Certain styles, such as pedestal tables that have a tendency to tip over when pressure is applied, should be avoided.

3. Care protocols
Having patient-handling procedures in place that are specific to bariatric residents is critical, not only for the safety of the resident but also their caregivers. For example, it’s not uncommon for bariatric residents with no personal mobility to need to be repositioned every two hours to avoid pressure ulcers. However, this procedure can place staff at risk for injury. Floor lifts can require four to six caregivers in order to safely transfer a patient. Specific storage areas for these lifts and bariatric wheelchairs near bariatric patient rooms and bathing rooms should be provided. Those facilities using ceiling lifts report needing fewer staff members to safely move bariatric residents as well as fewer staff injuries. When incorporating lift equipment, the resident room should be at least 14 feet high to accommodate a ceiling lift and 17 feet wide for a floor lift.

Bathing is another task where staff may be subject to injury. The use of a bariatric stretcher is recommended and can be accommodated with a combined bathroom and shower area that measures 8 feet, 10 inches by 14 feet, 9 inches and includes an 8-foot shower hose and a door that’s at least 44 inches wide.

4. Specialized resident programs
Given the high rate of depression among the bariatric population, care facilities should have specialized mental health assistance available. Therapy can occur in private resident rooms or in specialized therapy rooms away from public gathering areas. In either setting, bariatric seating should be provided and special considerations should be given to acoustical design to meet HIPAA privacy requirements.

Exercise is beneficial to those suffering from depression, and physical activity is a key component of weight management. Bariatric seniors may be prescribed specific exercise regimens by their doctors and facilities may offer access to a certified fitness specialist or specialized physical therapist, requiring settings and exercise equipment that can support 300-500 pounds or more. Excess weight can strain joints, so chair and aquatic exercises are recommended. Exercise rooms should have ample space between equipment (48-inch minimum), a 5-foot-wide walkway, and a 72-inch wheelchair turnaround. Since bariatric individuals can overheat easily, adequate ventilation is critical. Aquatic facilities require additional structural support for the concrete, weight of the water, and bariatric occupants; adequate spacing around the pool; and a bariatric lift or 42-inch-wide access ramp.

Challenges
Introducing additional support structures, safety features, and specialized furnishings and room designs for bariatric residents doesn’t come without challenges, beginning with the extra building expenses compared to traditional senior living settings. A​ppro-priate bariatric furniture and specialized equipment can cost three times more than standard items. However, the extra space and support are necessary to provide a high quality of care and life to bariatric residents. These measures also improve work conditions for caregivers and make good business sense since the price of bariatric equipment can be far less than the costs facilities can incur in workers’ compensation claims, sick days, and staff retention related to injuries arising from assisting in the movement of bariatric residents.

According to the Rand Corp., a nonprofit institution that provides research and analysis, if obesity rates continue to increase, there will be a greater number of adults dealing with health challenges, functional mobility limitations, and chronic illnesses. A continued and sustained increase in disability related to obesity would result in an increase in the need for assisted living or skilled nursing communities of 10-25 percent, according to research by economist Darius Lakdawalla published in the journal Medical Care. Just as senior living communities have developed specialized programs for dementia, unique programs and environments will be essential to meet the needs of bariatric residents. EFA

Meldrena Chapin is a design research consultant at The Design Consultancy (Atlanta). She can be reached at meldrena@meldrenachapin.com. Kathryn Rutledge is an interior designer at IIG Design (Weston, Fla.). She can be reached at krutle20@student.scad.edu.