Cascade View Nursing Center in Bend will have a new suite ready soon to accommodate a severely obese patient.

The room will be more spacious than others. The bed, commode chair and wheelchair will support more than 350 pounds.

Administrator Martha Jenness thinks she’ll fill the bed easily. “There is more and more need in the community for bariatric patients,” she said.

Recent research shows that a growing portion of the nursing home population nationwide is moderately to severely obese, defined as having a body-mass index of 35 or greater. The rate rose from 14.7 percent in 2000 to 23.9 percent in 2010, according to a study published last fall in the journal Research in Gerontological Nursing. Severe obesity is slightly less prevalent in western states nursing homes, according to the study, but it follows the same upward trend.

Nursing home administrators interviewed by Kaiser Health News said they can’t afford to care for the severely obese because Medicaid, which covers more than 60 percent of all nursing home residents, does not reimburse them for the specialized equipment required: motorized lifts, larger wheelchairs, bedside commodes and shower chairs; and longer intramuscular needles and blood pressure cuffs. The devices are expensive: $10,000 for a mechanical lift, for instance, and $5,000 for an extra-wide bed.

“The population is shifting faster than the ability of nursing homes to deal with them,” Cheryl Phillips, a senior vice president at LeadingAge, an association of nonprofit providers of services for older adults, told Kaiser Health. “We don’t have adequate staff. We don’t have adequate equipment. We don’t have adequate knowledge.”

Despite 27.1 percent of Oregon adults 65 and older being obese, defined as having a body-mass index of 30 or greater, the state Department of Human Services says caring for the heaviest people is not a problem. “Given our current data and based on our outreach and needs assessments, we do believe we have capacity to serve the current demographic,” spokeswoman Bobbi Doan said.

Oregon directs most of its Medicaid long-term care funds to “community-based care,” which includes assisted living, adult foster care and home-based care. Oregon serves significantly more people, around 11,500 consumers at any one time, in community-based care than in nursing facilities, which house about 4,000 people at any one time.

When seeking care in a nursing facility, severely obese Oregonians are more likely to find a place because the state’s Medicaid program pays those facilities a higher reimbursement rate than other states, so equipping for them makes more economic sense, said Mike Martynowicz, senior administrator of Central Oregon nursing facilities for Regency Pacific Management LLC, the Bellevue, Washington, company that owns Cascade View. That nursing facility, however, might not be in one’s hometown, he said.

Pilot Butte Rehabilitation Center in Bend, also owned by Regency Pacific, is one of a few nursing facilities in the area that routinely cares for people weighing more than 350 pounds. Martynowicz, interim administrator, said the facility accepts no more than one or two people at a time. Often that person comes from another region of the state because it can be so difficult to find a place for a severely obese patient.

Living long term in a nursing home, however, isn’t the ideal outcome for the patient, or the state’s Medicaid budget. That’s why the Oregon Division of Aging and People with Disabilities tries to help people stay in their homes, or some other community-based setting, said Christina Jaramillo, manager of delivery supports.

“I’ve got to hand it to the case managers” for being creative, she said. “There’s so many things they’re doing to keep people independent.”

If a person is at risk of ending up in a nursing home, Jaramillo said, there is money available that would pay for a portable lift.

It’s impossible to say how many people in Central Oregon are severely obese and needing care outside of their homes. Despite the state’s lack of concern about capacity, facility administrators said it’s difficult to find care at a level below nursing facilities, which generally have lifts, wide doorways and enough staff for a two-person assist at all times.

“We have had residents that have got to the point where their ability to ambulate has become, due to their weight and other medical conditions, a factor that we cannot provide their care anymore,” said Bryan Carnahan, administrator at Aspen Ridge Retirement Community in Bend. The assisted living facility lacks a lift, so if a person needed the help of more than two staff members to transfer from a bed or chair, he or she couldn’t stay at Aspen Ridge. “They go to skilled nursing (homes).”

Residential care facilities and adult foster homes can obtain exceptions to the Medicaid reimbursement rate that allow them to accommodate specific residents, Jaramillo said. That’s true whether the person is severely obese, or has other complex conditions.

Any residential-care or assisted living facility can work with obese people, said Janet Engel, the administrator at Fox Hollow Residential Care, a private-pay facility in Eugene owned by Prestige Care Inc. “It’s whether or not they will.”

Engel gained experience with obese patients while working in skilled nursing and so has been willing to work with those residents in a nonmedical setting. “You have to train your staff,” she said. “There’s some biases against large people. You have to get your staff to get away from that.”

Like most people, the severely obese try to avoid institutional care for as long as possible.

One Oregonian lived in a barn because it was the only building that would accommodate the person’s size, and family members were nearby, Jaramillo said. Then the barn began falling down, an ambulance responded and the person ended up in a hospital.

A hospital stay is usually what triggers a search for long-term care, Martynowicz said. “When they need the care, they really have gone through the resources that have been in place. It’s not a minor situation,” he said.

— Reporter: 541-617-7860, kmclaughlin@bendbulletin.com