inpatient obesity treatment

[truthseeker]

I am a PT and am trying to find an inpatient rehab unit for a 53 year old man with a BMI of about a million. He is 5'8" and about 500 pounds. He has some chronic kidney disease and his nephrologist actually took him off of diuretics and he has gained about 13 pounds a month for the last year and a half. Otherwise, he is motivated, still lives with his wife in their house but has a fairly long history of SI area pain, has knee OA and has one TKA. We are trying to find a facility in minnesota WITH A POOL that will accept him.

Does anyone on this board have any knowledge of such a place? He has been denied admittance to several places because he basically isn't sick enough.

His PCP and the discharge planner are working really hard to find something but so far,no luck.

any help would be much appreciated.

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[Xardas]

Your best bet may be to find a for-profit type private free standing rehab hospital a la Healthsouth. The MD's also need to do a better job of justifying medical necessity. Just b/c he has CKD doesn't mean he needs MD supervision which is a tenet of getting into an inpt rehab.

Also the whole pool thing is going to limit your options a lot.

He's going to be tough to place though.

 

[truthseeker]

Thanks for the reply. My thoughts on the pool are that is really the best way for him to be able to move. That will help with his pain, plus help with some of the weight loss. I only mentioned the CKD because it explained a large portion of his recent weight gain.

We will keep looking.

 

[Xardas]

Its going to be tough. Do you think this guy can actually do 3 hours of therapy?

 

[truthseeker]

not all at once. but I really have no idea how long he could go in the pool walking back and forth in chest deep water. In water that deep his effective weight would be only 150# which would probably feel pretty good.

Imagine setting down 9 bags of softner salt that you have been carrying for a year. I'm also trying to find SNFs with pools that can handle a 500# man. Often they put a cap on their "bariatric" programs at 350# which to me is barely bariatric.

 

[SSdoc33]

This guy is not a candidate for acute inpatient rehab

 

[truthseeker]

OK, fine, do you know anywhere in the area mentioned where he can get the services that he needs? Pool, and 500# bariatric services?

I don't deal with this very often and I and our team are at our wits end to help this guy. Have you had any experiences that are similar? and if so, where have you been able to refer to? I have heard a lot of "no"s and he needs to hear a "yes" from someone with the facilities and equipment he needs to not lay in bed and die in pain.

 

[fozzy40]

OK, fine, do you know anywhere in the area mentioned where he can get the services that he needs? Pool, and 500# bariatric services?

I don't deal with this very often and I and our team are at our wits end to help this guy. Have you had any experiences that are similar? and if so, where have you been able to refer to? I have heard a lot of "no"s and he needs to hear a "yes" from someone with the facilities and equipment he needs to not lay in bed and die in pain.

I applaud your effort for this patient. He's a tough case and unfortunately he is going to be a very tough placement as everyone said. Does he have a discharge destination after the hospital? Does he have family?

 

[truthseeker]

he is married, no kids. lives in town in a house with about 4 steps to enter. multilevel house but bathroom kitchen and hospital bed all on the main floor.

He can't go home. He will have to go somewhere else for awhile but I don't just want it to be a SNF without a pool if I can help it. He desats when he walks 50 feet because he tends to hold his breath. Supplemental O2 doesn't really make much of a difference. that's why we are trying to find a more appropriate placement after discharge.

 

[RUOkie]

he is married, no kids. lives in town in a house with about 4 steps to enter. multilevel house but bathroom kitchen and hospital bed all on the main floor.

He can't go home. He will have to go somewhere else for awhile but I don't just want it to be a SNF without a pool if I can help it. He desats when he walks 50 feet because he tends to hold his breath. Supplemental O2 doesn't really make much of a difference. that's why we are trying to find a more appropriate placement after discharge.

why are you so hung up on a pool?

IMO, pool therapy is next to worthless. It's only use is to make people think they are exercising to make them feel better about themselves. Once they get back onto a land based program, all the problems reemerge. It sounds like this man needs to stop holding his breath. Psychological assistance may be in order.

He needs a SNF and he needs someone to kick his ass.

 

[truthseeker]

I am hung up on the pool (In general I agree with you) because he can't move for long enough to make any impact, he is super anxious about falling, he weighs 500# and has fluid management issues.


I am kicking his ass, but he simply can't tolerate more than about 50 ft. of walking.

 

[DOctorJay]

Perhaps the Courage Center?

 

[truthseeker]

tried, they said no, tried sister Kenny, tried mankato, tried st cloud, tried avera in sioux falls, . . .

 

[padresp]

Rehab Institute of Chicago? If you are willing to expand your search, they take a fair number of morbidly obese patients.

 

[Louisville04]

Rehab Institute of Chicago? If you are willing to expand your search, they take a fair number of morbidly obese patients.

If all those facilities in MN turned him down, it is unlikely RIC would accept him. Plus could he tolerate 6+ hour car ride to Chicago?

Most rehab facilities are for profit and I am guessing they figured it was not financially prudent.

I am guessing he is not a veteran or you would have tried a VA facility.

 

[fozzy40]

What was his prior level of function at home? It sounds like he is mostly a household ambulator. Is it pretty much stairs he needs to do to get home? I'm assuming he is medically cleared to participate in pool therapy. As you mentioned, fluid shifts in the pool can have significant cardiovascular effects. Overall, it sounds like he is much more appropriate for a subacute or SNF placement though.

 

[truthseeker]

right, not a vet. I hadn't expanded to chicago. Might save the guy's life though if we can't find anything closer.

 

[truthseeker]

FYI, he developed some respiratory distress and we were able to get him admitted to a tertiary facility afterall.

Thanks for everyone's help anyway.

 

[fozzy40]

FYI, he developed some respiratory distress and we were able to get him admitted to a tertiary facility afterall.

Thanks for everyone's help anyway.

Glad your patient has a strong advocate🙂