Are Obese Residents More Likely to Be Admitted to Nursing Homes That Have More Deficiencies in Care? Ning Zhang, PhD,* †‡ Yue Li, PhD, § Rosa Rodriguez-Monguio, PhD,* Andrew Barenberg, MS, k Helena Temkin-Greener, PhD, § and Jerry Gurwitz, MD † OBJECTIVES: To determine whether obese older adults who qualify for nursing home (NH) placement are as likely as nonobese adults to be admitted to NHs that pro- vide adequate quality of care. DESIGN: Retrospective study. SETTING: NHs in New York State. PARTICIPANTS: Individuals aged 65 and older newly admitted to a NH in New York State in 2006–07. MEASUREMENTS: Total and healthcare-related defi- ciency citations for each facility were obtained from the Online Survey, Certification, and Reporting file. Bivariate and multivariate regression analyses were used to assess the association between obesity (body mass index (BMI) 30.0–39.9 kg/m 2 ) and morbid obesity (BMI ≥ 40.0 kg/m 2 ) separately and admission to facilities with more deficien- cies. RESULTS: NHs that admitted a higher proportion of morbidly obese residents were more likely to have more deficiencies, whether total or healthcare related. These NHs also had greater odds of having severe deficiencies, or falling in the top quartile ranking of total deficiencies. After sequentially controlling for the choice of facilities within the inspection region, resident characteristics, and facility covariates, the association between morbid obesity and admission to higher-deficiency NHs persisted. CONCLUSION: Residents with morbid obesity were more likely to be admitted to NHs of poorer quality based on deficiency citations. The factors driving these disparities and their impact on the care of obese NH residents require further elucidation. J Am Geriatr Soc 64:1085–1090, 2016. Key words: obesity; morbidly obese; nursing home; deficiency in care W ith the obesity epidemic (body mass index (BMI) ≥30.0 kg/m 2 ) 1 that exists in the United States, nurs- ing homes (NHs) have been experiencing a rapid increase in numbers of obese residents. The national prevalence of obesity in NH residents has increased from less than 15% in 1992 to 18% in 2002 and 25% in 2009. 2,3 Great varia- tions have been found between NHs in proportions of obese residents. Based on data from New York State (2005–07), the prevalence of obese residents varied from 0% to 44% and that of severely obese residents from 0% to 50%. 4 It is unknown whether obese older adults are as likely as those who are not obese to be admitted to NHs that provide adequate quality of care. Obese adults tend to be poorer and less educated, be paid less, and be less likely to have been employed than their nonobese peers. 5–12 There are concerns that, with advancing age, older obese individuals may have less access to high-quality NHs. To provide care for obese residents, NHs may need to invest in modifying their physical environments by providing extra space, wider doors, and larger bathrooms in addition to acquir- ing specialized equipment including larger beds and stretchers, special lifting devices, and other heavy-duty assistive devices. 13–15 Moreover, obese residents may require higher levels of staff effort by placing greater demands on personal care staff for assistance in per- forming selected activities of daily living (ADLs) than their nonobese peers. 16,17 The cost of such adjustments may be disincentives to some NHs to admitting obese individuals. Motivated by concern about possible disparities in quality of NH care associated with obesity, the present study examined whether obese residents are more likely to From the *Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst; † Meyers Primary Care Institute; ‡ Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; § Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York; and k Department of Economics, University of Massachusetts Amherst, Amherst, Massachusetts. Address correspondence to Ning Zhang, PhD, Department of Health Promotion and Policy, School of Public Health and Health Sciences University of Massachusetts Amherst, 715 N. Pleasant Street, Arnold Building Room #324, Amherst, MA 01003. E-mail: ningzhang@ schoolph.umass.edu DOI: 10.1111/jgs.14105 JAGS 64:1085–1090, 2016 © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society 0002-8614/16/$15.00