Understanding organizational context and heart failure management in long term care homes in Ontario, Canada

Jill Marcella, Jayanthini Nadarajah, Mary Lou Kelley, George A. Heckman, Sharon Kaasalainen, Patricia H. Strachan, Robert S. McKelvie, Ian Newhouse, Paul Stolee, Carrie A. McAiney, Catherine Demers

Department of Psychiatry and Behavioural Neurosciences, Hamilton, Canada.
Population Health Research Institute, McMaster University, Hamilton, Canada.
School of Medicine, University of Ottawa, Ottawa, Canada.
School of Nursing, McMaster University, Hamilton, Canada.
School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada.
School of Social Work and Northern Ontario School of Medicine, Centre for Education and Research on Aging and Health, Lakehead University, Thunder Bay, Canada.
School of Social Work, Centre for Education and Research on Aging and Health, Lakehead University, Thunder Bay, Canada.

DOI: 10.4236/health.2012.429113                

Abstract

Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants; average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.

Keywords

Heart Failure; Long-Term Care; Organizational Context; Focus Groups; Interprofessional; Disease Management

Conflicts of Interest

The authors declare no conflicts of interest.

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