Deborah Perry Schoenfelder , PhD , RN Evidence - Based Practice Guideline Assessing Heart Failure in Long - Term Care Facilities

diovascular disease with escalating mortality despite advances in treatment (Ahmed, Jones, & Hays, 2008; Heidenreich, Sahay, Kapoor, Pham, & Massie, 2010). The Centers for Medicare & Medicaid Services (CMS) (2008) report heart failure as the most common inpatient discharge diagnosis in older adults and one of the most expensive diseases to treat in the long-term care (LTC) setting (Hunt, 2005). Readmission rates average 25% within the first 30 days after inpatient heart failure discharge (CMS, 2008). Frequent readmission rates for heart failure care are potentially avoidable and directly correlated with increased mortality rates (Bueno et al., 2010; Heidenreich et al., 2010; Jencks, Williams, & Coleman, 2009). Interventions focusing on preventive care for vulnerable older adults in LTC facilities are crucial to prevent hospitalization and subsequent irreversible decline in function. Direct caregivers—primarily certified nursing assistants (CNAs)—provide 80% to 90% of the care for residents of LTC facilities and thus have the greatest potential to influence their care (Caspar & O’Rourke, 2011; Lerner, Resnick, Galik, & Russ, 2010; Vickery, 2004). Licensed caregivers assess residents on routine schedules or when direct caregivers alert them that a resident is in distress. Studies