Nursing homes address heart failure

LEWISTOWN – Congestive heart failure has become the top cause of hospitalization in people older than 65, said Julie Maidens, CHF nurse navigator at Lewistown Hospital. Each year, 400,000 new cases of heart failure are diagnosed and there is no cure, she said.

“Many seniors have heart failure, whether mild or severe, and this is a condition that needs to be managed each and every day in order to continue to live well and avoid hospitalization,” Maidens said.

Many area nursing homes have begun taking steps to help patients manage the symptoms of CHF as well as educate them on healthy lifestyle changes, Maidens said.

Heart failure is a chronic condition in which the heart is no longer able to work as well as it once did, Maidens said, causing a limited delivery of blood and oxygen throughout the body.

As a result, those with heart failure experience the following symptoms: shortness of breath with activity or at rest; coughing or wheezing; swelling of ankles, feet, legs or abdomen and therefore, weight gain from fluid building up in the body; tiredness, fatigue and inability to perform daily activities; lack of appetite and nausea; dizziness and confusion; and increased heart rate.

“Nursing homes have many residents with heart failure and it must be managed on a daily basis, as these residents are often not able to do so themselves,” Maidens said. “Staff must advocate for these residents living in their facility.”

The Golden Living Center-William Penn, in Lewistown, has been working with Maidens to expand its current CHF program and implement a new pilot program, said Rachel Casner, director of clinical education at William Penn.

“It’s essential that long term care facilities provide care for and teaching about heart failure,” Casner said. “We strive to keep our residents at their maximum level of independence and functionality, while controlling the symptoms and slowing disease progression.”

The current CHF program at William Penn involves the development and implementation of personalized care plans for each resident with a CHF diagnosis, Casner said. The program also focuses on education for residents and family members, providing materials and resources necessary to live a life with CHF or support someone with CHF.

“Treatment of CHF is never a fixed process, but rather a balancing act that requires continuous adjustments and frequent assessment,” Casner said. “Educating our residents and their loved ones is an important part of any treatment regimen we put in place, but is especially important in treating CHF.”

The Right Rhythm Cardiac Care pilot program, scheduled to begin at William Penn in late summer, is designed as a stepping stone for cardiac patients between the hospital and home, Casner said. It takes an all inclusive look at the patient, involving the facility’s nursing department, wellness and activity services, rehabilitation services and nutrition services.

“Each diagnosis has associated care maps which outline certain criteria for treatment and parameters for care,” Casner said. “Each resident, who is admitted into the program, will also receive a Transition Notebook, which will be a chronicle of their health journey.”

Brookline Manor, in Mifflintown, has been working on its CHF program since it was implemented a year ago, said Carol Armstrong, rehab manager at Brookline. The program is based around physical rehabilitation in an effort to improve patients’ day to day functioning, she said.

“The goal, for all our patients involved in the program, is to improve their quality of life while living with CHF,” Armstrong said. “So far, we have seen a good response and many patients have been able to return home.”

The treatment involves an hour of rehab exercises each day based on the patient’s needs as dictated by a personal care plan, said Traci Brubaker, physical therapist at Brookline. The exercises are geared toward decreasing fatigue and weakness while improving functionality and mobility, she said.

“The exercise program progresses in difficulty over time to develop strength and endurance,” Brubaker said. “The patient’s vitals are also monitored during each session to determine how much effort their bodies are exerting.”

Depending on the patient’s level of health, daily sessions can be spent practicing regular day-to-day activities like gardening, folding towels, building furniture or arranging flowers, Brubaker said. These practices provide a sense of security, assuring patients they can function successfully when they leave.

Once patients return home, Maidens said, it’s important they stay in consistent contact with their primary care physician and cardiologist to report any concerns or worsening symptoms. Maidens also recommends that a spouse, family member or friend is educated on the condition to assist with daily diet and activity.

For more information about congestive heart failure, visit the American Heart Association website at or the Center for Disease Control at