An effective home care provider can help seniors with congestive heart failure through improved health literacy and self-management. By advocating for seniors and ensuring their understanding of their condition and treatment plan, home care providers can help prevent health complications and hospitalizations. They do this by communicating clearly, taking notes during doctor's appointments, reviewing materials, and teaching seniors self-management techniques like daily weight and symptom tracking. With a home care provider's assistance, seniors with congestive heart failure can better manage their condition and health at home.

1. Home Care
A S S I S T I N G S E N I O R S W I T H
C O N G E S T I V E H E A R T F A I L U R E
T H R O U G H I M P R O V E D H E A L T H
L I T E R A C Y A N D S E L F
M A N A G E M E N T
Jaime Hadley – Communication II – July 2014

2. Executive Summary
Many seniors who require home care battle with chronic illnesses such as chronic
obstructive pulmonary disease, diabetes, and congestive heart failure. These illnesses
lead to hospitalizations, health degeneration, and emergencies. However, seniors
may decrease the risk of these negative occurrences by helping to manage their own
health at home. Home care providers have the opportunity to aide and enable seniors
in this self-management by facilitating open communication among the heath team
(the individual, family members, and professional care providers) to increase the
senior’s health literacy and by utilizing recommended tools and techniques to track
and improve health at home. This paper explains the concepts of health literacy and
self-management for seniors and provides guidance for home care providers
concerned with managing congestive heart failure in the home.
Points of Note:
 Though health literacy is an apparent issue across demographics, seniors pose
significant risk due to the wide breadth of ability and understanding associated
with mental and physical degenerations of aging and chronic illnesses.
 Multiple studies show a correlation between low understanding levels of chronic
illnesses and increased avoidable health complications and hospitalizations.
 Home care providers can work to open lines of communication between seniors,
physicians, home health, and family caregivers.
 Open communication and clearly explained/understood information about a
senior’s illness can lead to better self-management at home and overall better
senior health, especially when facilitated by a home care provider.
 Home care providers should be familiar with and able to teach steps to
controlling congestive heart failure in the home.
An effective and educated in-home care provider can make a great difference in the
health of a senior with congestive heart failure through increased health literacy and
assisted self-management.
http://selecthomecare.com/

3. Introduction
“When patients
are in doctor’s
offices, they
(might) hear 50%
of what’s being
said and maybe
their relative
hears another
30%, but they
walk away
without 20%”
(Evans 2013)
Of that 80%
actually heard,
how much is
understood?
Joanie, a 67 year old woman, has just been told by her
physician that she has congestive heart failure. She knew
with her diabetes, progressive weight gain, and recent
shortness of breath that this possibility existed. But the
diagnosis still comes as a shock. Her mind wanders, focused
on those words – Heart Failure; the terms heart and failure
together filling her with concern. While she processes her
emotions, the doctor continues, unaware of the loss of
attention from Joanie. He explains the symptoms of CHF,
her options going forward, and his recommended changes
in her medication and lifestyle. Joanie tunes back in to hear
“Do you have any questions at this point?” Her mind still
muddled, she answers “No.” The doctor hands her
pamphlets, information on diet and general health, warning
signs. He tells her to call immediately if her condition
worsens. Joanie thanks him and leaves the clinic.
The premise of effective health care relies on the patient
understanding and following the advice of the physician.
Unfortunately, many factors may impact the patient’s
understanding and follow-through: money, emotions, and
particularly a concept known as “health literacy”. In
Joanie’s situation, one common for many seniors, the
doctor assumes not only that Joanie hears his instruction,
but also that she understands how to follow through with
his prescribed care plan. Even if the physician takes the
time to ensure she has heard, he has very little power of
follow through and accountability with Joanie. He must
depend on her ability to monitor and regulate her own
health, known as “self-management”. Self-management can
be especially difficult for seniors.
“Seniors are totally reliant on their physician – an
individual they see only occasionally – to explain their basic
health condition. In appointments, seniors will nod ‘yes’ but
don’t necessarily understand what is being said.” (Gynn
2013)

4. An effective home care provider steps in to help the
senior overcome these obstacles, to increase the
senior’s health literacy and aid the senior in self-
management of their condition. For seniors with
congestive heart failure, an informed home care
provider can prove an essential leader at the bedside,
utilizing the unique ability to make observations
about their clients that no other care provider can
and report subtle changes to decrease the need for
unnecessary hospitalizations. (Harris 2014)
According to Mary
Gynn, RN and
experienced Senior
Preventive Health
Advocate, seniors face
many unique
challenges when it
comes to their
health. (Gynn 2013)
• They don’t fully
understand what
the doctor is talking
about;
• They don’t
understand their
role in receiving
prescriptions;
• They don’t
understand
explanations of
their condition,
medications or
treatment;
• Physical limitations
restrict
understanding (e.g.
Many seniors have
hearing problems);
and
• Mental limitations
restrict
understanding (e.g.
Complex
information is
communicated
quickly yet seniors
are expected to
grasp this in a 15-
minute visit) (Gynn
2013)
http://www.aplaceformom.com/blog/unlikely-connection-between-utis-and-dementia/

5. For many people, the term “health literacy” may be unfamiliar or vague.
According to the American Medical Association, health literacy encompasses
“…a constellation of skills, including the ability to perform basic reading and
numerical tasks required for functioning in the health care environment.”
(Cook et al 2006)
Rosie Harris, MSN, RN, defines health
literacy as “the state at which clients and
health care professionals understand each
other.” (Harris 2014) Improved health
literacy influences the way professionals
communicate with patients and the way
patients or individuals understand their
overall health. All levels of home care – from
family and companion caregivers to Certified
Nursing Assistants – can increase the
effectiveness and quality of care by
understanding and improving the health
literacy levels of the seniors they serve.
The impact of poor health literacy extends
beyond immediate health consequences.
Patients with low health literacy, those who
“read at lower reading levels,” “are more
likely to incur higher medical costs that those
patients who read at higher reading levels.”
(Cook et al 2006) In one study done on the
subject, 1 in 5 Americans were shown to read
at half the level required for understanding
most health care material (Cook et al 2006).
Unsurprisingly, in 1998, it was reported that
“an excess of $29 billion dollars in additional
annual health care costs” could be “attributed
to poor health literacy skills.” Lack of health
literacy affects the entirety of the health care
system, and should be a priority for every care
provider as well as patient.
Defining Health Literacy
“Patients over age 60 are
more likely to have both
poor health literacy skills
and suffer from chronic
conditions, such as
cardiovascular disease.”
(Cook et al 2006)

6. Defining Health Literacy (cont.)
With seniors being at increased risk
for poor health literacy
consequences, home care providers
must be prepared to aid the senior
one-on-one and advocate on behalf
of the senior in communications
with other members of the health
team. Recalling Joanie’s situation, a
home care provider serving as an
advocate could help Joanie to
overcome obstacles of
miscommunication. Physicians
often “do a poor job of assessing
their patient’s health literacy skills
and overestimate their abilities.”
(Cook et al 2006) In addition, many
patients feel uncomfortable asking
questions about the physician’s
recommendations. (Cook et al
2006)
One study found that “when asked
to determine how well their patients
understood what they said… [these]
physicians were correct only 2% of
the time.” (Cook et al 2006) The
presence of a home care advocate in
these doctor’s appointments can
help to avoid this
misunderstanding. Home care
providers advocating on behalf of
the patient remain uninhibited by
emotion or embarrassment, and
may ask questions and take notes
about the patient’s prescribed
treatment or condition.
As part of an Innovations Project for
Medicare and Medicaid, The Schmieding
Center of Northwest Arkansas offers a
course for advanced caregivers that focuses
on helping seniors stay healthy at home
and thereby decrease healthcare costs and
unnecessary ER visits, hospital visits, or
LTC visits.
Addresses:
• Health literacy
• Chronic condition self-management
• Communicating with Emotional
Intelligence
• Motivational Interviewing techniques
• Increasing medication awareness
• Advocacy
• Creating healthcare teams that
encompass ALL parts of the team (Harris
2014)

7. Role of the Home Caregiver
The individuals comprising a health care team come from different levels of expertise and
involvement. Family members, physical therapists, general physicians, home health nurses,
specialists, and home caregivers together comprise the health team surrounding a senior. The
home caregiver typically spends the most day-to-day time with the senior they serve, and can
be essential in connecting all the members of the ‘team’. When facilitating effective
communication on behalf of the senior, the home caregiver must remember to work towards
the goal of the patient. “It is important for all people [involved] to understand what is
important to the client and base decisions on that persons individual needs.” (Harris 2014) For
a caregiver to be effective in increasing a senior’s health literacy and self-management, the
senior must determine for his or herself that personal health is important.
Consider Joanie’s scenario, and how a home caregiver could advocate for her in the doctor’s
appointment to thwart instances of poor understanding:
1. When Joanie tunes out, an accompanying home care professional can remain undistracted by
emotion and able to listen attentively to the doctor’s words. (More so than an accompanying
family member)
2. Joanie’s home care advocate can be prepared to make a list of medications prescribed by the
doctor, and make note of any special instructions, avoiding the common “bag of medications” –
jumbled and possibly expired prescriptions that many seniors take without understanding (Gynn
2013)
3. The home care advocate can take a moment to gage Joanie’s understanding by asking Joanie to
repeat back what the doctor has said in her own words. The doctor can then clarify any
misconstrued points.
4. Joanie’s advocate can gather materials provided by the doctor and later review the information
with Joanie.
5. The home care advocate can make note of the doctor’s contact number and reassure Joanie that
any questions that occur to her can be answered at a later time.
With a prepared home caregiver present, Joanie can leave her doctor’s appointment assured that all
of her bases are covered. This type of information intervention has been shown to improve the health
of seniors with heart disease.
“Careful consideration of health literacy elements within a heart failure disease management
program (written patient education material, oral communication approach) is associated with
improved self-care behavior and clinically significant improvements in heart failure symptoms. In
one study, 23 patients with heart failure and low health literacy received an education booklet
specifically designed for them as part of a disease management program. Patients were tested on
their knowledge before and after the three-month intervention. After the intervention, 100% of
patients reported weighting themselves daily compared to 32% baseline. They also scored a mean
improvement of 9.9 points on the Minnesota living with Heart Failure scale.” (Cook et al 2006)

8. Self-
Management for
Congestive
Heart Failure
Many seniors like Joanie
are daunted by a diagnosis
of congestive heart failure.
They may already employ
a home caregiver, but be
unaware of the increased
help they could be
receiving by utilizing a
home caregiver with
knowledge of health
literacy, self-management,
and advocacy. The right
caregiver will assist the
senior in learning about
CHF, understanding their
medications, and
managing their lifestyle to
prevent early progression
of the illness.
Stuart D. Katz, MD,
professor of medicine at
New York University
School of Medicine and
director of the heart
failure program at NYU
Langone Medical Center
in New York City states
“Heart failure is a
progressive disease, but
the rate of progression
varies a great deal. At least
three-quarters of patients
who practice self-care can
help themselves in very
meaningful ways.”
(Freeman 2007)
In a comprehensive guide to congestive heart failure
management, professionals at The Washington Home
Center for Palliative Care Studies offer steps for the
home caregiver to assisting a senior with CHF in self-
management. (Schuster et al 2002)
1. Keep a daily log
2. Home caregivers may ease the seniors burden by
keeping a log of the senior’s breathing (difficulties,
coughing), medications and side effects, diet and
activities, and additional symptoms.
3. Know When to Call the Doctor
4. Not only should the caregiver know when and who
to call, but the information should be made easily
accessible to the senior.
5. Be Prepared with Information the Doctor Will
Want
6. Chest Pain, Weight Gain, Swelling, Difficulty
breathing, Decreased urination, Feeling dizzy,
Nausea or vomiting, Increased fatigue, Muscle
cramps, etc.
7. Have an Action Plan
A. Don’t Panic
B. Call
C. Follow Instructions
The most important step a home caregiver can take
to help a senior with congestive heart failure is to
record weight “at the same time every day and report
significant changes.” (Harris 2014) Roseanne Harris,
MSN, RN, recommends seeking additional
knowledge from experts, specifically at the American
Heart Association or the Mayo Clinic. (Harris 2014)

9. Conclusion
Anyone can be confused by health care information. Seniors face more obstacles than other
demographics when it comes to health, and a well-informed home caregiver can make a
significant difference in the overall health and wellness of a senior.
“Healthcare is a very complex system. It is easy to get lost and be pushed around, not heard.
It’s about taking an active role in meeting [one’s] own needs.” (Harris 2014)
The home caregiver carries great responsibility when acting as an advocate for a senior, and
may, through improved health literacy and self-management techniques, aid a senior in
achieving better overall health and avoiding hospital readmissions and illness progression.

10. Resources
Resources
Cooke, Catherine, Jann Keenan, and Richard Safeer. Dec 2006. "The Impact of Health
Literacy on Cardiovascular Disease." Vascular Health Risk
Management.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994011
/Accessed June 15, 2014.
Evans, Melanie. December 2013. "Providers Help Patients Address Emotion, Money,
HealthLiteracy."ModernHealthcare.http://www.modernhealthcare.com
/article/20131207/MAGAZINE312079983 Accessed June 15, 2014.
Freeman, David. 2007. “Living with Advanced Heart Failure.” WebMD
http://www.webmd.com/heart-disease/heart-failure/features/living-
with-advanced-heart-failure?page=3 Accessed June 6, 2014.
Gynn, Mary, RN. 2013. "Health Literacy for Seniors." The Florida Nurse.
Harris, Roseanne, MSN, RN, Instructional Development Specialist UAMS. Personal
Interview. June 18, 2014.
Hines, Patricia, Kevin Yu, and Michael Randall. Mar/Apr 2010. "Preventing Heart
Failure Readmissions: Is Your Organization Prepared?" Nursing Economics
Schuster, Janice, MFA, Carol Spence MS, RN, Michelle Jacobs, MPH, Anne Wilkinson, PhD,
Casey Milne RN, BSN, Suzanne Pieklik, and Sarah Myers, MPH. 2002. “Living
with Advanced Congestive heart failure: A Guide for Family Caregivers.” The
Washington Home Center for Palliative Care Studies.