title: The role of unregulated care providers in managing heart failure patients in long-term care facilities.
abstract: OBJECTIVE
  Heart failure is a complex syndrome in which abnormal heart function results in clinical symptoms and signs of low cardiac output and/or pulmonary or systemic congestion. Heart failure is common among long-term care residents, and is associated with significant morbidity and acute care utilisation. Heart failure guidelines endorse standard therapies, yet long-term care residents are less likely to receive recommended treatments. The objective of this study is to understand the perceptions and potential role of unregulated care providers in contributing to better heart failure management among long-term care residents.
  
  
  METHODS
  Focus group interviews.
  
  
  METHODS
  This qualitative study employed focus groups to explore perceptions from 24 unregulated care providers in three Ontario, Canada long-term care homes, about barriers to the optimal management of heart failure.
  
  
  RESULTS
  Three overarching concepts emerged characterising unregulated care providers' experiences in caring for residents with heart failure in long-term care: (1) the complexity of providing heart failure care in a long-term care setting, (2) striving for resident-centred decision making and (3) unregulated care providers role enactment nested within an interprofessional team in long-term care. These concepts reflect the complex interplay between individual unregulated care providers and residents, and heart failure-related, socio-cultural and organisational factors that influence heart failure care processes in the long-term care system.
  
  
  CONCLUSIONS
  Optimising the management of heart failure in long-term care is contingent on greater engagement of unregulated care providers as active partners in the interprofessional care team. Interventions to improve heart failure management in long-term care must ensure that appropriate education is provided to all long-term care staff, including unregulated care providers, and in a manner that fosters greater and more effective interprofessional collaboration.
  
  
  CONCLUSIONS
  Active and collaborative engagement unregulated care providers has the potential to improve the management of heart failure in long-term care residents.
authors.affiliation: Schlegel - University of Waterloo -Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Heckman
authors.affiliation: Conestoga College Institute of Technology & Advanced Learning and Schlegel Villages, School for Health Sciences and Community Services, Kitchener, ON, Canada.
authors.forename: Veronique M
authors.initials: VM
authors.lastname: Boscart
authors.affiliation: Institute for Work & Health, Toronto, ON, Canada.
authors.forename: Teresa
authors.initials: T
authors.lastname: D'Elia
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.|St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
authors.forename: Carrie
authors.initials: C
authors.lastname: McAiney
authors.affiliation: School of Social Work, Lakehead University, Thunder Bay, ON, Canada.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Kelley
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Stolee
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Strachan
authors.affiliation: Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002568:Certification / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000592:standards*; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards*; D009864:Ontario; D017410:Practice Guidelines as Topic / Q000592:standards*; D024382:Professional Role; D036301:Qualitative Research; D012866:Skilled Nursing Facilities
keywords: evidence-based practice; healthcare assistants; heart disease; long-term care; nursing homes; older people