Taking Healthcare by Storm: Industry Insights with Erin Woodford

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Erin Woodford, MSN, RN,  a member of the Skilled Nursing Facility Heart Failure Certification oversight work group with the American Heart Association and  Vice President of Population Health for Genesis Healthcare.

Erin discusses the American Heart Association’s Skilled Nursing Facility Heart Failure Certification, which improves care quality, reduces hospital readmissions, and supports better outcomes for residents. She highlights the importance of early detection, staff training, standardized protocols, and family education in managing heart failure within long-term care. 

Learn more about American Heart Association Certified Care™.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-082925-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

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 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today we are going to be talking about a critical topic. So very important, affecting millions of older adults, especially older adults who are living in long-term care facilities.

We are gonna be talking about congestive heart failure. We are joined by a member of the skilled nursing facility, heart failure certification oversight work group. The American Heart Association, Erin Woodford, MSN rn. She's also the President of Population Health for Genesis Healthcare. This specialized certification caught my attention as it is so very important because so many, residents, older adults in long-term care facilities do carry a diagnosis of congestive heart failure.

And we know that congestive heart failure is one of the leading diagnoses that is going to put these residents in the hospital, and what many people may not know is that the more that a older adult. A resident of a long-term care facility is in the hospital. The more times that an individual goes into the hospital, the lower their quality of life and the lower, shorter their lifespan is.

So we wanna do everything in our power to make sure that we are taking good care of these individuals with a heart failure diagnosis. In the facility. That means recognizing signs and symptoms early so we can treat in the long-term care facility and avoid a hospital admission because that keeps people alive longer.

This specialized certification where facilities receive specialized training in order to treat heart failure effectively in the facility is raising the standard of care. It's reducing hospital admissions and it's bringing peace of mind to patients and families because they know that the facility has.

Specialized training in treating, recognizing symptoms of heart failure. So whether you're a healthcare provider, an administrator, or an advocate, this conversation is going to offer valuable insights into how evidence-based care is transforming long-term care for heart failure patients. Erin, thank you very much for joining us today on this important topic.

Thank you Dr. Storm. I'm so happy to be here to discuss this very important topic as you just outlined. Thank you so much. Wonderful. To start, can you explain what the Skilled Facility Heart Failure Certification is and why the American Heart Association created it?

Sure. Let's, start with the second piece, why we created this certification. So the American Heart Association has a. Obviously a long history of recognizing hospital systems for the quality of care, so We identified the need for next level care in the non-hospital setting with a focus on systems of care, right?

We began our journey to improve care and outcomes at all levels within the non-hospital space. In 2019, we launched the first post-acute certification program, and that was the Skilled Nursing Facility Heart Failure certification. The certification provides a framework for evaluating skilled nursing facilities against American Heart Association evidence-based guidelines, as you just referenced, our programs are designed to standardize coordination.

Adherence and implementation of those evidence-based care standards by validating that the facility has followed our certification requirements. You know, our mission is for patients and their families to feel competent in choosing the American Heart Association certified facility. So that's why the American Heart Association's check mark has served as an important emblem of excellence amongst consumers for decades.

So now the heart check serves as the standard for those seeking the best of heart failure care.  And I think that's really why we created it. That's a little bit of what the program is and it is crucial  to continue to provide this care at a high level across all care settings. I agree, and I don't think maybe many individuals understand how much care really can be given in a long-term care facility.

And, I try to tell people it's really essential that we start care. Like even if a resident needs to maybe eventually go out to the hospital, we need to start care in the facility because it's like absolutely quick. Like we have to get care started. Yeah, absolutely. And, and I think that's one of the, the misconceptions about skilled nursing is the clinical capabilities within our walls, right?

  We do start that care and often we manage complex cardiac care and heart failure within our walls. Without that transfer to acute care as you, emphasized earlier, that transfer to acute care. 'cause sometimes have, very negative consequences for our patients.  So it's getting the appropriate care in the right setting at the right time that we are really focused on.

Yes. So how prevalent is heart failure among residents in long-term care facilities? And what unique challenges does this population face because they're in these facilities?  I don't think. Anybody would be really surprised to learn that heart failure is quite prevalent amongst residents and skilled nursing facilities.

Approximately a quarter of our patients with heart failure are discharged to s NFS and cardiovascular disease, including heart failure is the largest diagnostic category among the estimated 1.5 to 2 million residents in skilled nursing facilities in the United States. Really  those numbers are staggering.

Residents with heart failure in our walls in a skilled nursing facility face several challenges, and first off, let me say management of the heart failure patient is very complex and it is the number one cause of readmissions to the hospital. Many residents have multiple comorbid conditions which complicate heart failure management.

There's often a lack of standardized protocols leading to inconsistent care in addition to competing health concerns. Heart failure care may not be prioritized above other health issues, especially in patients with a decreased mental capacity. These challenges highlight the need for improved protocols, education and support for staff in skilled nursing facilities to better manage heart failure and improve the patient outcomes associated.

So heart failure is, as I just spoke to. One of the biggest concerns for a patient in a skilled nursing facility, and with that is the biggest concern of clinical and operational staff in our walls, in skilled nursing facility walls, to effectively manage these patients. It's really exciting to think about, we're kind of, starting that acute, even doing what the hospital would be doing in the skilled nursing facility.

Yeah, absolutely. Yeah. So what are some of the common symptoms or warning signs of heart failure that staff in skilled nursing facilities need to watch for? There's several common symptoms that staff should be trained to watch for in skilled nursing facilities. Shortness of breath  fatigue and weakness, swelling irregular heartbeats, persistent cough or wheezing.

 Increased need to urinate, sudden and weight gain, decreased appetite and nausea, confusion, impaired thinking.  Obviously chest pain. There are just a few. Honestly, early detection and prompt management of those symptoms and detection of them is crucial for improving the outcomes and quality of life for our patients with heart failure.

Yeah, I don't think people realize it's so important to, to, for that early detection  to really get on top. Things before. Yeah.  And there's early detection tools that are evidence-based that a lot of facilities utilize. And, you know, utilizing an early detection tool is, often necessary in order to effectively identify those changes and manage them effectively.

For sure. So what are the main requirements a skilled nursing facility must meet to earn this certification from the American Heart Association? There's six standards and each standard has  requirements as approved by the American Heart Association and organizations pursuing certification must have a disease specific program in place that follow those six requirements.

 I'll just quickly go through those six requirements. The first one is program management, and that would include  oversight of the program with an interprofessional committee and a program champion.  Then we have personnel education, and that would include staff education, both onboarding and ongoing annual education That has to meet a minimum of a one hour disease specific requirement.

Patient caregiver education and support. So this is the patient and caregiver education component of the certification, and that  represents individual education and support that we provide to the caregiver or the patient and or the patient.  And then care coordination. And  that standard  those facilities must demonstrate coordination for the patient population across the care continuum, which we have discussed earlier, how important those care transitions are.

 And that is through the pre-admission, throughout admission to the skilled nursing facility, and then at discharge from us. And then the clinical management is the utilization of those evidence-based guidelines as we talked to earlier. And then  one of the. I would consider one of the most important areas is the performance improvement piece.

So the ongoing quality improvement must be present and adherence to the evidence-based guidelines aimed at improving the care and the outcome specific to disease. You know, it's that ongoing improvement where we're gonna learn the most in a skilled nursing facility. So, that performance improvement piece is a very important part of the program.

Yes. So those are the six standards, you know  in a very condensed format, but that's what they represent. I was gonna say, quality improvement should be like the main product. Yeah. Yeah. Absolutely.   I always, you know, the evidence-based guidelines, the quality improvement, I believe really do believe Dr.

Storm is where we, learn and where we grow from, right? Where the next level of care is identified.  That next level, I mean, that future innovative care is identified through the QAPI process. Yes. I'm a huge fan. I'm a QAPI fan, so me too. Yeah. So you talked a little bit about patient and families, which I love that is included, you know, in the education.

So how does this certification benefit patients and families in terms of care, quality, safety, and outcomes? Yeah  that's a great question.  It really assures the patient and families that the skilled nursing facility. Offer services that are backed by the American Heart Association Science.

It actually provides confidence that the facility is recognized by the American Heart Association based on professional evaluation criteria developed by heart failure. And skilled nursing experts. And additionally, it ensures that the heart failure care is coordinated from pre-admission through discharge, working seamlessly with the skilled nursing facility, and that directly will impact their care or the care of their loved ones.

 Almost all certified care organizations report it sustained improvements in patient outcomes since receiving certification, and a majority of the organizations. Reported an increase in patients returning to the community. So we are actually helping our patients with heart failure get to home or their next level of care, lower level of care  which is exciting stuff.

That is exciting stuff because typically people just think about, oh, like they're just keeping  the residents in the facility. But really, you know, thinking about it as a rehab  opportunity  is really wonderful. I improving quality of life  and potentially getting individuals home. That's fantastic.

Absolutely. Yeah. Absolutely.  And teaching them the tools in a certified organ, certified skilled nursing facility is crucial to them staying at home too. So,  That's how it would impact the patients and families. They're getting the tools and the training by that certified facility in order for them to go home and stay at home.

So that's why we're here, you know, that's why we're here today.  For those kind of outcomes. So from an operational standpoint, how does this certification help skilled nursing facilities themselves? Whether in terms of readmission rates, staff training, partnerships, maybe, you know, changing culture in the facility.

Oh, absolutely. So certification offers obviously several operational benefits for skilled nursing facilities. It obviously can lead to lower hospital readmission rates if we manage heart failure effectively. The comprehensive education and training for staff ensures that the skilled nursing facility is well equipped to provide high quality care, and honestly, that can improve staff competency or does improve staff competency and competence.

 It also can help with retention of staff. At the skilled nursing facility  being certified can enhance a facility's reputation, making it attractive as a partner for hospitals, healthcare providers, and insurers, which can lead to better collaboration and referral networks. And then certification also signals to patients that families that their facility meets rigorous standards, which can increase trust and satisfaction to the patients and families.

It's the great benefits, not only yeah, getting the certification, but it kind of extends beyond, just certification.   And it's important clinical certification, but it also helps operationally in so many ways. And that confidence in our community and the confidence that our health partners have in a certified facility is honestly immeasurable in value.

  That's something that we, can't even measure the value, but when, we have that seamless care transitions it is, has many operational benefits. Yeah. So how does the certification process encourage or require coordination between hospitals and skilled nursing facilities during transitions of care?

The certification process encourages and often requires coordination between hospitals and skilled nursing facilities during transitions of care through.

Several key mechanisms. The first one is standardized protocols. Then we have comprehensive assessments, med reconciliation dynamic care plans that address patient need across all those care settings.  Effective communication is. Where essential information about the patient's condition, treatment plans, and care preferences must be communicated clearly and promptly between the hospital and skilled nursing facility, and then that training and education for staff.

That includes best practices for transitions of care, enhancing their ability to manage these processes effectively. Effectively, these elements help ensure that transitions are smooth, safe, patient-centered, and ultimately improving outcomes and reducing readmission rates. I will just say all transitions of care should be smooth and safe.

Yes.  That should be the gold standard. So I love that the certification really focuses on that because it is just so many things fall through the cracks during transition care. Yeah, absolutely. And often care transitions, like you just said, things fall through the cracks and it's, one of those things that, if you don't have a solid process around, you are not gonna hold yourself to it, right? If you're not, we talked about quality improvement earlier, and if you're not looking at your care transitions process through a quality improvement lens like the American Heart Association Certification Program leads you to do, then you're often missing some things in regards to that care transitions, right?

We, often will have some quality improvement items associated with care transitions. Yes. So last question. What do you see as the future of the Heart Failure certification program? Are there plans to expand, adapt, or deepen its impact? Yeah, great question. One of the key foundations of the American Heart Association and more specifically our certification division, is quality improvement.

And we talked a lot about quality improvement today. Not only do we hold our certified organizations to it, but we also hold ourselves to it as science changes. We are at the forefront of updating our standards beings that we, the Heart Association, are the ones that write the standards that gives us real time direction to stay current.

In addition, we closely monitor CMS requirements and industry trends that impact our programs, and we recently just went through a review of our standards and we have version three officially coming out January 1st in 2026. Our programs are ever evolving, which is important to have the very best outcomes for our patients.

That's great and I look forward to the expansion because I am a huge fan of long-term care. So I would love to see more innovation like this, but this is just fantastic. Now, if people wanna learn more about this certification I'm assuming they can go to the American Heart Association site and search for certification for a long-term care facility.

Heart failure certification. Absolutely. They could go to heart.org/certification certified care, sorry. And reaching out to a member of our certification team is also an option, and that's certification@heart.org. Email. Wonderful. Erin Woodford, thank you so very much for being with us today and sharing with us this important certification from the American Heart Association.

Thank you for having me, Dr. Storm. I look forward to working with you in the future, and we look to 2025 and 2026 to get more certified skilled nursing facilities. Yes.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

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