Guide To Long-Term Care For Coronary Artery Disease
ContentsEffects On Individuals With The Disease Effects On Caregivers And Families Learning More About The Disease Short-Term Care Needs Long-Term Care Needs Long-Term Care Options Selecting A Long-Term Care Provider Financial Considerations Legal Considerations Organizational Support For Coronary Artery Disease FAQs About Long-Term Care For Coronary Artery Disease
Coronary artery disease (CAD) is the most common type of heart disease in the U.S. claiming 370,000 lives a year. Although CAD often coincides with increasing age and additional health concerns, this is not a disease that only affects seniors. It is a disease impacting the lives of approximately 16.5 million Americans ranging from their twenties onwards.
CAD occurs due to a build up of a sticky, waxy substance called plaque in the coronary arteries. Over time, this buildup may restrict the oxygen supply to the heart by narrowing the arteries and reducing blood flow. If blood vessel flow is significantly reduced, this may lead to angina or a heart attack. It also weakens the heart muscle over time leading to an increased risk of heart failure.
CAD typically begins when plaque in the coronary arteries hardens, narrowing the channel for blood flow through the arteries. The plaque may also rupture causing damage to the artery. This process may be accelerated with a buildup of fat and high cholesterol in the blood vessel, which is why lifestyle changes are frequently recommended to combat CAD.
There is no cure for CAD, however it may be managed with changes to lifestyle and medication. Patients benefit from a wide range of care options available to support them and their families. The key is to identify which care provider will best suit the needs of the individual.
Effects On Individuals With The Disease
Many people do not discover they have CAD until a complication occurs such as a heart attack or angina. These complications may manifest as chest pain that lasts for a few minutes, as well as an uncomfortable squeezing or pressure on the chest. If a family member is suffering from chest pain, it is essential that it is checked by a doctor.
Following diagnosis or an incident such as a heart attack, individuals may struggle to come to terms with the cardiovascular disease. CAD is a chronic disease, and patients may initially be seeking an alternative diagnosis with less serious implications.
Another common result of CAD is heart failure where the heart is unable to pump enough oxygen-rich blood to the body to keep it functioning properly.
Symptoms of heart failure include:
- shortness of breath
- difficulty breathing and tiredness
- swelling in the ankles, feet, legs, stomach and veins in the neck
Heart failure may lead to limited mobility because shortness of breath may prevent an individual from walking longer distances or even climbing stairs without difficulty.
Dealing with the threat of a heart attack or angina may place a considerable emotional strain on a person with CAD. They may become more stressed or anxious about their health and other issues, or require increased emotional support from family.
If an individual has had a heart attack or angina, fear of a repeated attack may prevent them from returning to a previously more active and enjoyable lifestyle, even when they have permission to do so from their doctor. Depression is also more common in people with CAD so it is important to watch for changes in mood, especially after an individual is initially diagnosed with CAD.
A doctor is likely to recommend lifestyle changes such as quitting smoking, changing eating habits and engaging in regular exercise. This may present a significant barrier if an individual is only learning about the cardiovascular disease in later life. Introducing changes to diet and lifestyle at any age may be challenging so individuals may need the support of their family to implement these important changes.
Effects On Caregivers And Families
Family members have a key role to play in supporting individuals with CAD. Medical professionals may highlight the importance of lifestyle changes, but it is a the spouse/partner and family members who have the opportunity to influence an individual’s choices on a regular basis. Unfortunately, family may also feel indirectly responsible for the health of the person which may put strain on the relationship.
Individuals with CAD may depend on family members to take them to hospital appointments which may disrupt the routine of families who are managing multiple commitments, such as work, children and their own busy lives.
Alongside these concerns is the stress and worry that naturally accompanies an illness within the family. As a caregiver, taking care of one’s own wellbeing is important. Caregivers may want to consider exploring the Family Care Navigator for support and additional resources available within each state.
For a spouse/partner or family who is dependent on an individual with CAD, there are financial implications as well. An individual’s absence from work, alongside the additional costs incurred for treatment, may place significant financial burden on the spouse/partner or family. Later in this guide, we will explore the financial options available to families to help minimize this impact.
Learning More About The Disease
Family members of an individual with CAD may have many questions. However, it may be difficult to know what to ask to better understand the disease and its implications for the person who has it.
Below are some questions suggested by Cardio Smart that are worth discussing with an individual’s care provider.
- What might be causing the CAD?
- How does this condition relate to how they are feeling?
- Are there tests to show whether the condition is progressing?
- Are there certain symptoms we should watch for or report?
- What eating or exercise plans should they follow?
- Is cardiac rehabilitation available?
- Do they need to take these medications for the rest of their life? If so, is there a way they can reduce their need for these medications over time?
Having as much knowledge about CAD as possible puts an individual and their family in the best position to manage the disease going forward.
Short-Term Care Needs
In severe cases of CAD, surgery may be recommended to reduce the risk factor of a heart attack. These procedures open or replace blocked arteries, thus easing the pressure on the heart. If an individual requires surgery, they will need additional care at home as they recover.
A doctor may recommend that an individual participate in cardiac rehabilitation as part of their recovery process after a heart attack, angina, heart failure or surgical procedure on the heart. These programs are usually 12 weeks in length with the aim of supporting individuals in making the necessary lifestyle changes to manage CAD long term.
Typical activities in a cardiac rehabilitation program include exercise classes, nutrition counseling, support in quitting smoking, and opportunities to learn more about CAD.
Long-Term Care Needs
For most people with CAD, it is possible to continue living a normal life. In fact, fear of doing damage to the heart may prove more restrictive than the reality of living with the disease.
Medications may be used to manage CAD long term. The most common medications used to prevent complications from CAD include:
- Statins - For those with high cholesterol levels.
- Low dosage aspirin - Reduces the risk of blood clot, preventing angina and heart attacks.
- Beta blockers - Reduce high blood pressure and heart rate.
- Nitroglycerin patches, sprays or tablets - Used to treat angina by opening up the coronary arteries improving oxygen-rich blood flow to the heart muscle.
- Calcium channel blockers - Widen the coronary arteries which reduces chest pain by allowing blood to flow more freely to the heart muscle.
- Angiotensin-converting enzyme inhibitors (ACE inhibitors) - Lower blood pressure and slow the progression of CAD.
Monitoring The Disease
Individuals with CAD will need to make a long-term commitment to monitoring their condition. This means attending regular appointments to track their health. This is an essential part of preventing other health issues related to CAD in the future, so it is important that individuals receive the necessary support in keeping these appointments. Family can support the individual by accompanying them to appointments and/or helping with transportation to appointments.
Long-Term Care Options
Long-term support does not have to involve uprooting an individual from their home or paying for expensive 24 hour care. For some individuals, it may be as simple as having a friendly face to call on in times of need or having someone who regularly stops by to assist with care.
In terms of social connection, setting up computer access for a family member opens up a world of possibilities to combat isolation and loneliness. Online support groups for CAD may be found via the Daily Strength website, and for women, on the Women Heart support site.
If the family is concerned about an individual’s ability to manage the demands of their condition independently, it is worth exploring the options available for outside support. Since most individuals with a heart condition are capable of living independently, a service like home care may be the best option.
Home care is received in an individual’s home to help with various personal and daily needs while a person remains living independently. Examples of services that home care provides include personal care such as bathing, dressing, assistance managing medication, grocery shopping and meal preparation.
To learn more about home care and the services typically provided, please see our home care overview.
Independent living facilities allow seniors to continue to enjoy their independence, but provide access to services and amenities that make life easier, for example cooked meals or local social activities.
An assisted living facility (ALF) also offers independent homes for seniors, but with the assumption that some assistance may be required, such as medication support or other daily activities. As the family of someone suffering from CAD, it may be a relief to know that help will always be someone close by should they need assistance. This may also reduce anxiety for the person with CAD, especially if they live far from family and friends.
Perhaps the most important long-term care need for individuals with CAD is the support they need to help them make the lifestyle changes that will prevent their condition from getting worse. Making lifestyle changes as a couple or family may help make the process easy for your family member.
Selecting A Long-Term Care Provider
To find the right long-term care provider, it is necessary to identify an individual’s specific needs. Some questions to consider include:
- Does the individual have difficulty remembering to take their medication?
- Is the individual anxious when at home alone?
- Has the individual been experiencing frequent complications related to their condition or are they managing their condition well at home?
If the answer to these questions is ‘no’, an individual may be able to continue living at home independently.
If home care is required, consider what care the person needs assistance with. If it is meal preparation or help with household chores, finding a service that provides these services that may be sufficient. If it is likely that their needs may increase over time, choosing a care provider that can provide more services as the individual’s condition changes may be a better option.
If the answer to the questions above was ‘yes’, it may be time to seek a different solution for long-term care. When visiting care facilities, look at how the different facilities are designed and the services they offer to see if they will meet the individual’s needs.
For example, is transportation available for medical appointments? How far will an individual with shortness of breath have to walk to access the dining room and other common areas to interact with others? Are staff trained to manage emergencies relating to CAD? It is also advisable to visit a care facility at different times of day, for example in the morning and at mealtimes, to better understand what life might be like as a full-time resident.
Ultimately, the best fit will depend on the needs and preferences of the individual accessing care. For more assistance choosing the right care provider, please see sites like Quality Check which independently assess alternate care providers.
The cost of diagnosis and treatment of CAD may be high. Since increased stress from financial concerns may heighten the risk factor of further complications for individuals with CAD, it is important to understand the options available to manage finances.
Medicare will cover the cost of any surgical procedures related to heart conditions and may also cover costs for rehabilitation services over a fixed period. It is unlikely to cover additional assistance that is not directly medical, such as transportation to hospital appointments or continuing home care.
If there is a concern about meeting these costs, an individual may be eligible for support with Medicaid. Nearly two-thirds of all nursing home residents receive Medicaid. Medicaid may be able to cover long-term care costs such as home care or an ALF.
While Medicaid does not cover the cost of prescription medications, it may pay the premium for the Medicare Part D prescription drug plan. The U.S. Department of Veterans Affairs may also cover the cost of long-term care for veterans unable to pay for this themselves.
For funds to pay for one-off expenses such as cardiac rehabilitation, it may be appropriate to take out a short-term medical loan. This is advisable only if such services are not covered by health insurance policies, as it may be a far more costly alternative in the long run due to high interest repayments.
Perhaps the greatest financial challenge facing individuals with CAD is the event of needing to fund long-term care.
Home equity is one option that may be used to fund long-term care. This is a low interest loan, secured by the value of the home, that allows seniors to access the value of their property. This allows users the freedom to continue living independently in while using these funds to access home care services. The process is similar to a reverse mortgage where home equity value can be released to the policy holder in installments.
If an individual requires an ALF or full time care, it is possible to sell the home to fund long-term care. This may generate a large sum of money in the short term, however it may have adverse effects on how one pays for long-term care.
First of all, it may disqualify an individual for Medicaid and other financial assistance programs. Secondly, since life expectancy is unpredictable, it may be that this does not provide enough funds to pay for long-term care for the duration of a person’s life. Exploring insurance policies is therefore another worthwhile option.
Long-term care insurance policies will reimburse users a certain, pre-agreed amount daily towards the cost of assisted living services. The cost of such policies is dependent upon when the policy was taken out and the maximum daily amount users would like to withdraw. This may be a great way to plan for the future, however, it is worth noting that the types of insurance available may be limited if an individual is already accessing long-term care services.
In some cases, life Insurance policies may be converted into plans to pay for long-term care. The value of the plan (which depends on how many payments have been made prior its conversion) is entrusted to an administrator, who may use the money to pay for long-term care. Life insurance policies may be redirected to fund home care, assisted living or continuing care facilities as forms of long-term care.
Having a clear picture of the legal needs of a family member and a secure plan in place for the future may eliminate much stress further down the line. Here are some key considerations regarding the legal needs of an individual with CAD.
Preparing a living will may prevent difficult decisions being made under stress later in life. In this document, individuals state what kind of care and treatment they would like to receive should they be unable to make or express their choices due to health complications later on.
For example, these may include decisions such as would they consent to being kept alive through the use of artificial feeding fluids. Having a legal document stating what kinds of procedures should be used or withdrawn in the event of terminal illness puts the individual in control and prevents family from having to make difficult decisions on behalf of the individual.
Making provisions for a power of attorney is another step that makes transitions in later life simpler for the individual and their family. Establishing a durable financial power of attorney allows an individual to designate financial powers to another trusted individual. This allows family members to perform tasks such as cancelling bills or services no longer required by the user and to help make the best uses of finances when it comes to accessing long-term care.
Similarly, a durable power of attorney for health care allows an individual to assign decision making regarding health care to a trusted third party should they become unable to make decisions for themself. Having these conversations with family before long-term care becomes a necessity may make the process easier for everyone involved and ensures the wishes of the individual receiving the care are met.
In order to allow beneficiaries to access funds for long-term care, it may also be a good idea to set up a living trust. A living trust allows a trustee to control the assets of a property put into the trust and use these funds to pay for long-term care or other services.
Organizational Support For Coronary Artery Disease
There are a number of organizations that offer support and information to individuals with CAD and their families. Some key organizations are highlighted below that may be accessed by clicking on the name:
- CardioSmart - A site run by the American College of Cardiology. Provides up to date information on managing heart conditions.
- The American Heart Association - A non-profit dedicated to fundraising and public information about heart health. The American Heart Association has many resources on their website concerning coronary heart disease.
- Mended Hearts - A non-profit offering support to those with coronary heart disease.
- Women Heart - An informative site for women concerned about their heart health.
- Family Caregiver Alliance - A non-profit providing support for families of those with long-term care needs.
FAQs About Long-Term Care For Coronary Artery Disease
1. What increases my risk of developing coronary syndrome?
There is some genetic link to the likelihood of developing CAD, however, it is also heavily influenced by lifestyle. Smoking, a high fat diet, being overweight, and leading a sedentary lifestyle all put individuals at greater risk of CAD.
2. How can I prevent coronary artery disease?
Again, this comes down to lifestyle changes. Quitting smoking, eating a healthy, balanced diet, maintaining a healthy weight, and engaging in regular exercise will all reduce your risk of CAD. If you have already been diagnosed with CAD, you can reduce associated health risks by taking prescribed medication as instructed and taking steps to reduce stress since this aggravates CAD.
3. How can I support a family member with coronary artery disease?
Your family member will be able to tell you the type of support that they would like and could benefit most from. Let them know that you are available to support them. This could be as simple as batch cooking them some healthy dinners or offering to transport them to medical appointments.
4. What are the symptoms of a heart attack?
The warning signs to be aware of are:
- Weakness or tiredness
- Shortness of breath
- Chest pain or a feeling of pressure on the chest
- Pain in the jaw, arm or throat
If these symptoms persist for more than five minutes, call 9-1-1.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.