Severe aortic stenosis does not mean that transcatheter aortic valve implantation has already been recommended. TAVI is one possible intervention considered through a specialist heart-valve assessment that weighs anatomy, symptoms, frailty, other conditions, goals and alternatives. A long-term care home should support the person safely while that decision is made or after a different decision, without presenting itself as the team that determines candidacy.
Ask the cardiology or valve clinic for a current summary: severity, usual symptoms, activity and transfer advice, medicines, investigations, pending appointments and individualized urgent signs. The guide to after-hours hospital decisions in long-term care can structure escalation questions, but only the treating team should set this resident’s thresholds.
Document the baseline the home can recognize
Record usual walking distance, transfer assistance, breathlessness, chest symptoms, dizziness or fainting, swelling, fatigue and recovery time after activity. Note how cognition and communication affect symptom reporting. Staff need enough detail to recognize a meaningful change rather than treating “tired” or “short of breath” as a fixed feature of age.
Ask how observations will be handed over between personal support workers, nurses and the on-call clinician. A daily weight, blood pressure or other measure should be used only when ordered with an interpretation plan. Collecting numbers without knowing who reviews them can delay rather than improve care.
Translate cardiac advice into safe daily assistance
Obtain explicit guidance for transfers, bathing, walking, therapy and rest. Do not create a universal activity restriction from the diagnosis. Ask whether the person needs pacing, a wheelchair for longer distances, supervision after symptoms or an adapted shower routine. The goal is to carry out the heart team’s advice while preserving as much independence as is safe.
Test the plan under realistic conditions: getting to breakfast, standing from a low chair, walking to the toilet at night and attending an off-site appointment. Ask what staff do if symptoms begin halfway through a transfer. The home’s answer should name immediate actions, assessment and escalation, not merely “we monitor closely.”
Keep the heart-team decision separate from admission
Confirm where the valve assessment stands: referral sent, investigations pending, consultation booked, further discussion needed or a different plan chosen. A facility’s willingness to admit does not establish procedure eligibility, and a TAVI referral does not guarantee that the procedure will occur. Avoid scheduling a move around a presumed intervention date.
Ask who receives clinic correspondence and who communicates changes to the resident and substitute decision-maker. Record goals and questions for the appointment, including expected benefit, burdens, alternatives and what care looks like without intervention. The resident’s values belong in the heart-team discussion even when family manages logistics.
Plan transport, escorts and procedure-day handover
Valve assessment can involve imaging, tests and several visits. Clarify who books accessible transport, who escorts, who can provide history and who pays. The guide to specialist transport and escort responsibilities helps prevent the common discovery that the home cannot send a staff member on the appointed day.
If a procedure is offered, request the hospital’s individualized instructions for medicines, fasting, arrival, consent, discharge and follow-up. The home should confirm that it can implement the post-procedure plan before discharge occurs. Do not stop or alter antithrombotic, blood-pressure or other medicines based on generic preparation advice.
Rehearse deterioration and emergency communication
Ask the cardiology team to define which changes need an urgent call or emergency response. Then run a scenario with the home: the resident faints during morning care or develops new severe symptoms overnight. Who stays with the person, who calls emergency services, which documents travel, and who alerts family and the valve team?
Keep the latest medication list, goals-of-care documentation, decision-maker details and clinic contact readily available. Emergency planning should reflect the resident’s informed choices without turning a preference to avoid burdensome treatment into a blanket instruction to ignore treatable symptoms.
Compare homes on coordination, not cardiac branding
Few homes need a special marketing label to support a resident awaiting valve assessment. What matters is reliable symptom recognition, transfers, medication administration, access to clinicians, appointment logistics and prompt handover after hospital. Ask the nursing lead to review the case and state any limit in writing.
Use the Canadian long-term care home directory to compare distance and services, then confirm current acceptance directly. A home near a cardiac centre may still lack escort capacity, while a farther home may coordinate well. Map the whole pathway rather than choosing on postcode alone.
Discuss goals of care before a crisis, while keeping them distinct from the heart team’s procedural recommendation. Ask what outcomes the resident values, which burdens they would accept and who speaks if capacity is lost. Document existing advance-care planning and confirm its provincial use. Staff still need to assess new symptoms and offer appropriate treatment; a decision not to pursue TAVI, if that is eventually made, is not a decision to withhold all cardiac, comfort or emergency care.
Finally, reconcile medicines at admission and after every valve-clinic or hospital visit. Ask the prescriber to resolve conflicting lists and provide instructions for any planned procedure. Families should never stop anticoagulants, antiplatelets, diuretics or blood-pressure medicines from a general TAVI leaflet. Confirm who can obtain urgent clarification when the next dose is due before the clinic opens.
Does severe aortic stenosis mean TAVI is indicated?
No. Severity is only part of the decision. A specialist heart team assesses symptoms, anatomy, overall health, goals, expected benefit and alternatives. Neither a family nor a long-term care home should present the procedure as decided before that assessment.
Should staff restrict all activity while assessment is pending?
Not by default. The treating clinicians should give individualized guidance based on symptoms and function. Staff should follow that plan, observe response and report change rather than inventing universal exercise, blood-pressure or fluid rules.
Can the resident return to the same home after TAVI?
Possibly, but it must be confirmed for the actual post-procedure needs. The hospital and home should exchange the discharge plan, medicines, mobility status, wound instructions and follow-up before transfer. A pre-procedure bed does not prove post-procedure capability.
This guide supports care coordination. The heart-valve team, treating clinicians, resident or decision-maker, transport services and receiving home must confirm candidacy, daily guidance, procedure planning and emergency response.