Assisted living

[sistasoul]

Hi all,

Has anyone worked for an assisted living as the charge nurse? This position consists of 60 some odd residents and there would be two LNAs (Med techs)administering oral meds. The LNAs are also trained to administer medications. I would be responsible for administering all injections including insulins and treatments. I would also be responsible if one of the med techs called out and I could not get coverage. And of course if anything should go wrong with one of the residents I would be responsible to assess and send to the hospital.

I am sure there is more to the position than that. I only spoke with Human resources and not anyone involved in clinical care.

[VivaLasViejas, ASN, RN]

I was the DNS for a 90-bed ALF. During my tenure, I had to supervise the med aides and resident assistants, participate in service plan meetings, write policies and procedures, field phone calls from doctors and family members even on my days off, delegate certain nursing care tasks to staff (some of whom we almost literally dragged in off the streets!) do the scheduling, get coverage for call-ins, assess residents quarterly and PRN, hire, discipline and fire staff...you name it, I did it. I even stood in for the administrator when he was out or on vacation.

This is not a job for the faint of heart. I wish you the best of luck, you are going to need it.

[sistasoul]

Hi Viva,

I will not bet be the director but be the charge nurse for the assisted living on second shift. I do not feel comfortable with have medication aides administering medications and I really do not want the responsibility of having to fill in and find coverage for staff. Too much stress and life is too short. I told them I had second thoughts on the position would be happy to discuss working PRN or per diem in another position in the facility in either their short term stay unit of their memory care. I will see what happens.

I have not been on this all-.nurses in at least a year and I remember I always enjoyed your posts. I hope you are well

[VivaLasViejas, ASN, RN]

Thank you! :) I'm glad you're re-thinking this job. It may not be quite as complicated as my job was, but life is indeed too short for the kind of stress all ALF nursing jobs entail. I personally would never work in one again.

[walkingon, CNA, LPN]

No way would I take that job. I work in a small AL memory care facility. Most often, I am charge nurse working with one QMA and 3 CNAs (day shift) for 40 people, and it's very, very difficult...so much so that I'm contemplating leaving long-term care altogether even though I love it. In my experience, second shift is usually not as well-staffed as day shift, which can be a problem if you have a lot of sundowning residents and family members (that work during the day and come to see residents in the evenings) wanting information about their loved ones. Your QMAs, even if they're awesome workers, can't do nursing tasks. The thing that sticks in my craw about your post, though, is that you'd be responsible for finding coverage for call-offs. Nope nope nope. If your facility is like mine, our admin is constantly scrambling to try to find coverage for CNA call-offs. I can't see one nurse trying to keep up with 60 residents and be on the phone trying to staff the place at the same time....God help you if anyone falls or needs to be sent out! RUN, don't walk away from this offer!!!

[amoLucia]

Pts in assisted living facilities are SUPPOSED TO BE at a higher lever of ADL functioning (and a bit more cognitively intact) than NH pts who typically need more supportive care because of their increased needs.

Note: key words here are "SUPPOSED TO BE".

Sadly, Assisted Living pts are becoming more and more in need of higher levels of care than the facility is supposed to provide. (Or really can actually provide.)

Pts are just SICKER than they were supposed to be for admission criteria. They have more chronic illnesses that require more care. Like they really should be in a NH but they (or their families) opt for AL facilities. ALs are NOT staffed like NHs because the pts are supposed to be able to take more care of themselves.

'Why' you ask? Because ALs are cheaper than NHs. This means there's money somewhere that disqualifies these pts for financial assist. So they are PRIVATE PAY. To my limited knowledge, ALs do not accept Medicare or Indigent Care.

Also facilities DO NOT GET PAID for empty beds so Admission Directors stretch & lower the admission criteria so as to admit sicker pts to fill their beds.

I am sure that there are most likely some well-run and responsibly managed ALs out there. PP VivaLasViejas and other AL nurses can tell you stories to make you want to be super duper cautious as you interview. Ask to see a job description if you can to learn the scope of your responsibilities. Will there be another experienced RN/DON higher than you or might you be the top nursing license?

Just go in being wary. Remember, if it sounds too good to be true, ... Also, be careful re monies offered.

Come back to the site if you have more questions as I'm guessing you will.

Good luck.

[amoLucia]

I realize I made a mistake re ALs admitting pts - to my knowledge they don't admit MEDICAID or indigent pts. Medicare is an insurance, like BC/BS or Aetna.

[VivaLasViejas, ASN, RN]

Actually, some ALs do admit Medicaid residents. Medicare, on the other hand, does not cover AL or any form of long-term care except for SNF patients who are receiving rehab services, and even that requires a three-day (or more) qualifying hospital stay.

[amoLucia]

Viva - can they do a direct 'caid admit? I could imagine that they might 'have to' accept 'caid if an in-house pt were to spend down to qualify for 'caid. But a direct admit?

Always learning here. TY

[VivaLasViejas, ASN, RN]

Yes. Most won't, but occasionally there is a facility that will take direct admits. My sister is one of them. I wouldn't say her place is the nicest, but it could be a lot worse. Fifteen percent of their population are Medicaid residents.

[amoLucia]

Like I said, always learning something! TY