Thirty residents? I'm sorry, but that would be HEAVEN.......I'm the lone RN for a building that currently houses almost 90. Of course, there are medication aides and resident assistants who do most of the care, and we use home-health agencies for all wound care and therapies. I'm a DNS rather than a floor nurse though, so that may account for the difference.......Either way, we both have a lot to do!
And yes, I think ALF's have become "Nursing Home Lite"---I've got sliding-scale insulin-dependent diabetics, dementia, complex medical, even some who are turn-Q-2hr. and dependent for all their ADLs. Just about the only residents we don't
accept are wanderers, tube feeders, and people who need mechanical lifts or thickened liquids. Everything else is up for negotiation, although I occasionally do say "No #$%&!! way!" to some of the prospects that land on my desk courtesy of the marketing director.
I did work (briefly!) for one company where the sales rep---the SALES REP, for God's sake!!!---made all the admissions decisions without nursing input. I promptly resigned when she moved in a 250-lb. Parkinsons patient who was so rigid he required three staff AND a Hoyer lift to transfer him. She'd just move these folks in and say "Here, YOU figure out how to take care of them." This man also choked continuously on his own saliva, and aspirated twice during the 10 days he spent in the facility before he was finally sent to the hospital and then moved to an ICF where he belonged.
So if you're not working for a company like that, be very thankful! The one I work for now is pretty sensible, although they occasionally try to sneak a prospective resident past me who I know isn't suitable for assisted living. I'm pretty flexible, but I balk when I'm presented with something I know is going to progress fairly rapidly and require moving to a higher level of care within a few months, and if they are already having behavioral issues or swallowing problems, I prefer to pass.