Frustration with "Assisted Living"

[Leda1st]

I have just started a nursing job where I visit patients who live in a long term care facility that provides skilled nursing in one area and assisted living in another area. (By the way, the folks living in this facility have - or had - LOTS of cash - this is one of the "higher end" facilities in town, and supposedly one of the "better" ones.) I came from the hospital, so this is all new to me. My frustration is with assisted living - well, with the facility overall, actually. So, I'm just going to vent about a few things I have observed:

(1) There are "med techs" (basically a nursing assistant - not even a CNA - with a week or so of extra "training") giving medications, not a nurse. I was a nursing assistant, then an LPN, now an RN, and I can tell you that as a nursing assistant, I did NOT have the knowledge and judgement that I had as an LPN! The rationale is that it is "assisted living", and therefore the person giving meds is essentially not much different than a family member giving medications. Fine. Okay. The thing is, I have quickly learned that the whole concept of "PRN" is pretty useless in assisted living.

(2) My understanding is that, somehow, our lovely state allows people like the marketers, the accountants, the secretaries, the payroll and HR people, etc. who are in an "administrative" part of the facility (although technically still in the building) can be "counted" as caregivers regarding the caregiver to patient/resident ratio!! Are you freakin' KIDDING me??? And yes, I am serious. The evil part of me is tempted to go out of my way to approach one of these folks in their nice outfits and ask them to help me change a patient who has just had a BM. (Yes, I am an RN, and I STILL CLEAN UP INCONTINENT PATIENTS! It is STILL part of my job - I didn't "graduate" from basic care when I graduated from nursing school.)

(3) A lot of these patients in "assisted living" don't receive the care they need. I provide a "supplemental service" to what the facility provides (and I work with CNA's that do the same thing), and it breaks my heart to see patients flat out neglected, left in incontinence briefs until they are literally dripping wet, wearing the same clothes for an entire week, etc. Most of the "caregivers" seem to do a lot more sitting around than actually providing care. I have gone to "higher ups" about this (and told family members of patients/residents to do the same), and I (we) might as well go into an empty closet and talk to myself (ourselves).

(4) On that same note, the facility seems VERY reluctant to transfer folks into skilled nursing from assisted living. This seems to be ESPECIALLY difficult when the folks in question are running low on funds. I realize that the place is a business and has to make some money in order to do things like run the facility and pay my salary (which is average, not extravagant, trust me). HOWEVER, I have heard some comments from the "marketing" type folks that have just made my stomach turn. I would think that a "nicer" place that charges upwards of $3500/month (not including things like incontinence supplies) for a semi-private room in "assisted living" would actually provide decent "assistance."

Anyway, the whole thing just makes me very, very sad. There ARE some CNA's and nurses who are excellent and really care about the residents, and I think (hope) I am one of them. It just upsets me to see that on an administrative level, this seems to be about making a profit, providing the least amount/quality of care that can be legally "gotten away with", and not about caring for elderly people.

Thanks for listening. I am planning to try to hang in there - I get as much as I give to these folks (the residents/patients), and being able to provide the little bit of "TLC" that I can makes me feel like I am doing what I was put on this earth to do. Any words of encouragement from long-term LTC nurses would be greatly appreciated.

[pinkyken]

I to work for assisted living. Boy do I heard you. Your right about all of it. I'm a LPN and just try and tell medtechs about why you sure not give prn for certain reasons man do they look at you like what are you crazy. They know a whole lot more then I do. I've had my share of problems just trying to explain the why..

[favthing, APRN]

I work as a nurse in Assisted Living. The owner is a RN who hires only nurses to administer meds (even though the state of MI allows for med techs).

Assisted Living facilities are highly individual as to the quality of care they provide. Where I work, our owner/COO maintains high standards, and most of our "RCAs" are certified nurse aides. The AL where I work has a great reputation.

The challenge I have is since I am a nurse passing meds, I function in the traditional AL "med tech" role, PLUS round with the weekly physician, take care of pharmacy/labs, attend to emergencies, deal with family concerns, set up appointments, document, interact with outside providers (psych/dental/home care nurse, hospice)...we do have a Wellness Director, but she is in a more management role, and I guess she does paperwork and monthly vitals, etc. Anyway, I love my job because I love the residents and the independence of being their advocate because I DO have the role of setting up so many factors in their care.

I definitely, without a doubt, believe nurses and only nurses should be administering meds. I do much more than pass a med...I'm checking legs, checking respirations, looking at color, assessing mental status and general well-being, checking care provided, not to even mention I know what meds I'm giving and what to look for, when to hold, etc. I get to know my residents when doing the med pass, and my assessment is done almost naturally after having been doing this about a year and getting to know the uniquenesses of the residents.

[Havin' A Party!, ASN, RN]

... I have given my notice...

Very smart move.

Good luck!

[mee9mee9]

what happens to the employees jobs at assisted living facility if the facility license is expired and the state finds out?

[Havin' A Party!, ASN, RN]

Hey, Mee.

Usually, a facility whose license expires out of an inadvertent oversight by management will be given an opportunity to remedy its documentation... and it will be allowed to remain in operation... though there may be a fine and potentially other conditional requirement(s) imposed.

In that case, employees and residents will not be affected.

In the rare instance when the State totally shuts down an ALF, staff will continue to be needed until all the residents have been placed in appropriate settings.