Frustration with "Assisted Living"

Specialties Geriatric

Published

Specializes in ER, Cardiac, Hospice, Hyperbaric, Float.

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.

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Please see my post "Fired from Assisted Living!"...I was fired from this facility 1 week ago today. The staff they hire off the streets are given a crash course in med passing, they have no idea what they are giving. I had to call for orders to treat bed sores and fecal impactions...and got in trouble for it as this is an assisted living, not LTC! And God forbid if you send someone to the hospital for fear the doctor may decide the patient needs to be in a LTC facility! If you see all the responses I got, you'll see assisted living isn't what is cracked up to be! I am lucky in the long run I am out of there before I lost my RN license! Thanks!

jerenemarie

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Specializes in med surg,.

Ok first a cma certified medication aide usually is a cna 6 weeks training with a 6 weeks cma training not one week as you stated. Just like nurses there are good and bad ones. They give the same medicines to the same pts for months at a time. A nurse takes all new orders and transcribes them to the mar and is a reference for any questions the cma may have. I have worked in a nursing home(as a lvn) with cma that were dedicated and trustworthy. They have a very hard job that even after working in a hospital as a RN I not sure if I could pass that many meds to that many patients. If you see neglect or abuse then let someone know and if it doesnt resolve with in the facility then go above that. Alot of times it is very understaffed and they are doing what they can so maybe that is the issue at hand. Coming from that environment gives you a different perspective. When there was a problem I did the best I could for as many as I could.

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Specializes in med surg,.

jena marie sounds like a train wreck just be glad to get out of there!!!

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Specializes in LTC.

To the Op I agree with you 100 percent. You basiciakky described the alf I work at. One good thing is that my facility no longer use med techs only nurses. To be honest there were more med errors from nurses than med techs. Scrary I know...

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I am a CNA who has worked in assisted living and skilled nursing as well. I think that you are right when you talk about the care in assisted living. I worked at one place (not long) where the residents were paying about 3600 dollars a month and for what. Some of these residents should have had home health care or had skilled nursing services. I also passed medications for these residents and did not have the proper training (IMO) to be giving these out. It is sad to me about what companies will do to make a few bucks. The really sad thing was I was making 8.50 an hour to do all of this.

To the PP talking about the CMA that would be a great idea but I did not even have a CNA at the time. I had about two weeks training total before I started working at the assisted living place.

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Find out what the regs are in your state. In our state, they've changed a lot of regs for Assisted Living.

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Specializes in Dir of Nursing SNF/rehab.

Many states have adopted regulations regarding Assisted Living Facilities. These facilities will become as regulated as nursing homes in the near future, subject to both state and federal mandates. This is probably a good thing. And do follow the advice of previous poster---check out the regulations in your state. There are laws about Elder care abuse and neglect in every state, even if the ALF is poorly regulated. And be careful---as an RN, you are a "mandated reporter".

I would suggest that you do what I did. I was not happy with the way most nursing homes are run, so I decided I would try to do something about it. As Director of Nursing you have the power to change the things you don't like---both by influencing administration, and direct care staff. The attitudes and dedication to patients from the staff comes from their leadership. It is not easy, but it is rewarding work.

Try it---you might like it!

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Specializes in geriatrics, school nurse.
:nurse: I am shocked to hear all the similarities to the ALF that I work at, we are using med aides that are not even certified CNAs let alone state certified to be med aides. Evidently, there is a loophole somewhere in the regs that lets the facility call what they do "assist" with meds. They pop meds out of bubble packs, sign the MAR, bring the meds to the resident and give them to them to take. I call that medication administration, just by signing the MAR ( the medication ADMINISTRATION record) they are admitting that they administered the meds!!! There have been med errors made by med aids, but then, the nurses also make errors. The big difference is that nurses use the nursing process and critical thinking when we do our jobs, including while passing meds. The med aides are not able to use these skills. The med aids receive a short training, mostly orienting on the floor and passing meds. I took a semester long pharmacology class. I look meds up in the drug book when I am not familiar with a med, or want to know what the adverse effects are, I have suggested to the med aids to use that book, but they dont. I would like to hear from other nurses in ALF and how the facilities they work at use med aids.
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Specializes in ICU, CM, Geriatrics, Management.

Would like to note that all AL facilities are not alike. The places describe above sound horrible.

OTOH, I'm familiar with several AL communities that are absolutely fabulous... with respect to resident care... and as employers.

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Ok first a cma certified medication aide usually is a cna 6 weeks training with a 6 weeks cma training not one week as you stated. Just like nurses there are good and bad ones. They give the same medicines to the same pts for months at a time. A nurse takes all new orders and transcribes them to the mar and is a reference for any questions the cma may have. I have worked in a nursing home(as a lvn) with cma that were dedicated and trustworthy. They have a very hard job that even after working in a hospital as a RN I not sure if I could pass that many meds to that many patients. If you see neglect or abuse then let someone know and if it doesnt resolve with in the facility then go above that. Alot of times it is very understaffed and they are doing what they can so maybe that is the issue at hand. Coming from that environment gives you a different perspective. When there was a problem I did the best I could for as many as I could.

I am a Memory Care Supervisor in an ALF in Florida, and these medication aides are not required to be a CNA, they are only resident aides, meaning they have no training, they are individuals that they pick up off the streets to do patient care,and pass meds, i really dont even think they have high school diploma's because they cannot read, and they have no knowledge of vital signs. They are passing Cardiac meds with no-preassessment.The medication aide certification is a 4hr class, and that's it. Now, isnt that a joke or what. The aides, were signing out for meds and not even giving them. I have had several patients missing numerous doses of their ABT, and it was signed out on the MOR(medication observation record), since we cannot call it MAR because they do not administer. I even had one med that should be given weekly and they were signing out that they were giving it daily for 10days. Thank God, when i checked the blister pack it had, week 1, week 2, week 3, and week 4, and there was only one that was missing, but still, if they were reading it they would see the weekly underlined and wouldnt have signed it out. I think all they do is go down the line and say for example, if it's a 12n med pass, they just go down the line and sign out all the 12 noons, regardless of whether it says, daily, weekly, monthly, every other day. I usually block it out, but i guess after spending hours discontinuing meds that seem to have reappeared on the MOR, i missed that one. I just started this job 6weeks ago, and there were orders that were d/c'd prior to me starting that seemed to have reappeared on the MOR. I just think that the nurse prior to me, recieved orders to D/C meds, made the change on the MOR, and didnt fax the orders to the pharmacy so they can update their system, that way they dont reappear, when they send the MOR for the next month. I have given my notice because i cannot be held responsible for aides, who just dont have a clue. I had to work too hard to obtain my license.

I have written up the aides that made the med errors with not giving the ABT and signing off for it (also notified doctor on this one). I also wrote up the aides that were signing off daily for 10days on the med that was supposed to be signed off weekly, Thank God the blister pack only had 4pills with week 1 - week 4 written below each pill on the packet, and only 1 was missing. I recommended to my Administrator and my D.O.N that these aides need to be retrained, and also documented that on my employee counselling form.

Please give advice on what else i might need to do to cover myself....... Another question is ultimately who is responsible/liable for med errors that are made by these aides?

Thank you.

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Specializes in Gerontology, Med surg, Home Health.

The regulations will change when consumers make them change. As long as people are willing to pay huge $$$$ to live in Assisted Living and have someone with a few hours of class overseeing the meds, things will stay the same. The LTC industry wasn't so great when it started. I was an aide before there was certification. Walked in at 4, had orientation (ha!) and was feeding patients with swallowing difficulties by 8 that same night. Assisted Living is a wonderful option for people who can't/don't want to live alone. There are excellent ones and crummy ones...same as in any business.

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