Has Anyone Here Worked in Assisted Living?

[westieluv]

I am currently an RN at a large dialysis company. I also have experience in Med/Surg, Cardiac Stepdown, Hospice, and LTC.

Last week I was feeling frustrated with my job and some of my company's policies, so on a whim I applied at a very nice, upscale, local facility to work in their assisted living quarters. I had kind of forgotten about it, but this morning I found an email in my inbox and they want to "move forward in the employment process" and want me to take a talent assessment test. I admit, I am a bit intrigued.

My questions are, what is it like to work in assisted living? I have worked LTC and, while I loved the residents, I found the work to often be grueling and difficult, as I'm sure most of you can relate to at least somewhat. Is working in assisted living much like working in regular LTC? Are there endless med passes? Having never worked in Assisted Living, it seems to me like it must either be relatively easy, since the residents are still fairly independent, or just like LTC.

Any information, shared experiences, or clarification would be very much appreciated!

[VivaLasViejas, ASN, RN]

Yes, I worked in assisted living for about six years off and on. And I can tell you that many residents are nursing-home candidates---dementia, wandering, confused, combative, 2-person or Hoyer lift assist. Some are even total care. ALF is pretty much what LTC was about 15-20 years ago; most were still somewhat mobile, and a few were completely A & O. Nowadays, the independent ones are living in ILs; most ALF residents require help with medication, bathing and incontinence care.

Some states require that licensed nurses pass meds and do all 'skilled' care, while others put the nurse in an administrative role and require her/him to delegate most nursing tasks to trained caregivers. These caregivers do not have to be certified. A lot of time is spent training them to pass meds and administer SQ injections, including insulin, and monitoring them to assure that these tasks are being done correctly. I've had to delegate people to do tracheostomy care, give Lovenox, even give insulin per sliding scale. And the reason for this is to maximize profits for the management company while paying these caregivers slightly above minimum wage, and to allow these increasingly complex residents to "age in place". Which is a noble concept, except when you don't have the skilled staff to care for them properly.

I won't lie to you. ALF nursing is a minefield, and of course, if you have a bad survey you're apt to wind up jobless. I loved it because I was never bored, but there are so many drawbacks---and risks to your license---that I hesitate to recommend it. It is a 24/7/365 responsibility; you literally have to be available to your staff all of the time to answer questions, to tell them what to do in case of an emergency, even to fill in as a med aide or caregiver when somebody calls in. Fifty-to-sixty-hour weeks are not unusual, and sometimes you have to come in for NOC shift after you've been at the office for your eight-hour day.

And, if you're REALLY lucky, you have to participate in the facility's marketing program, which often involves going out into the public arena with the administrator and the sales/marketing director to entice people into coming to live at your building. This takes time away from your nursing assessments and staff oversight, and is generally a PITA but it's part of your duties as a manager. Plus there are endless service-planning meetings, re-delegations, record-keeping, documentation, coordination of care with outside agencies such as home health, auditing medication records, and participating in facility activities. Sometimes, you even wind up serving lunch with a napkin over your arm (at which point I asked myself if I really went to nursing school for this).

As I said, the rules and regulations differ by state, as do nursing responsibilities; but even so, it's quite a culture shock moving away from the medical model to the community-based model. I'm not saying "don't do it", but you want to go into this with your eyes wide open. Hope this information is helpful to you.

[westieluv]

Wow, thanks! Your post is very helpful and informative!

I also posted this in the General Nursing forum and got a couple of responses similar to yours, so at this point, I think I will pass. I had a feeling it couldn't be as easy as overseeing a bunch of well functioning elderly residents who just need help once in a while. The way things are going in healthcare today, what with everyone wanting to squeeze every ounce of work out of every nurse for the least amount of money, this does not surprise me. Also, because there are so many elderly people who feel like they belong in assisted living when they really need 24/7 supervised care and extensive medical interventions on a daily basis and companies are happy to accommodate their wishes for the Almighty Dollar and then it falls back on the woefully inadequate staff to try to compensate.

I am currently transitioning from chronic dialysis in an outpatient clinic to acute dialysis in a hospital setting. While there is a certain amount of responsibility that comes with performing dialysis on a patient, I will only be running one treatment at a time, so a 1:1 staffing ratio. I would have to be a fool to give that up to be the only nurse in a busy assisted living facility.

Thanks again, you have been more helpful than you know!