What eveyone should know before working in an assisted living facility.

Specialties Geriatric

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There is things that one should know before working in an assisted living facility. The first thing is that if they have more than 8 pts who are complete care who can not do anything on their own from baring weight to feeding themselves you need to take note of that. The reason why I say this is because most assisted living places do not have Hoyer lifts or machines that help assist with pt transfers and the simple reason behind this is that most of the residents there should be able to help out and are not suppose to be complete care. You are more at risk for injury if you have to lift someone who can not bare weight at all. No one should have to lift someone that is dead weight period for the safety of the resident and the caregiver. Just think about it most of the elderly have very fragile bones/ or they have arthritis which is very painful for them. Lifting someone with a two person transfer who can not help it all is horrible for the pt and the caregiver. One as the person performing the transfer it is hard on your back and other parts of your body. You could really injure yourself or the pt if they are dropped or if the transfer is to rough for them. Which is likely to happen if they are to heavy and are about the fall. In skilled they do not want you to lift anyone period that is why they have Hoyer lifts, and other lifts to help. So that is something to think about before taking a job working in an assisted living facility. Just remember that most of them are suppose to be able to do their own care, they are not to be complete transfers at all. Don't let the people who runs the place tell you anything else. In less they have a working Hoyer lift in the facility. I just wanted to share this because no one told me and I had to find out the hard way did not get paid anything and breaking my back it the sometime!

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Moved to Geriatric Nurses/LTC Nursing for more response.

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Specializes in School Nursing.

I was under the impression assisted living the residents were independent for the most part?

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Specializes in LTC, assisted living, med-surg, psych.
I was under the impression assisted living the residents were independent for the most part?

Not even close. In the ALFs I've worked in, we've had everything from wanderers with severe dementia to total care patients to brittle diabetics who need blood sugars checked six times a day. ALL of whom should have been in memory care or an ICF. We basically became "nursing home lite" in the past 10 years, only we didn't get more training, or better staffing, or CNAs instead of lay caregivers.

For the nurse, it's a really scary thing to be responsible for as many as 100 residents, 30% of whom are NH candidates, and to make sure the caregivers are administering meds correctly, giving the right amount of insulin per the MD's order, AND getting the laundry done and the meals served. That's why I'm no longer doing it.....it got too stressful and I wound up having a breakdown. You couldn't pay me enough to work in a large facility again.

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Specializes in retired LTC.

And it is NOT an isolated issue. It quite widespread in the field. And I believe it all boils down to $$$. - that is, making money for the company by admitting inappropriate residents or keeping declining residents when they are no longer appropriate for the facility.

Keeps the precious census up.

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Yes my point for anyone who wants to work in an assisted living facility is that a lot of times it is harder because they don't have a lot of the things that skilled nursing does. And the pay is crap! Like 9 an hour if your lucky yea right lol

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Specializes in Corrections, Psych.

I was Wellness Director at a mid-sized ALF for right at a year. Between the 24/7 on call schedule, the regional manager who claimed if "(I) wasn't here at least 50 hours a week, (I) wasn't doing something right" despite only paying me for 40 hours/week (and that wasn't much!), and being encouraged to keep residents who had long since declined past the point we could care for them, I hit the door as soon as I could. Nursing Home Lite is absolutely correct.

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Specializes in Cardiac.

I worked in a small 15 pt ALF during my last year in nursing school and for about 3 months as the RN once I graduated.. You're absolutely right about them keeping inappropriate residents and the work being hard & everyone is underpaid! I didn't know it was widespread though, I thought I was just at a bad facility. We had one total care pt.. She had been there for years and had declined (96 years old!); but she was private pay & had the largest private room/bath in the facility so they let her stay because the family liked her receiving "one on one care". Right... I couldn't take the stress of the RN position! Even before I was done with school I was the most educated person working in the facility & was doing the narc counts & keeping track of the MARS in between RN/LPNs visits. I worked 2nd m-f and the lady I trained to replace me had absolutely no clue about any of the meds, couldn't grasp the importance of doing daily weights or b/p/HR for certain meds, did not know how to do accuchecks or draw up insulin, and had no clue about PRNs even though the indication for the med was written on the MAR. I was terrified for the residents when I left.. ? I also felt that the legality of the whole thing was questionable the entire time I worked there, but at the time I had no other choice and had to work.

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Specializes in LTC.

In 2012, my now deceased husband engineered an interview for me at what turned out to be an ALF. He was beside himself when I was unable to even get an interview after I graduated in 2010. He was at the Liver Transplant Center of Westchester Medical in New York and struck up a conversation with an LN who had accompanied a patient there. Long story short, he got me an interview. When I got there I was interviewed by 4 different people, the last 2 coming in together and looking extremely bored about the whole process. It was obvious to me that they either already had someone in mind or maybe the position was not even real. Anyhow, at the end, they told me that they had 100 residents but we're only licensed by the state for 40. Now after reading this, I understand. I am glad they did not hire me. I had no idea such crazy and dangerous practices were going on in ALF land. I do know that they are surveyed infrequently like once every 5 years. Question is, when surveyors do show up where do they hide the extra 60 people?

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Specializes in PACU, pre/postoperative, ortho.

My mom was at an ALF for about 6 months & while in general it was good, we had problems when it came to her meds, specifically coumadin. Mom's inr is volatile & we check it ourselves each week (sometimes daily). Every time the MD would adjust or hold her dose, it was like pulling teeth to get the staff to medicate appropriately. At one point, we had told them to hold her dose as she hovered close to 4 & realized they continued to give it when her results kept climbing & were at 6. The nurse wanted a written order every time or said Mom had to refuse. Got a blank look when I asked her about "nursing judgment"?!?! Even a written letter from doc to adjust her dose per POA/family was not acceptable.

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Specializes in Cardiac.
My mom was at an ALF for about 6 months & while in general it was good, we had problems when it came to her meds, specifically coumadin. Mom's inr is volatile & we check it ourselves each week (sometimes daily). Every time the MD would adjust or hold her dose, it was like pulling teeth to get the staff to medicate appropriately. At one point, we had told them to hold her dose as she hovered close to 4 & realized they continued to give it when her results kept climbing & were at 6. The nurse wanted a written order every time or said Mom had to refuse. Got a blank look when I asked her about "nursing judgment"?!?! Even a written letter from doc to adjust her dose per POA/family was not acceptable.

The reason for this is because none of the staff giving medicine are capable of using nursing judgement because they are not nurses, or usually even CNAs. They want those written letters because they have no autonomy to make clinical decisions because they are not medically trained. We need doctors orders to give pts tums. Like seriously, couldn't even give something PRN for fever of they didn't have it ordered.. Another reason I left the RN position... I could not educate them on things like this to a point where they'd understand :/

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The reason for this is because none of the staff giving medicine are capable of using nursing judgement because they are not nurses, or usually even CNAs. They want those written letters because they have no autonomy to make clinical decisions because they are not medically trained. We need doctors orders to give pts tums. Like seriously, couldn't even give something PRN for fever of they didn't have it ordered.. Another reason I left the RN position... I could not educate them on things like this to a point where they'd understand :/

I beg to differ on the nursing judgment comment. It's one thing to "assess" the patient (which is what an RN should do) versus "hold" a medication. Without clear guidelines as noted in the physicians' order, it would be like I've made my self a doctor. Not good when it comes to keeping ones license.

Judgment on the other hand, comes into play for things like an infiltrated IV and you stop the IV pump to assess and most likely replace the IV then you resume the medication. That is not holding a medication (the IV), it's simply remedying an issue so the medication can safely be administered.

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