What's It All About, ALFie?--Help and Support for Assisted Living Nurses

Specialties Geriatric

Published

It's not independent living........and it's not a nursing home. It's not a secured Alzheimer's facility.........yet it does house some Alzheimer's patients. It's definitely NOT a 'retirement community'..........but some tenants who still drive, live active lives, and manage their own affairs come here for the meals and housekeeping service.

What is it? Why, assisted living, of course! ;)

And as anyone who works in this relatively new field knows, ALF nursing has its own unique challenges. We care for residents with a wide range of conditions and abilities, from the independent 65-year-old retiree who does his or her own thing to the blind 95-year-old diabetic who needs daily glucose monitoring insulin injections. We serve as supervisors, administrators, confessors, staff developers, mentors, companions, receptionists, marketers, counselors, even chief cooks and bottle washers from time to time. And we are guided in our practices by a set of regulations that vary by state, are often muddled and contradictory, and WIDE open to interpretation by state and federal surveyors.

This thread, then, is for us---the bold, the brave, the confused---who go to our "cushy 9-5 desk jobs" every day (any of you fill in as NOC shift med aide lately? I have;) ) and put our careers on the line to assure quality care for each and every resident in our communities. Please feel free to ask for or offer support; share ideas that have (or have NOT) worked in your community; or even just vent!

Welcome!!

Specializes in Gerontology, Med surg, Home Health.

1. To be an MDS coordinator you must be an RN

2. Not many places will hire an MDS coordinator who has no experience.

3.Seems like too many patients even in a ALF

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Specializes in Assisted Living.

I submitted my resignation today at the ALF where I've worked as a "part time RA" and "prn LPN" for the last 3 years. I showed up for work yesterday to do the month end audits and was told that the week-end nurse (who broke her leg last week) was being replaced by a recently hired LPN from a "sister facility." He will be given all her nursing hours & RA hours until she can return to work.

This action by our Executive Director is an obvious ploy to get me to resign. Several years ago the parent company fired and forced resignation of 90% of their "older" employees which saved the company tons of revenue. I suspect I became the latest statistic...honestly though, I've had such a sense of peace & relief since turning in my 2 week notice today! It will just have to take us a little longer to pay off some bills & I can live with that.

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Specializes in Med-Surg, Peds.

I'm curious, are caths expected/common in an ALF setting?

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Specializes in Med Surg, Home Health.

Is it safe to have 1 nurse overseeing 108 residents, 80 in ALF and the rest in ALZ units, who take over 1200 meds over 24 hours? Just asking....

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I have a second interview for RN for a new ALF with 6-8 residents specializing in Parkinsons. I am a new grad with a ton of business/military experience so I believe my management skills are adequate for the job. I am looking forward to working with a specialized group of patients. This facility is only 6 blocks away from my new home and I am very excited. Any advice? Thanks!

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I just started my new job at Cambridge Court Assisted Living today. And I am so excited I really think I am going to enjoy it. I know its alot of responsibilities but I believe its going to be rewarding! All the information is great and I love this forum.....

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I left LTC about one year ago, after many years in every nursing role from staff nurse to DON to regional nursing consultant. AL is not stress free, but it is definitely less stressful than any nursing job I ever held in LTC. There is a certain amount of loneliness for me on the job because I am the only licensed person for a 70 unit ALF/Retirement community and I miss having other nurses to talk with about nursing. Here, we "assist" with medications and "assist" with ADLs. I have unlicensed medication assistants and resident assistants to provide care.

I would agree with earlier posters that a brand new nurse might get themselves into trouble in AL because of inexperience with assessing signs and symptoms of illness in elderly persons. These residents all look very healthy compared to what you see in the nursing homes. There are still many with complex medical issues and many have a fear of going to a nursing home if they reveal the extent of their health problems. I also find that since AL is generally private pay, many families and residents don't want to pay for higher service levels to receive the care and services they need. Census is an issue here, just like in LTC. There is pressure to admit residents who may not be appropriate for AL, not just from the corporate level but also from families who prefer to see their loved one in this setting rather than a nursing home.

Overall, I think AL is a good industry for a seasoned LTC nurse who is tired of dealing with tons of paperwork and unreasonable surveyors every three months.

I come from LTC as well. I just accepted a position as health srvs directior at an assisted living. Sounds exactly the same as yours. Really looking foward to it. I'm tired of runninng to the end of the hall because I can hear my trac pt choking and the administrators wont move him to the front of the hall where I might be able to keep up with him. I pass meds to 30 pts and do IVs and wounds and on and on. So yes, Im TOTALLY looking foward to the new job!.

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I'm a PN student. I want to work LTC or ALF but everyone else seems to think that's horrible. I've been told several times not to "get trapped into LTC." Now, I'm a big girl and will do what I want but it sure would be nice to hear some GOOD experiences with working LTC or ALF. Thanks!

If you can, get 2 yrs in med surg first. You wont regret it.

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OK I just started working at an assisted living and I'm confused on somethings. When I mentioned if we use anything like A&D for rashes on you know where, I was told by my supervisor and another co worker that we can't without a Doctor's order. My thought was, when I worked in skilled we put it on everyone unless told not to and second it's not medicated so why? it's like putting on lotion. i'm new there and don't want to ruffle feathers put this gets on my nerves, there's no reason for rashes so easily prevented. Is this really the case? Can't we just ask the family to bring some in.

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I'm curious, are caths expected/common in an ALF setting?

not from what i've seen.

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Specializes in long term care, school nursing.

Kellyma- Regarding the A&D ointment: on one hand, I would permit families to bring in the ointment for the resident to use since it has no medication in it. But on the other hand, in assisted living, the residents should be able to move and care for themselves quite a bit so you should not have rashes you know where. Just my 2 cents worth. And catheters are permitted in AL if the resident cares for it independently or with some guidance. I have a resident that is about 90% independent with a suprapubic catheter. Home health care visits monthly to change the catheter. My staff assists with education, hygiene, and reminding to empty the bag. Hope this helps.

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Specializes in Med Surg, Home Health.
kellyma- regarding the a&d ointment: on one hand, i would permit families to bring in the ointment for the resident to use since it has no medication in it. but on the other hand, in assisted living, the residents should be able to move and care for themselves quite a bit so you should not have rashes you know where. just my 2 cents worth. and catheters are permitted in al if the resident cares for it independently or with some guidance. i have a resident that is about 90% independent with a suprapubic catheter. home health care visits monthly to change the catheter. my staff assists with education, hygiene, and reminding to empty the bag. hope this helps.

i'd be careful about this. rules about this can vary by jurisdiction. i'll do my best to explain my take on why the rules can be so strict.

assisted living, in my state, has very strict rules due to the fact that most creams and medications are applied by uncertified staff. so basically any procedure that is based on a medical condition needs to be outlined step-by-step by the doctor, legally. regular lotion doesn't need an order unless it's for a certified medical condition like a rash, and then it does. this ensures that the doctor stays informed of the resident's condition (doctor now knows resident has skin breakdown issues, which they might not if we independently applied the a&d appointment).

on the other hand, a caregiver can make decisions about a resident's non-medical, everyday quality of life, and independently apply lotion for this purpose (to smell good, to have the skin feel soft, to feel cared for). and a nurse, as a nurse, can give a temporary nursing order for just about anything as long as they are also actively trying to get further advisement from the resident's doctor. we do this a lot for pressure sores - our nurse gives us a temporary order so we can start treatment asap, and then if the doctor disagrees with the particular kind of dressing we change our approach as soon as we hear back from them.

now, lets say we don't follow this process. the chances of getting in trouble from a&d ointment in relatively low, especially if family is on-board with its use, but in my state we have to formalize the application w/a doctor's order to be safe from getting dinged on inspection. getting dinged on inspection means fines, and unhappiness from corporate.

at my facility we tend to err on the side of caution about following the law. this may make our process slightly byzantine but does ensure we pass inspection with flying colors every time.

as for the type of health issues found in alf - alf is the new nursing home, just as a nursing home is the new hospital. we get a lot of people who are in no way, shape, or form independent or medically stable. it's not pleasant but we need to figure out systemic solutions and then get together on advocating for them, rather than just expressing the usual shock and annoyance.

so let's get to it!

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