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

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    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!!
    favthing, Rascal1, Nurse Smiley, and 1 other like this.
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    I left my assisted living job as LPN/Care Coordinator for the memory care unit, in July. I really miss this job now and have thought about asking to come back. I never thought I would miss it so much, with all the nonsense that goes on at times. I hated finding out that so and so wasn't coming into work during the evening shift because her car broke down or some excuse. That would mean that I would have to pass evening meds, even though I came into work at 8am or 9 am. UGH! Yet I haven't found a job that equals the ALF job I left. I have had a nice long break from this ALF and nursing. Yet, now I'm actually "homesick" for my job there. Odd isn't it??? Maybe I just needed this break from taking care of people for awhile.
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    Quote from HannasMom
    I left my assisted living job as LPN/Care Coordinator for the memory care unit, in July. I really miss this job now and have thought about asking to come back. I never thought I would miss it so much, with all the nonsense that goes on at times. I hated finding out that so and so wasn't coming into work during the evening shift because her car broke down or some excuse. That would mean that I would have to pass evening meds, even though I came into work at 8am or 9 am. UGH! Yet I haven't found a job that equals the ALF job I left. I have had a nice long break from this ALF and nursing. Yet, now I'm actually "homesick" for my job there. Odd isn't it??? Maybe I just needed this break from taking care of people for awhile.
    Could very well be.

    I would caution you not to idealize your old job, however much you enjoyed parts of it. Any ALF where the nurse has to work the floor more than once or twice in any given year is not well-managed, IMO. (I had the same problem with messed-up schedules, no-shows and call-ins before I took over staffing; sometimes I'd get a frantic call from the weekend med aide going "it's 0630 and there's nobody here!" In the 2 months since, I have had NONE. Part of my system makes the caregivers responsible for replacing themselves if they can't make it to work.)

    Perhaps there is another ALF in your area, or within a reasonable commute? Working in assisted living can be so satisfying, mainly because much of our clientele are still A & O, they just need help with physical tasks such as bathing and dressing. I love to just sit and shoot the breeze with residents; we tell funny stories, brag about our grandchildren, and sometimes even cry on each other's shoulders. It's more like having a group of older friends than 'taking care of patients', although I certainly do that, too!

    I wish you luck in finding a good position, no matter where it may be. Please keep me posted.
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    I have just spent 3 weeks of telephone and in person interviews for a Health Services Director position at a currently being built Alzheimers and Dementia Care Facility in Texas. The administrator that I interviewed with had indicated she was in pursuit of level 3 and 4 residents. Being that I had been an ADON for 9 years and Medicare Manger for 3 years in a SNF I fully understood the types of residents that they plan to admit to this new facility. Well, I was in fact offered the position and was thrilled until I was informed of the starting salary...$45,000/ year which is about $2000/yr more than my current pay. I currently working in a clinic which we all know that your day ends at 5 p.m., all weekends off, all holidays off, no concern about being on-call 24/7. I'm shocked and disappointed that with such a tremendous responsibility of a HSD's role and the types of residents they plan to admit the salary being offered seemed to be more in the range of a assisted living apartment community. In the state of Texas to obtain a level 3 or 4 at the very least the resident requires assistance to transfer, may be incontinent, may require spoon or syringe feeding. It just seems as if this facility plans on attempting to pass itself off as a ALF, but will be in essence a NF. Is this typical?
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    I recently started at a retirement 'home'. It is very much like assisted living, as the residents live as they want, yet they don't leave unless someone takes them. It is a large home, 3 stories tall, housing only 6 residents. They only pay ss to live there and we do not get any money from the government. The home was given to the community by a lady many years ago. We have no government involvement whatsoever, and in fact up until 2 years ago, the administrator was doing total care for the patients, setting up meds for the week while kitchen help assisted in care of the patients. Now I'm the RN on staff, with no CNAs or anything, only living aides to assist. I set up meds for the week and the aides put them in cups and place them in front of the patients. It's actually kinda scary not having any rules to go by, but I am working on correcting that. I cherish the non-government involvement. But I am planning on correcting things so that we are for the most part compliant. However the home does not have the means to hire actual CNAs to care for the patients, and most of the staff have been doing this for years. I however live less than a mile from the home and do alot of checking in. Especially since we have one very ill patient. She is refusing medical treatment (going to the hospital) and she has every right to do so, until she is not conscious to make those decisions - then we have POA over medical needs to take over at that point. I guess this is sorta my introduction into this field. I just wanted to lay a groundwork in case i have questions (and I am sure I will).
    I love it there by the way. Scary but I do love it. Anyone else in this type of situation? Probably not but if there is, please please speak up so I can know who to direct questions at
    Jennifera likes this.
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    To answer LMC's question: No, the sort of residents you're describing are definitely NOT typical for assisted living, at least not where I come from. It wouldn't surprise me if this facility you're talking about plans on staffing like an ALF as well..........and if I were you, I'd be very careful about accepting a HSD position there, because your license may very well be on the line when (not if) things go sideways.

    Like other levels of care, ALF residents' acuity has risen over the years; we now take sliding-scale diabetics, certain tube feeders, and even residents who require assistance with trach care. We do not, however, admit those who have to be fed by hand, who are two-person transfers, who are wanderers, or who cannot manage at least some aspects of their ADLs.

    We simply do not have the staffing and training levels those tasks require---one of the main reasons why assisted living is so much less expensive than nursing homes. Our caregivers and medication assistants are laypeople trained in basic care tasks, including first aid and CPR; and while many are very knowledgeable and conscientious, most are NOT certified nursing assistants or techs. So when a resident who's lived in the building for awhile begins to decline, I always get home health or hospice involved in order to meet their increasing needs, because we do try to allow them to "age in place". Sometimes, however, even with the best of care some will wind up in a NH, because we're not set up to manage people who become totally dependent.

    I realize different states have different regulations for ALFs, but regardless, the emphasis is supposed to be on "assisted" living, not nursing-home care. I would be very careful about taking on such a responsibility, especially if you are the ONLY nurse. As for salary: where I sit, $45,000/yr. looks pretty good (I'm only making $40,000), but NO amount of money is worth having 24/7 responsibility for the lives of people who don't belong in an ALF.

    Hope this information is helpful to you. I wish you the best, no matter what you decide to do. Please keep us posted here.
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    Hi all, my name is Amy I am going to an interview at a local ASL for the wellness director. Can any of you tell me what this job is and how much you can expect in pay? It says part time 24 hours a week but I was just wanting to pick someone's brain about it first.

    Thanks
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    "Wellness director" is only one of the many different titles for what is, essentially, a Director of Nursing-type position, only ALFs don't like to call it that because of its perceived association w/ nursing homes. (In some facilities the wellness director is actually the activities person.) In any case, 24 hours doesn't sound like enough, unless the building is very small (like less than 30 residents). This is because you are responsible for delegation of nursing tasks, e.g. blood sugars and insulin injections, staff training, oversight of the med room, and sometimes admissions and administrative functions such as service plan meetings and public relations. I'm working (officially) 32 hours a week and have 43 residents, and in addition to all of the above, I do the scheduling, give in-services, handle all the MD orders, supervise caregivers and med aides, and coordinate care with outside agencies such as physical therapy and the county mental health office.

    I'm on salary, so I don't really know how an hourly wage would compute; I do know this doesn't pay anywhere near what hospitals or even nursing homes pay. But at this stage of my life, I'm doing what I do as much for the satisfaction as for the money---I made $30 an hour at my last hospital job, and they couldn't pay me enough to go back---and of course we aren't starving to death.

    You will want to research the job and the company thoroughly before you accept a position; alas, there are a number of companies that will promise staff and residents alike the moon and stars, then try to get away with spending as little as possible for supplies, proper staffing levels and so on. Just make sure you go into it with your mind AND your eyes open........and good luck!
    Havin' A Party! likes this.
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    so what does a job like that usually pay or what pay should I not work below?
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    You really should research nursing salaries in your area to see if ALF wages are competitive..........Here, where hospital jobs pay new hires an average of $25 an hour and nursing homes around $21/hr. (that's before shift differentials, certifications, or experience), ALFs pay around $20-22/hr. It's not great, but you will almost always be the best-paid staff member in your building.....even the administrator earns less in a lot of places.
    lots2care4 likes this.


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