A Place for Mom: Finding the Right Assisted Living Community

**VivaLasViejas, ASN, RN**

As we discussed in the first two articles of this series, the rules and regulations that govern assisted living communities vary widely from state to state, and thus impact the types of services offered. Some states, such as Oregon, allow unlicensed staff to be trained and delegated by a nurse to perform certain tasks of nursing care, e.g insulin preparation and administration, while others are much more strict and require licensed nurses to be present in a building 24/7 to pass medications and do treatments.

Accordingly, the types of residents who can be accommodated in these facilities are very different from state to state. I have a friend in the Midwest who manages a building in which no one who needs medication management or assistance with transfers is allowed to move in, although they will keep the resident if s/he turns out to need those services at some point during their residency. Another acquaintance is an ADON in a facility that takes virtually anyone who comes through the front door, including patients with stable PEG tubes and those who need mechanical lifts for transfers.

At my community, we are very flexible in the types of residents we accept, although feeding tubes and Hoyers are places we choose not to go. We have several who are total care, all the way down to turning and changing every two hours; we also have a few who are very independent and still drive their own cars. Most are somewhere in between, and we do work hard to assist them to "age in place"---in other words, as they become more frail and need more help, we adjust their care plans in order to provide the services they need. We will even care for them during the dying process, bringing in hospice if they so choose, and coordinating care so that they can spend their final days surrounded by familiar faces and their own possessions.

Sometimes, however, we find we must turn down an admission. The severely demented who are apt to wander, those who have dysphagia or need to be hand-fed, and those who need 24-hour supervision and care are kindly directed to the nearest memory-care facility or nursing home. It's when a prospective resident has a complex medical history and/or active psychiatric issues that we enter a huge "grey area" and must consider many factors, including how s/he would fit in with the other residents, before we decide whether or not to accept him/her.

Recently, a couple of highly interesting but dicey initial evaluations landed on my desk. For most types of residents my input isn't needed, but when they are as complicated as these two, even my administrator will tell people that mine is the last word. One was a gentleman in his late 60s who was alert and responsive, but he was also over 300 lbs., aphasic, a frequent faller, a sliding-scale diabetic, and he had gnarly wounds on his coccyx and hip. At the time, we had two others who were equally heavy care, and we didn't need another 'project'. To his case manager, I said thanks, but no thanks. Forty staff members heaved a sigh of relief.

The other one was, to put it bluntly, a hot mess. For one thing, at age 56 he was really too young to be appropriate for us; and living with eighty-five people old enough to be one's parents doesn't do much for a person in the social arena. Worse, this poor fellow had psych issues that probably would have scared the daylights out of our elderly folks: he had PTSD and tended to hallucinate scenes from the Gulf War, complete with gunfire which made him dive under the dining-room table at his adult foster home. And to complicate matters, he was also bipolar and had an active case of alcoholism. I felt bad for turning the guy down, but I already had a younger mentally ill man in my building and I wasn't about to move in another. We simply don't have the training or the staff to deal with residents like this---especially those who resist taking medications.

In the fourth and final article we'll explore ways to find a good facility, as well as how to take action when the services rendered are not all they should be.

merrywhiterose · Sep 12, 2012

We take almost anyone. We have residents that have their own vehicles, alzheimers, morbidly obese, one trach, 2 g-tubes, rehabs, gaping wounds, psych, etc. When the other facilities turn someone down, we usually take them. It's great clinical experience!

**VivaLasViejas, ASN, RN** · Sep 12, 2012

We take almost anyone. We have residents that have their own vehicles, alzheimers, morbidly obese, one trach, 2 g-tubes, rehabs, gaping wounds, psych, etc. When the other facilities turn someone down, we usually take them. It's great clinical experience!

So I'm assuming you're largely staffed by nurses and CNAs, rather than lay caregivers with on-the-job training? I've had one trach in assisted living, and that was scary.....your place sounds more like a nicer version of a nursing home. Can you tell us more about it?

DSkelton711 · Sep 18, 2012

I go by state regulations and also safety of the potential resident. We don't take just anybody. It would be unfair to the resident to say "yes" but not really give them the best care possible. What are staffing policies in places that take those people with gaping wounds, psych disorders, and rehabbers. This sounds more like skilled care than an assisted living and would not fly in my state or facility.

A Place for Mom: Finding the Right Assisted Living Community

About VivaLasViejas, ASN, RN

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