AL vs. LTC

[MsPiggy]

Good Morning All,

My title kind of says it all. I'm an old LPN almost 26 years and pretty well rounded.

After a 2.5 year break after leaving a case management position at a cancer center I

recently accepted a position at a very upscale new AL facility.

My position is to assist the CENA's/PCT's (they use both) as needed, do the scheduling and be on call 24/7. They (management/marketing) working hard at filling these beds and the pressure is on the marketer to do this and get the facility in the black.

My concerns; the woman that was doing my job before me was canned the day after I arrived (not a good sign). She is not a nurse but despite being overwhelmed was attempting to do for this owner/company.

I feel there are some very inappropriate residents which leads to what I am asking. We have a resident couple, seperate rooms-they are both HUGE fall risks and do so ever day almost. One the woman has severe dementia and wanders/trips/falls/becomes combative at times.

The other, completely non compliant, will not ask for assist with transfer is a two person assist/total care for adl's, etc..Family has a nanny cam in the room. This man has a tool box in his room as he used to be a tradesman-I get that but the CENA alerted me to the fact that he had a large new claw hammer on the table in his room. Fearing for her, the residents wife, or another residents safety..Do I even have to say how uncomfortable this makes me?

I phoned the daughter, told her I found it and put it locked in my desk drawer until she could retrieve it and take it home. She was VERY angry and said he had every right to keep this in his HOME and I was to return it. I pointed out all the safety risks to her-"What if he fell on it?, or hit someone with it when upset, etc?" She was not having it.

I returned it to his room, notified the CENAS and left a letter for the owner of this AL I about what happened and I wanted to speak with her today. My birthday -Happy Birthday to me!! LOL..

What I am asking is, is my spidey sense right? This seems absolutely ridiculous, dangerous and a huge catastrophe waiting to happen and impact my license. BTW, it is a private pay non-licensed AL, with a separate NON licensed care company (that I am supposed to supervising/running) doing the care giving. These are total care patients-not what I would consider AL, but skilled.

There are a few more inappropriate ones but this is the biggy that may have me turning in my resignation today. Thoughts? Input?

I feel like there is no protection for me here and when things go down it will get bad. The Cena's are fantastic but they are overworked, underpaid, no benefits and will move along if this will be their typical resident. Also the owner has declined to pay my malpractice because she says it's a non risk for me because everything is unlicensed.

I apologize for the length of this post. This is my first and perhaps my last AL position. It is entirely different than what it was/is portrayed to be.

I appreciate any insight, advice, thoughts.

Kindly,

Ms. P

[VivaLasViejas, ASN, RN]

I've worked extensively in AL and the best I can tell you is, get out of there while the gettin's good! What you're seeing in your facility is typical of AL these days, with owners in it for as much $ as they can possibly get. They like to hand you a resident who belongs in a nursing home or Alheimer's unit and say, in essence, "Here, you figure out how to take care of them." The powers that be don't care that you're risking your license by taking on people who are totally inappropriate for the AL setting. All they want is money, money, money.

So RUN, do not walk, away from this situation. Find another job and give your notice. This one isn't worth it. Good luck.

[MsPiggy]

Thank you mucho for responding.

Of course the owner re-assures and insists since it is unlicensed and the "care company,llc" that I am hired to run is also unlicensed-any licensed care is to be contracted by the family through a hospice or a licensed provider. However as I pointed out, the CENAS are providing typical basic nuursing home skills in addition to dealing with these non compliant patients. There are also a few completely bed bound patients.

Owner tells me to think of it as leasing an apt. She wants/expects me to completely balance the medical/health care budget to account for staffing appropriately. I have no idea WTH she is talking about. Like, how many jobs do you want me to do for this crappy salary and no benefits? She told me the budget was my salary & the Cena's salary vs. What we were charging families for care packages-give nothing away for free.

I'm off today dealing with a sick dog-The fun never ends! I just cannot wrap my head around this. I also live in a state where AL rules and regs are at this time very vague. I don't think the fact that this place is AL would prevent anyone from suing me or them if something catastrophic were to happen.

[mtjoanna]

Would it be possible to speak with your local nurse's union rep and get an idea of your liability here? Or possibly your state board of nursing? If you've documented unsafe conditions, addressed it with family and admin, documenting their responses, does this leave you liable in case of an incident? I'm with the Vivalosviejas that this sounds like an untenable position and would personally be seeking employment elsewhere. If you do decide to stick it out, this would be an excellent time to become very knowledgeable about your license liability. Hope it works out well for you either way.

[MsPiggy]

I've decided to quit. I told my employer tonight over the telephone and will take in my keys/phone tomorrow.

I just don't feel it's worth the risk or frustration. I might have been more inclined to stick it out were I younger and more feisty

but my gut (and everyone else) is telling me this is not right for me.

Thanks for responding to my post. Since I am unfamiliar with working in the AL community it is helpful to have others who are confirm

what my gut tells me.

[amoLucia]

"Run, Forrest, run". Somebody used this phrase elsewhere here on AN, but it is my rec to leave also with all the others' rec.

Admissions/marketing staff get bonuses for keeping the bed census filled. They really don't have much invested in the appropriateness of the level of care needed for new residents. They have no licenses to protect so they leave it to you.

To mtjoanna - I don't know if any of those entities you mention could help OP. I was thinking more along the line of APS/DYFS. Or a State Ombudsman's Office?? The place sounds like a fancy schmancy boarding home.

And I don't know where OP could have documented her concerns so as not to be a 'he said, she said' type situation that the Administrator could just say "oh, I didn't know". I see the Admin & Admissions as weaseling & backpedaling if something bad goes down.

I would like to know how they advertise themselves though.

Good luck to you, OP.

[MsPiggy]

Thank you. They advertise as a supportive style, catered living. Whatever the heck that means.

I feel nothing but utter relief this morning-though unemployed at the moment. The Cena's have been blowing up my phone since I left wanting to know where I'll land.

[MsPiggy]

And you are exactly right- I was even told I could earn bonuses for keeping my budget inline but it was all very vague.

The marketer is just driven to fill the beds at all costs. There is no nurse determining if these residents are appropriate for AL, just the marketing person and the family/resident.

I pointed this out. No one seemed concerned. n fact I was told it would be discrimination if we refused to lease to someone r/t a disability because again-it is unlicensed AL not a medical facility.

The whole thing makes me uncomfortable.

[lifelearningrn, BSN, RN]

This is one of many reasons I am so upset with the state of our elder care right now... these so-called "AL" facilities are popping up all over the place, and are just another way to drain one of our most marginalized populations of every penny they have. The families feel "better" about placing their parents/grandparents in an AL "community" because it sounds better than "nursing home"... but really these elderly are being dumped on people not qualified to handle their complex needs.

[walkingon, CNA, LPN]

NO WAY at my AL would a resident be allowed to keep a big claw hammer in their room, let alone a whole tool box! Wow...disaster waiting to happen. You made the right choice.

[MsPiggy]

"these so-called "AL" facilities are popping up all over the place, and are just another way to drain one of our most marginalized populations of every penny they have. The families feel "better" about placing their parents/grandparents in an AL "community" because it sounds better than "nursing home"... but really these elderly are being dumped on people not qualified to handle their complex need"

Exactly. I admit though I'm familiar with the concept-what I experienced was residents in need of skilled care, and in some cases receiving it but all under the guise of unlicensed supportive care.

[MsPiggy]

I guess because I'v been doing this so long I am pretty good at thinking about "worst case scenarios", because I've seen a lot of them unfold over the years.

And yes even though it's their home, it's also other peoples homes and workplaces. Just-no. It's unnecessary and dangerous and I'm not going to argue with the family member that thinks it's not only okay but their right and with no thought to everyone else's right to a safe and serene environment.

I have had four calls from CENA's today thanking me for trying and telling me I am the first person there to ever take their concerns seriously and try to address them. This is so sad. They will lose these wonderful caregivers.

I'm bummed but the more I thought about it-I don't want to be on call 24/7 every day.

I'd like to get into a calmer quieter area. You know like a dermatologist or plastics Doc so I can get a discount on my juvaderm injections:yes:

I hope the state develops more solid AL regulations. That must be why they are popping up all over the past few years because the regs are so vague. I wonder if the average consumer realizes that this isn't really a good alternative or replacement for skilled nursing.