Assisted living ?

[GretaRN]

Hi all,

Question or a few...working in alf-dementia unit for 1 year now...there is a lot of "I hope their not writing that in the chart" by wellness director...example - resident resistant to care ,the resident required 2/3 girls to get her ready..When we have a resident on hospice we are not allowed to medicate w/morphine etc., they have a pca come in and they medicate...Why as a nurse am I there??? If I as a nurse do these things it is considered a nursing home... As an RN if a pt. condition warrants it "I" chart it..ex: if resident is declining and losing 3 pounds a week... I do an assessment etc. and chart it, vs as well. Well there is a meeting coming up for nurses re: charting next week...unfortunately many of our residents are incontinent and not really assisted living residents but they want to keep them as long as they can $$$...question do you think I should not be charting these things??? I guess its not a question. I know I am correct in doing these things...maybe I should start looking for another job?

I do love my job and the residents but I feel even though they may be at the end of their lives sometimes we have to do all we can for them not just let them decline without trying to help and "chart" what we do for them and their condition...I did work a LTC and I know ALF are not nursing homes but I need someone to put these things into perspective for me...Thanks for the support.:redpinkhe

Greta

[nurse0520]

From My own experience of my grandmother being in an assisted living after having 2 strokes to me it is our screwed up healthcare system in the USA. My grandmother did not qualify for a nursing home for very long and was sent to an assistant living because she still owned her house and medicare would have taken her house. Where as my other grandmother who did not own their house anymore broke her hip only and can still take care of herself and walk is in a nursing home under medicare and medical assistance go figure!

[favthing, APRN]

I work in assisted living and pass meds as a nurse. In many ways its more like a nursing home than "assisted living". Our dress code is not a nursing uniform, but business-casual. I love the philosophy of assisted living, and find that residents have come to trust and rely on me for health-related concerns. I think assisted livings are so broad in their potential, each one or each company is unique.

As for charting, if I see a resident needs the kind of care that would warrant a problem with State, I talk with the family and my boss about either sending out to the hospital, getting a home care RN in (for wound care or catheter issues, etc.), or talking hospice. I see that I take just as good of care of my residents (if not more because the goal is holistic care) in AL as I would in a nursing home. I just have to utilize outside, specialized resources to provide care rather than do it myself, and chart in this way. I still assess and follow up like I would in any other setting, but I'm more of an "organizer" of care. And I chart in a way so that my attention doesn't have to go in to regulation like it would in a nursing home, so that we stay assisted living.

As for a med tech passing meds in assisted living, no way! As a nurse, I'm going to be looking for desired and adverse effects, getting to know my residents WHILE I administer meds, and during the med pass I'm performing subtle but very important assessments. From my assessment, I may use nursing judgement to hold a med! I mean, most anyone can pop a pill into a mouth, but the administration of meds from a nurse to a patient or a resident involves a LOT more than just giving pills.

[GretaRN]

Thanks for your reply, sounds just like my place. I just have to wrap my head around the idea w/charting and what is acceptable to chart and not (regulations) We also call in other RN'S to do special care...I kind of feel incompetent when we do this because I am so used to do these things myself. I am still in the mind-set of skilled care....thanks again Fav!