Assisted living

Hi Viva,

I will not bet be the director but be the charge nurse for the assisted living on second shift. I do not feel comfortable with have medication aides administering medications and I really do not want the responsibility of having to fill in and find coverage for staff. Too much stress and life is too short. I told them I had second thoughts on the position would be happy to discuss working PRN or per diem in another position in the facility in either their short term stay unit of their memory care. I will see what happens.

I have not been on this all-.nurses in at least a year and I remember I always enjoyed your posts. I hope you are well

No way would I take that job. I work in a small AL memory care facility. Most often, I am charge nurse working with one QMA and 3 CNAs (day shift) for 40 people, and it's very, very difficult...so much so that I'm contemplating leaving long-term care altogether even though I love it. In my experience, second shift is usually not as well-staffed as day shift, which can be a problem if you have a lot of sundowning residents and family members (that work during the day and come to see residents in the evenings) wanting information about their loved ones. Your QMAs, even if they're awesome workers, can't do nursing tasks. The thing that sticks in my craw about your post, though, is that you'd be responsible for finding coverage for call-offs. Nope nope nope. If your facility is like mine, our admin is constantly scrambling to try to find coverage for CNA call-offs. I can't see one nurse trying to keep up with 60 residents and be on the phone trying to staff the place at the same time....God help you if anyone falls or needs to be sent out! RUN, don't walk away from this offer!!!

Pts in assisted living facilities are SUPPOSED TO BE at a higher lever of ADL functioning (and a bit more cognitively intact) than NH pts who typically need more supportive care because of their increased needs.

Note: key words here are "SUPPOSED TO BE".

Sadly, Assisted Living pts are becoming more and more in need of higher levels of care than the facility is supposed to provide. (Or really can actually provide.)

Pts are just SICKER than they were supposed to be for admission criteria. They have more chronic illnesses that require more care. Like they really should be in a NH but they (or their families) opt for AL facilities. ALs are NOT staffed like NHs because the pts are supposed to be able to take more care of themselves.

'Why' you ask? Because ALs are cheaper than NHs. This means there's money somewhere that disqualifies these pts for financial assist. So they are PRIVATE PAY. To my limited knowledge, ALs do not accept Medicare or Indigent Care.

Also facilities DO NOT GET PAID for empty beds so Admission Directors stretch & lower the admission criteria so as to admit sicker pts to fill their beds.

I am sure that there are most likely some well-run and responsibly managed ALs out there. PP VivaLasViejas and other AL nurses can tell you stories to make you want to be super duper cautious as you interview. Ask to see a job description if you can to learn the scope of your responsibilities. Will there be another experienced RN/DON higher than you or might you be the top nursing license?

Just go in being wary. Remember, if it sounds too good to be true, ... Also, be careful re monies offered.

Come back to the site if you have more questions as I'm guessing you will.

Good luck.

I realize I made a mistake re ALs admitting pts - to my knowledge they don't admit MEDICAID or indigent pts. Medicare is an insurance, like BC/BS or Aetna.

Viva - can they do a direct 'caid admit? I could imagine that they might 'have to' accept 'caid if an in-house pt were to spend down to qualify for 'caid. But a direct admit?

Always learning here. TY

Like I said, always learning something! TY