Care plans and Assessments At an ALF???

vintagemother, BSN, CNA, LVN, RN · Jul 31, 2016

I worked in an LTC. I was responsible for the care plan updates as well as writing initial careplans.

In RN school, they harped on the fact that RNs only, and not LPN/VN's could do these duties.

Basically, since an RN at some point reviews my work, it's evidently legal.

Honestly, I did my job without RN oversight. But my DON/RN was a good one and did review my work. I guess that's how they get away with this.

And its also how they pretend LV/PNs don't do these tasks.

But we know the truth!

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NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Jul 31, 2016

First, you must understand the rules and regulations of healthcare facilities. At the bottom of the line are personal care homes in which non licensed staff assist with medications. There are no licensed staff requirements for these facilities. The administrator or his/her designee (both usually non-licensed) is required to do an assessment on the residents to make sure they are appropriate to enters personal care home. If medication here has to be administered instead of 'assisted', the non-licensed staff have to receive what is termed proxy-caregiver training by an RN or equally-to-higher trained personnel.

Next up on the ladder is the assisted living facility. Here, medications are administered or assisted by Certified Medication Aids and the assessments are performed by the Wellness Coordinator. Similar to the personal care home, assessments of needs for admission and retention must be done by the staff...again usually by a nonlicensed person.

Keep in mind that regardless of how the physical environment looks, this is NOT a nursing home. Therefore, since non-licensed personnel in these facilities are permitted to do assessments within these 'step-down' facilities, it is expected by them that if these facilities choose to employ LPNs, the LPNs can assume with proficiency the duties of their subordinates. And in an ALF, one of those subordinate duties is assessments....with a weekly RN visit (more often IF the facility chooses to pay for more visits).

Think about it. Did your LPN training ever include clinicals in an ALF or PCH? Your minimum clinical training facility probably began at the LTC facility, similar in physical resemblance, but higher up on the healthcare ladder.

The ALF is required by regulations to provide PROFESSIONAL OVERSIGHT. That's where you, the LPN, comes in...in that you provide daily oversight of your subordinates and taking on the assessment role, with the RN over-seeing your assessments weekly. Does all of this make sense?

The ALF can alleviate the LPN and just go with the RN oversight if they want to. But the ones I encountered chose to keep the LPN onboard, realizing that your knowledge is essential to residents whose next stop most of the time is the nursing home. But mostly, you can recognize a change in condition that may need to be addressed at another level, requiring an unscheduled visit by the RN or a phone call to that resident's doctor, when your aids cannot. These types of referrals keeps the ALF in compliance with the type of residents allowed to be housed there.

When I first entered the regulatory side of nursing, I, too, believed all of these folks were going to jail....until I became somewhat proficient on the rules and regs of each individual healthcare sector. I'm still learning. (I highly recommend going to your state's community health regulatory website and reading up on your type of facility. It is an easy read in layman's terms, designed for the general public). But now, I do understand why former managers and educators were such a PITA with all those inservices. :up: