Challenges of ALF and how to handle..

How can things go sideways in an ALF? Let me count the ways........

Actually, it's no different from any other LTC: people fall, break things, get UTIs, have psychotic episodes, wander away, pick fights with other residents, get sick, suffer MIs and CVAs, have adverse drug reactions, get drunk, get depressed, lose their will to live. And that's just the staff.......just kidding.

Seriously: ALF residents, like all of us, are NOT static beings. Their needs are constantly changing, and your job is to pick up on the subtle and not-so-subtle clues that this is happening.....and be ready to adapt your plan of care to meet those needs. As in all of nursing, you should be sure that your documentation is up-to-date and reflects the good work you're doing on behalf of the resident; you also need to make sure your staff is properly trained, so that they know what to do whenever the stuff hits the fan and you're not there to assess the situation.

You can PM me if you'd like to talk about this further, or check out the thread "What's It All About, ALFie?" for more discussion.

I am an RN in Florida. I have just been hired as a Resident care Director in a 70 Bed ALF and 17 Bed Alzhiemers unit.

I have worked all shifts in long term care and been in in the supervisory capacity ,but never in management.

This facility was looking for a nurse with good clinical skills and they are willing to train me in management. I have been an RN for 15 years .

I am a little anxious, as I not familiar with the florida state and federal regs and I dont know what to expect in this position. If anyone has been or is in in this kind of position ,I would appreciate your guidance and enlightment on what being an ALF RESIDENT CARE DIRECTOR is all about.I will appreciate help from anyone ,and also if anyone knows some websites that will help me!!!!! Thank you

Glamour

First of all, congratulations on the new job!! You will definitely have your hands full, but here are a few ideas for you:

1) Check out the American Assisted Living Nurses Association website. They can point you in the direction of continuing education, support systems, even certification as an assisted living nurse.

2) Good training is a MUST. If your company is a member of a state alliance for healthcare facilities, long-term care etc., they will often send you to a two- or three-day course that covers the major aspects of ALF nursing and their implications. Take advantage of every educational opportunity they offer, and if they don't offer, ASK. You cannot be a successful ALF nurse if you don't know the rules!

3) Speaking of rules: invest in a copy of your state's Nurse Practice Act and familiarize yourself thoroughly with the sections related to delegation and/or assignment of nursing care tasks. You will probably be working with unlicensed caregivers whose educational and knowledge levels vary widely; you have to know the regulations so you can assess their abilities and delegate care appropriately.

4) This is a position which carries a LOT of responsibility, and never more than at survey time. You will spend a lot of time talking with the surveyors and assisting your administrator with the plan of correction, if necessary; however, if you make sure your staff and documentation are survey-ready at all times, you won't have to fear this process, which can be intimidating for new managers.

5) Whatever you do, DON'T try to be buddies with your staff. It's OK to be light-hearted and have fun on the job, but remember: you are the boss, and sometimes you have to make hard choices. It's even harder if the employee you are disciplining is your friend. In addition, the staff won't take you seriously when you need them to do so if you go out with them for drinks after work or invite them over for a Saturday-night barbecue.

6) Love your residents! People in assisted living can be delightful---they may need a little help with ADLs, but they often can and do have meaningful relationships, continue to participate in arts and crafts, travel, join in community activities, and generally enjoy life.

Good luck to you!

dear mjlrn97

thank you very much for such an informative answer.its much appreciated. just to let you know ,i went to get all the new hire paperwork filled out today and also took a tour of the facility.

the administrator said that she just cannot wait for me to start which is in a weeks time. i was shown my office and it looks a mess, with everything lying everywhere,but i guess its also because the place did not have a rcd for a long time,lots of others have been in there trying to fill out.

is it possible to tell me were to start when i eventually get to that office in a weeks time. the administrator was not able to tell me much ,cos she says that she is not a nurse, the others are all cnas and med techs!!!!

she is sending me to another facility for 2 days to learn the computer input stuff, as well as the companys policies. if anyone else can help me prepare for this start ,i would appreciate.

regards

glamour

sounds like your facility is a lot like mine---i'm the only licensed person in the building, except of course for the administrator, but he's not a nurse. all the other staff are unlicensed caregivers and med aides.........most of them don't even have cna certification. so one of the very first things you'll want to find out when you start work is how well staff are trained: do they know and practice proper care techniques, are they receiving ongoing education about geriatric health issues such as dementia and behaviors, can they read and write well enough to document care, etc. you also need to ensure that delegation for nursing care tasks such as insulin injections and complex wound care, is up-to-date and done according to the regulations of your state.

and that's just your first day.

seriously........it sounds like your facility is pretty chaotic right now, and like many of us alf nurse directors, you're going to be doing the vast majority of your learning on the fly. just keep in mind that resident safety is your very first priority---your med techs need to know how to administer and document medications correctly; caregivers need to be doing transfers and performing resident care safely; the med room needs to be continually monitored; and you need to be on top of residents' changes of condition. i do hope your staff is very competent, because they are your eyes and ears---you cannot oversee that many residents without them.

once again, i wish you the best of luck!