CNA's running assistive Living Facility

Marie_LPN, RN, LPN, RN · Feb 21, 2006

The "why" is because no one's doing anything to put a stop to this.

elkpark · Feb 21, 2006

I agree with you that CNAs are in no position to be advising people on their family members' medical conditions.

However, the reason that CNAs are running assisted living facilities without licensed nursing personnel is that clients in assisted living facilities are supposed to be people who are medically stable but need some help with ADLs, taking their meds at the right time, etc. -- the same kind of help that a family member (untrained, unlicensed) might provide at home, and no one would see any problem with that. "Assisted living" is not intended to be skilled nursing care, and the various regulatory and licensing agencies have determined that CNA-level care is adequate/appropriate for that client population ...

lindarn · Feb 21, 2006

I agree with you that CNAs are in no position to be advising people on their family members' medical conditions.
However, the reason that CNAs are running assisted living facilities without licensed nursing personnel is that clients in assisted living facilities are supposed to be people who are medically stable but need some help with ADLs, taking their meds at the right time, etc. -- the same kind of help that a family member (untrained, unlicensed) might provide at home, and no one would see any problem with that. "Assisted living" is not intended to be skilled nursing care, and the various regulatory and licensing agencies have determined that CNA-level care is adequate/appropriate for that client population ...

That may be true, and I have heard that argument before. I know that is how the nursing home industry got this legislation passed-to allow unlicensed personnel to administer medications, and perform other professional duties that have been reserved for health care providers. The argument that, "its just like the person is home and their relative is administering their meds".

This aguement doesn't fly in my book because the relative administering the meds in the persons's home, doesn't have 20 or 30 other individuals to give meds to. And has the person's best interests at heart, at least most of the time, or should.

Lindarn, RN, BSN, CCRN

Spokane, Washington

LPN1974, LPN · Feb 21, 2006

I recently had a relative (of my husband) in an assisting linving center in Idaho. THe center is ran by CNA's. THey do everything, including med pass. They even went as far as telling my mother-in-law that this person had not been having mini-strokes and he probably had a "real stroke". I was angry because I don't think they are educated enough to be telling family members about medical situations like this. (in fact he had several TIA's that led to a CVA and his death.) I don't understand why the CNA's are allowed this much power, there is never a nurse there. Does anyone know why or have any comments?

I think it's all about money. It's a cheaper way of taking care of elderly folks instead of placing them in regular nursing homes.

IMHO, if they need assisted living, they should get that assistance at HOME, if they have to go to a facility, they need more care than what an assisted living facility provides.

Elderly people are so prone to accidents, get sick easily, have sudden CVA's, MI's, etc.

IMHO, a nurse should always be around close somewhere, for some kind of supervision and assistance.

DusktilDawn · Feb 21, 2006

That may be true, and I have heard that argument before. I know that is how the nursing home industry got this legislation passed-to allow unlicensed personnel to administer medications, and perform other professional duties that have been reserved for health care providers. The argument that, "its just like the person is home and their relative is administering their meds".
This aguement doesn't fly in my book because the relative administering the meds in the persons's home, doesn't have 20 or 30 other individuals to give meds to. And has the person's best interests at heart, at least most of the time, or should.
Lindarn, RN, BSN, CCRN
Spokane, Washington

Agreed. A relative being taken care of at home would be more of a one-on-one situation, or greater depending on the support within the home. They would not be responsible for 20-30 individuals, and would only have one persons interests at heart.

The point is, IT ISN'T the same as being taken care of at home. Assisted Living, key word being assisted, implies that assistance is required. Assistance for medical needs, including medication, should be provided for by appropriate, trained, licensed medical professionals.

Josifek · Feb 21, 2006

Money has a great deal to do with the situation. Caring for the elderly is a big business. If you were to approach these situations from a business perspective it makes no sense to hire a LPN for $17.00 per hour when one can hire a PCA for $10.00 per hour and still be legal. It's a shame that this is the mentality when it comes to caring for the elderly. I worked as a private PCA once at an assissted living home for a family whose 94 year old father lived there. The reason they needed to hire a private person to come in and sit with him was because he could do practically nothing for himself. The CNAs who worked at the place were not supposed to be giving total care to these folks as it was "assisted" living. So the place would take in pretty much anybody and then the families would end up paying double: one price to the facility and another to the nursing agency who would send out a sitter every day from 0800 to 1730. I really mean that this man could do almost nothing for himself. I did the same things for him that I would have done working as a CNA in a skilled care LTC facility. I always felt bad about leaving him there in the evenings because once I was gone he was pretty much alone save someone coming to help in into bed in the evening. Also, he wasn't the only one in the facility who needed such care. This same company owned a skilled care facility next door to the assisted living home. I could never understand the criteria for who would qualify for which facility since a good number of the folks in the assisted living place really needed more than a little assistence.

Long Term Care Columnist / Guide · Feb 22, 2006

The acuity in assisted living---just like everywhere else in health care---has risen in recent years. I recently returned to ALF nursing after a 5-year absence, and in my building we have residents with severe dementia (but who don't wander), diabetics requiring sliding-scale insulin, even a couple who are 2-person transfers at times. Five years ago we couldn't admit sliding-scale diabetics or even hospice patients; now, we take care of people with pressure sores, vascular wounds, ostomies, and relatively complex medical needs that once would have had to be managed in a nursing facility.

Fortunately for all concerned, I'm in the building at least 32 hours a week and there are only a maximum of 42 residents (we currently have 38), so the capability to deal with the demands of higher-needs residents is there---what's needed is training. I'm a strong believer in teaching caregivers the WHYs of the nursing care we provide; otherwise, you can train a monkey to do a fingerstick, but you can't give him the critical thinking skills to make him ask "Why am I doing this task? What would happen if I didn't do it, or if I did it differently from how I was taught? What are the risks here if I do it wrong?" If this teaching can be done successfully, lay caregivers can be amazingly effective in the ALF setting.........I've seen it happen. But ALFs, like all other healthcare facilities, are only as good as the staff managing them, and the staff is only as good as the training they receive.

Just my two cents' worth. :nurse:

Town & Country · Feb 22, 2006

Also has to do with the pesky fact that there's more and more elderly people requiring care, with less and less nurses to perform said care. Personally, I think there would potentially be enough nurses but the situations new nurses encounter after school scare them off. Plus the suits running the LTCs wouldn't staff appropriately anyway; less money in their pockets.