Assited Living: The new skilled care

Specialties Geriatric

Published

I am an LPN who is working in a very nice, privately owned ALF.

It seems that for the past six months, the residents that are coming in to live there require alot of care than what ALF can provide.

These residents, most are in the later stages of Alzheimer's are in need of total care.

The facility is half full and I know that they are looking for warm bodies who have $$$.

I am sooo frustrated because I am the only nurse on day shift caring for 30+ residents doing new admissions, med pass, processing MD orders, dealing with pharmacy, residents, and there families.

We do have HH come in to do labs and the occasional wound dressing.

Is anyone else experiencing this?:nurse:

Specializes in Telemetry, Orthop/Surg, ER,StepDown.

i am at a 70 bed ALF. It was starting to go the way of a SNF, but I have to say... for all the issues I've been dealing with during my first three months, my ED has finally said he trusts me and has not once interfered with my yea or nay of a new prospect and has even told the Business Manager and Marketing Director to back off with their attempts to run the medical side and that my decision was the final decision and no one got to second guess it because as far as he knew, they hadn't gone through nursing school. I could have kissed him that day. He presents what the referral source brings to us and then leaves the evaluation and the approval to me. I'm finding out that that is a rare rare thing, and so...while I'm on the lower end of the pay scale for the job, some things help ease that gap.

Specializes in Assisted Living, MDS, med-surg, hospice.

What do your state regulations say? I am a Wellness Director in Tennessee and our facility has secured dementia unit. Ask to read your state regulations.

i am at a 70 bed ALF. It was starting to go the way of a SNF, but I have to say... for all the issues I've been dealing with during my first three months, my ED has finally said he trusts me and has not once interfered with my yea or nay of a new prospect and has even told the Business Manager and Marketing Director to back off with their attempts to run the medical side and that my decision was the final decision and no one got to second guess it because as far as he knew, they hadn't gone through nursing school. I could have kissed him that day. He presents what the referral source brings to us and then leaves the evaluation and the approval to me. I'm finding out that that is a rare rare thing, and so...while I'm on the lower end of the pay scale for the job, some things help ease that gap.

Is your facility hiring? I'm not sure if I'm joking or not. Management relying on nursing judgement for admits doesn't happen just anywhere!

Specializes in LTC, assisted living, med-surg, psych.

It happens in my building. ;) But that's because my ED is a former paramedic who understands the medical side of things almost as well as I do, and he trusts my judgment even more than he does his own. I am fortunate indeed.

Specializes in LTC, MDS.

Ive noticed the trend with skilled, too. SNFs are the new sub-acute and sub-acute is the new med-surg. So all the long-term SNF patients are being sent to ALFs and ALF patients are staying home

So is it because the alf are not governed by the state that they accept these people...it would have to be private pay stuff....are they cheaper as private pay than say a nursing home private pay....if the trend continues i would think regualtion would come into play and put a stop to that...

Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
So is it because the alf are not governed by the state that they accept these people...it would have to be private pay stuff....are they cheaper as private pay than say a nursing home private pay....if the trend continues i would think regualtion would come into play and put a stop to that...

Absolutely correct. ALF's are not inspected by the "state" however they answer to DSS (Department of Social Services). Now I know a great bunch of social workers, one which is very special to me, HOWEVER- none of the social workers I know can inspect a bedsore, watch for proper technique on incontinence care or wound care...not sayn they can't- just that they are not trained to do that and according to regulations, only a nurse can look at "private areas". Where I come from, the ALF's are private pay and because their rates are cheaper than LTC, thats where people go. Most advertise that they have "Special dementia care" which is lovely, but when the person becomes total care, then who provides that? I have seen nghtmares come from ALF in terms of residents who were really more care than they could handle and developed horrid bedsores, weight loss, and so forth. I am not saying all ALF's are like that...but some are.

Specializes in LTC.

My nursing home was seeing low census over the summer and we figured out that the new ALF in town was starting to take residents that would normally come to a nursing home because their census was only 18 total.

The residents we ARE getting were formerly kept in the hospital...it's like Med-Surg with 25 people. IV vanco x 2, morphine pump, urostomy, new colostomy, huge wound dressings, wound vacs, 4 fx's, TKAs, THAs, ect....I think the people in the hospitals on Med Surg used to be in ICU, and the ICU people must have not survived in the past. Crazy.

Specializes in Med Surg/Tele/Ortho/Psych.

They regulate in Texas.

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