Assited Living: The new skilled care

  1. 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?
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    About NJayne17

    Joined: Apr '08; Posts: 40; Likes: 28


  3. by   onthemark
    If it were up to me, the facility should either accept only patients requiring assistance (not total care), or get another nurse to work with you. It doesn't seem fair to either you or the patients the way it is now. Good luck!
  4. by   VivaLasViejas
    Thirty residents? I'm sorry, but that would be HEAVEN.......I'm the lone RN for a building that currently houses almost 90. Of course, there are medication aides and resident assistants who do most of the care, and we use home-health agencies for all wound care and therapies. I'm a DNS rather than a floor nurse though, so that may account for the difference.......Either way, we both have a lot to do!

    And yes, I think ALF's have become "Nursing Home Lite"---I've got sliding-scale insulin-dependent diabetics, dementia, complex medical, even some who are turn-Q-2hr. and dependent for all their ADLs. Just about the only residents we don't accept are wanderers, tube feeders, and people who need mechanical lifts or thickened liquids. Everything else is up for negotiation, although I occasionally do say "No #$%&!! way!" to some of the prospects that land on my desk courtesy of the marketing director.

    I did work (briefly!) for one company where the sales rep---the SALES REP, for God's sake!!!---made all the admissions decisions without nursing input. I promptly resigned when she moved in a 250-lb. Parkinsons patient who was so rigid he required three staff AND a Hoyer lift to transfer him. She'd just move these folks in and say "Here, YOU figure out how to take care of them." This man also choked continuously on his own saliva, and aspirated twice during the 10 days he spent in the facility before he was finally sent to the hospital and then moved to an ICF where he belonged.

    So if you're not working for a company like that, be very thankful! The one I work for now is pretty sensible, although they occasionally try to sneak a prospective resident past me who I know isn't suitable for assisted living. I'm pretty flexible, but I balk when I'm presented with something I know is going to progress fairly rapidly and require moving to a higher level of care within a few months, and if they are already having behavioral issues or swallowing problems, I prefer to pass.
  5. by   NoahscoopsRN
    I currently work at an "Assisted Living" facility and I use quotations for a reason..90 percent of our residents should be in nursing homes, period. We have a paraplegic, lots of Alzheimer's/wandering issues and numerous residents with hoyer & other mechanical lifts. I've been told, "the face of assisted living is changing" and that is why they are accepting who they are accepting. It is RIDICULOUS. We have about 80 residents by the way, I'd love to have just 30!
  6. by   happyinillinois
    I worked in a "High-end" dementia unit and they were constantly acepting patients who didn't belong there. It was all aboiut the $$$$.
  7. by   DixieRedHead
    Happening at my facility too. We have skilled and AL beds. (60/40) We have many residents who are total care, there is just nothing to skill them. This is the result of the changes over the years in skilled criteria and the demise of ICFs.
    I have managed to increase the nursing assistants to the same ratio as on the skilled unit although they do not have a bath team and spread baths over two shifts. Our AL beds are always full because residents are moved to make way on skilled for rehabs.
  8. by   HDHRN
    Hello! Im in the same boat. I have worked on my AL's unit for 1.5 years. We are full! I have 28 residents and am the only nurse on the floor during my shift. I have two RCTs. We have at least three residents now that should be skilled care. They just take up too much time. I am only part time and work 5 hours! That's not enough time. Especially if you are super busy with new orders, falls, and charting. I left last night at 20 til 10 and my shift ends at 9. my boss is on our ass about staying too long, well I am sorry I am not gonna dump it all on the next shift if I can help it. We don't have a nurse overnight, so I have to get as much as I can done. I hope it gets under control soon.
  9. by   Hotnurse06
    I'm currently in the same situation. My facility is all completely private pay. Just about all of my patients are 2 to 3 person assists, or total dependents. We have thickened liquids, feeds, colostomies, wound care, and special diets. I feel that assisted living should be just that, assisted. When it gets to the point where the patient is non-weight bearing, then they are no longer appropriate for the facility. My facility doesn't even have stand-up or Hoyer lifts, so as you can imagine, we have a lot of turn-over with the staff. Who wants to injure their back?
  10. by   Vtachy1
    I know right?!?!? I saw this article and I said "you know, you can put lipstick on a pig and its still a pig" I see the trend too!
  11. by   DixieRedHead
    Quote from Vtachy1
    I know right?!?!? I saw this article and I said "you know, you can put lipstick on a pig and its still a pig" I see the trend too!
    I read this article. Sounds all nicey nicey, but what happens when the "one Registered Nurse for three homes" has a code in a building she is not present inn? This is a recipe for losing your license in a hurry.
  12. by   KimberlyRN89
    I am not a nurse yet, but I work as a "caregiver" in a Alzheimer's assisted living facility. When I first started 2.5 yrs ago, the resident service director (at the time), told me that they had certain criteria that prospective residents had to meet (i.e., no diabetics, none that required 2 person assist, things like that). But as the months went by, it dawned on me that this was not an ALF, just a nursing home in disguise. Before the resident service director resigned, she mentioned to me during my annual evaluation that it was definitely not her idea to accept residents who required so much care..but with the economy the way it is, the company (we are owned by a very large company that has facilities in 30 states) was telling her to accept EVERYONE who was interested in living in the community. So I say that to say this: sadly, this seems like the trend for most ALF's these days. And I think it's awful that they can get away with this..but they are not regulated like nursing homes are..and that's why things will stay the same
  13. by   favthing
    I have a med pass of 44 residents, and a total number of over 70 residents. We don't have med techs, but it is family-owned so we've got the uneducated (as in, not even taken an aide course) kids and friends of the kids of the owners as management and nursing care decision-makers. As assisted living, we are not regulated like a nursing home, but definitely have nursing home patients. There's a great divide between reality of quality of care and the "sales" image. I've been in assisted living for 3 years, and as I'm looking for a new job, I'm hearing things like "even though it's AL, we CAN count it as long term care", as though a favor. We have a new nurse who recently started, and I want to just take her hand and guide her out of there right now...she reminds me of myself when I started. ALFs are scary as a nurse, as while there's increased acuity, the care paradigm has remained as though there are a bunch of little old people with a sound mind, body, and voice directing their lives, what AL used to be.

    While residents may be with a NEED of 'skilled care' at ALFs, the set-up for 'skilled care' is not in place. SCARY. Okay, now I sound bitter, so I'll stop now.
    Last edit by favthing on Nov 8, '11
  14. by   clinicalteach
    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.