Just when you think you've heard it all......

Town & Country · Oct 28, 2004

I read this, and even knowing what LTC facilities are like, even I am shocked, and that is saying something.

I work for a 911 dispatch center for EMS in Florida. Last night a recieved a call from and assisted living facility. The person on the phone was asking for lifting assistance for a patient that had fallen on the floor. I then asked if there was a nurse on duty that could come in and help the patient up off the floor. The man told me there was no staff on duty. This was around midnight. Assuming it was the patients roomate suffering from dementia, I called the main line number to the ALF. The same man answered the phone and told me he was the only one there. Of course we sent out an engine to assist the woman and when they got onscene they said there actually was NO staff on duty! The man who answered the phone was a maintenence man.

We promptly sent a deputy over there to see what was going on. The maintenence man explained to him that he was CPR certified and had been authorized to watch the pts for a full two hours every night when there was no staff on duty. The deputy wrote an information report and called us back saying he didnt know enough about nursing home laws to make any criminal charges.

So my question is, is this legal?? Do assisted living facilities have seperate laws than nursing homes do? Is this something I should report? I know if that was my mother and there was no qualified staff on duty for any amount of time at any hour I would be outraged.

Just another note, the deputy was told by the maintenence man that the patients he was supervising were "independent livers" and at low risk of injury during the night. The deputy told me the lady who fell out of bed was 98 years old. And who knows how long she was on the floor. Can she really be an "independent liver" if she was on the floor unable to get herself up?

http://www.prairielaw.com/messageboards/board.asp?channelId=26&mbId=124

UM Review RN, ASN, RN · Oct 28, 2004

It might be legal, it might not. I do know that ALFs have very different laws governing them than do LTCs. For instance, unlicensed personnel can "give" medications to the residents, but are not actually dispensing them. REALLY fine line there, IMHO, but just an example.

The best way to find out the law is to get in touch with the Dept. of Elder Affairs. Here's a link. The hotline number is there too.

http://elderaffairs.state.fl.us/doea/english/PARTNER/partnerombud.html

UM Review RN, ASN, RN · Oct 28, 2004

It might be legal, it might not. I do know that ALFs have very different laws governing them than do LTCs. For instance, unlicensed personnel can "give" medications to the residents, but are not actually dispensing them. REALLY fine line there, IMHO, but just an example.

The best way to find out the law is to get in touch with the Dept. of Elder Affairs. Here's a link. The hotline number is there too.

http://elderaffairs.state.fl.us/doea/english/PARTNER/partnerombud.html

missmercy · Oct 28, 2004

It doesn't surprize me -- unfortunately I think it probably happens alot more than we find out about. When I was in high school -- I was a certified NA, worked at a retirement home -- "assisted living at it's finest" or so they said. I worked from 3-11P.

After the kitchen crew had finished cleaning up (usually by 7), I was the only staff member on until the next shift -- she was then the only person on until the kitchen gang got in to start breakfast. (like the kitchen gang was going to leave the kitchen and come out to help with ANYTHING!) We had 35 residents -- all 70 or older, a couple of rather excentric gals, a few senile folks and almost every a medical condition of some sort.

The building was 3 floors tall, and I carried a cordless phone with me on "security rounds" - so residents could call me if they needed assistance -- or I could call 911 "just in case". I was also responsible for "giving meds to any residents who required suppertime or bedtime meds.

Nothing horrible ever happened on my shift -- a couple of falls, a drunk guy sneaking into an empty room to sleep it off, a resident dropping his cig butt in the trash -- got the fire out right away -- he was sitting in the dining room -- just happened to be locking DR doors to the patio when he did it. But a midnight gall found a resident on the floor in the hallway -- apparently she had started down to the desk for some reason and then fell in the hall on her way to her room -- tried to get to her room to phone for help -- had an MI and died -- probably within 10 mins of the staff member doing her 2A rounds.

missmercy · Oct 28, 2004

It doesn't surprize me -- unfortunately I think it probably happens alot more than we find out about. When I was in high school -- I was a certified NA, worked at a retirement home -- "assisted living at it's finest" or so they said. I worked from 3-11P.

After the kitchen crew had finished cleaning up (usually by 7), I was the only staff member on until the next shift -- she was then the only person on until the kitchen gang got in to start breakfast. (like the kitchen gang was going to leave the kitchen and come out to help with ANYTHING!) We had 35 residents -- all 70 or older, a couple of rather excentric gals, a few senile folks and almost every a medical condition of some sort.

The building was 3 floors tall, and I carried a cordless phone with me on "security rounds" - so residents could call me if they needed assistance -- or I could call 911 "just in case". I was also responsible for "giving meds to any residents who required suppertime or bedtime meds.

Nothing horrible ever happened on my shift -- a couple of falls, a drunk guy sneaking into an empty room to sleep it off, a resident dropping his cig butt in the trash -- got the fire out right away -- he was sitting in the dining room -- just happened to be locking DR doors to the patio when he did it. But a midnight gall found a resident on the floor in the hallway -- apparently she had started down to the desk for some reason and then fell in the hall on her way to her room -- tried to get to her room to phone for help -- had an MI and died -- probably within 10 mins of the staff member doing her 2A rounds.

boulergirl, CNA · Oct 28, 2004

ALF's tend to be much more loosely regulated than nursing homes or hospitals, although I hear this will change eventually.

I have been left alone once with the residents overnight--and not too happy about it. What if a fire had broken out? Am I supposed to evacuate 40-50 people all by myself?? Turns out the situation mgmt placed me in is illegal. The nurse who left alone like that ended up resigning while under investigation.

Several months ago (on my night off) they had a new NA and a housekeeper running the building one night on 11-7. The housekeeper barely speaks English and can't read the pager, so residents were pulling their call lights the whole night and she ignored the pager. Now mgmt. is much more diligent about staffing the building.

boulergirl, CNA · Oct 28, 2004

ALF's tend to be much more loosely regulated than nursing homes or hospitals, although I hear this will change eventually.

I have been left alone once with the residents overnight--and not too happy about it. What if a fire had broken out? Am I supposed to evacuate 40-50 people all by myself?? Turns out the situation mgmt placed me in is illegal. The nurse who left alone like that ended up resigning while under investigation.

Several months ago (on my night off) they had a new NA and a housekeeper running the building one night on 11-7. The housekeeper barely speaks English and can't read the pager, so residents were pulling their call lights the whole night and she ignored the pager. Now mgmt. is much more diligent about staffing the building.

Antikigirl, ASN, RN · Oct 28, 2004

"So my question is, is this legal?? Do assisted living facilities have seperate laws than nursing homes do?"

They sure do! Each state has different codes to go by...and that one is scary! We have staff and one nurse per shift so that there is always someone there! When I took on my job at mine, I heard that CNA's and Unlicensed Care staff passed meds I freaked out! But it is legal, and we passed the state inspection with flying colors. Could have bowled me over with a feather! This assisted living deal, which I have been working in for 2 years..still is confusing to me..what I feel shouldn't be done..is totally okay...very confusing and I have yet to understand it all!

But remember, most assisted living facilities are ASSISTED! That means it is for folks that are basically independant but may need some extra help with laundry, remembering meds, transport to doc appointments...items like that. They are 'suppose' to be elderly residents that can't quite handle apartment living, yet are not ready for 'the home'. And I spend 3/4 of my phone calls explaining this to MD's (LOL, they think we have a lab, pharmacy, nurses caring for each patient..etc..they just don't get it! We don't even have a defib or pulse ox!!!).

We have two sides to our facility..real independant living (no staff) and our side..the assisted side. It is a huge complex! But the bonus to the independant side is they do have a licenced medic on the other side for emergencies (even though our admin does not want us to respond to them...my state requires me to...basically I assess and call 9-11 just like if I responded to someone in their own home!). The trick is with our facility..we do have more staff and real RN's per shift...most do NOT! (and boy do my residents pay for that...Oh my I would have had to start saving for retirement as a fetus to be able to afford a year in one!!!!!!!!).

But to not have a licensed medic on duty at night...that is insane! Most falls happen at night, MI's and strokes tend to hit very early AM! That would scare me too much! We have 10 service areas 12-13 rooms each...during day/swing there is one caregiver per area, one nurse per shift...at night one nurse and 1 caregiver to 2 areas...so a skeleton crew, but at least a crew!

But what is getting scarier, is that assisted living facilities are taking on more complex residents...ours included! Residents that would best be served in a SNF...so we are running about going crazy all day trying to handle 160 patients (the one shift nurse that is~!). And despite it all, admin hasn't hired two more nurses which we all feel is needed (one per floor..two story huge complex!).

Assisted living is gaining popularity, but I fear it is more for folks emotions than for function! People don't like the idea of living or sending loved ones "to a home" so they send them to these, and many really don't qualify as independant enough!

Antikigirl, ASN, RN · Oct 28, 2004

"So my question is, is this legal?? Do assisted living facilities have seperate laws than nursing homes do?"

They sure do! Each state has different codes to go by...and that one is scary! We have staff and one nurse per shift so that there is always someone there! When I took on my job at mine, I heard that CNA's and Unlicensed Care staff passed meds I freaked out! But it is legal, and we passed the state inspection with flying colors. Could have bowled me over with a feather! This assisted living deal, which I have been working in for 2 years..still is confusing to me..what I feel shouldn't be done..is totally okay...very confusing and I have yet to understand it all!

But remember, most assisted living facilities are ASSISTED! That means it is for folks that are basically independant but may need some extra help with laundry, remembering meds, transport to doc appointments...items like that. They are 'suppose' to be elderly residents that can't quite handle apartment living, yet are not ready for 'the home'. And I spend 3/4 of my phone calls explaining this to MD's (LOL, they think we have a lab, pharmacy, nurses caring for each patient..etc..they just don't get it! We don't even have a defib or pulse ox!!!).

We have two sides to our facility..real independant living (no staff) and our side..the assisted side. It is a huge complex! But the bonus to the independant side is they do have a licenced medic on the other side for emergencies (even though our admin does not want us to respond to them...my state requires me to...basically I assess and call 9-11 just like if I responded to someone in their own home!). The trick is with our facility..we do have more staff and real RN's per shift...most do NOT! (and boy do my residents pay for that...Oh my I would have had to start saving for retirement as a fetus to be able to afford a year in one!!!!!!!!).

But to not have a licensed medic on duty at night...that is insane! Most falls happen at night, MI's and strokes tend to hit very early AM! That would scare me too much! We have 10 service areas 12-13 rooms each...during day/swing there is one caregiver per area, one nurse per shift...at night one nurse and 1 caregiver to 2 areas...so a skeleton crew, but at least a crew!

But what is getting scarier, is that assisted living facilities are taking on more complex residents...ours included! Residents that would best be served in a SNF...so we are running about going crazy all day trying to handle 160 patients (the one shift nurse that is~!). And despite it all, admin hasn't hired two more nurses which we all feel is needed (one per floor..two story huge complex!).

Assisted living is gaining popularity, but I fear it is more for folks emotions than for function! People don't like the idea of living or sending loved ones "to a home" so they send them to these, and many really don't qualify as independant enough!

boulergirl, CNA · Oct 28, 2004

I agree with TriageRN_34's post. Assisted Living is a rather iffy environment. I have seen residents moved in and placed on the assisted-living unit when they clearly should have been on a secured Alzheimer wing on in a skilled-care facility. Why?? They have not been properly evaluated, but the family wants their loved one placed SOMEWHERE with a vacancy. Mgmt. just hired a new nurse, but we didn't have one for awhile, so residents were not fully evaluated before they were moved in. Sometimes I feel like our facility is a holding cell. (Of course, we have people who have lived there for years, but usually their condition changes and they have to move.)

The idea of having a medic in the building at night sounds great to me. If a resident's blood sugar dips too low or they appear to be having a stroke, I would feel much better having someone there who well-trained to handle this sort of thing. I don't like having to take charge in emergencies when I barely know what I'm doing.

boulergirl, CNA · Oct 28, 2004

I agree with TriageRN_34's post. Assisted Living is a rather iffy environment. I have seen residents moved in and placed on the assisted-living unit when they clearly should have been on a secured Alzheimer wing on in a skilled-care facility. Why?? They have not been properly evaluated, but the family wants their loved one placed SOMEWHERE with a vacancy. Mgmt. just hired a new nurse, but we didn't have one for awhile, so residents were not fully evaluated before they were moved in. Sometimes I feel like our facility is a holding cell. (Of course, we have people who have lived there for years, but usually their condition changes and they have to move.)

The idea of having a medic in the building at night sounds great to me. If a resident's blood sugar dips too low or they appear to be having a stroke, I would feel much better having someone there who well-trained to handle this sort of thing. I don't like having to take charge in emergencies when I barely know what I'm doing.