Night time coverage for ALFs

Long Term Care Columnist / Guide · Jan 21, 2004

We had a policy at my facilities which called for caregivers to call 911 for all falls occurring when I was off duty. The paramedics hated coming out, but it was the only way to assure that the resident was properly assessed whenever there was no licensed person in the building. There was really no way around it, because my company was NOT going to pay me for being on-call 24/7, and I didn't want to be called in the middle of the night everytime someone went down on one knee next to their bed.

I also made the staff call whenever a resident on Coumadin started bleeding and they couldn't stop it within 5 minutes. We learned this one the hard way, we had a female resident whose INR was something like 5.5, only nobody knew it until she scraped off a hunk of skin on the edge of her dresser and began bleeding profusely. The staff tried for over an hour to stop the flow, but finally called 911 when she started feeling faint and her face turned white. The paramedics came, took her to the hospital, and her H&H were like 7-something and 19-something!

Took 4 units of packed cells to bring her back to normal, and of course they had to keep her in the hospital a few days to adjust her meds and get her INR back within therapeutic range.

Of course, I loved it when some staff members just didn't understand the necessity of calling 911, and why I couldn't assess someone over the phone from 30 miles away.........they'd call me to find out what to do for so-and-so, who was having chest pains and SOB. HELLLL-OOO??! My first answer was "Why are you calling ME?! Call 911!!":(

jrenae · Jan 22, 2004

mjlrn97, thanks so much for your help. I feel the same way.

Marti Ann · Feb 21, 2004

My company is looking to open an ALF having 20 units. Our state doesn't require a nurse to be on site 24hours/day, just wondering what other facilities do? If someone falls does the person who is working call the nurse on call or do they assess for visible injuries or c/o pain and then determine if a 911 call is necessary? In my mind the nurse will have to drive in to make the assessment, I would never make an assessment over the telephone? :eek:

In Fl it is not a requirement for an ALF to have a nurse on duty at anytime: RN or LPN. someone, yes, it could be the housekeeper only has to have CPR and first aid. that's all we ck for. I hate this with a passion. No nurses to ck CNA's who pass med either. so who does assessment? no one! . poor, poor residents and families. someone is losing out here. guess who?