Renashia

I did a clinical at a alzheimer's unit in Tigard during my Master's program. At that time the Director was receiving around 45-47,000 a year. That Director was also a ARNP. In Seattle as DON in an Assisted Living I make between 48-50,000 a year depending on bonuses for no-overtime and staff turnover. With 5 years of nursing expereince and an almost finished Masters in nursing. I would suggest searching on google for salary comparisons for your area to see what a HSD is making. You have the years of nursing expereince to negotiate a respectable salary.

My facility got hit in Washington about 2 months ago. 75% sick in the Resident population. Our other facility had a 85% sick rate, but higher acuity. Word of warning. Norwalk is NOT killed by hand sanitizers. Staff must wash hands or use enough hand sanitizer that you hands stay wet for 1 minute. Use a 10% bleach 'activated' solution, normal bleach solutions are not effective either. We had an excellent infection control guru that I was able to get good guildlines from during our outbreak.

Actually part of the reason I posted was becuse I was looking for a journal in Assisted Living. We are really in a grey area. Not a retirement hoe not a SNF. Good and bad. I'm also lucky that I have a good boss. MAkes life so much easier for me.

It's also nice to see an age-mate as a DON. I'm the youngest person in our parent company running a nursing dept.

Weetziebat, I hope they have those every year. I think the only thing saving me is that my LPN has years of SNF expereince and I have a very small AL (58 rooms). My newest project is trying to memorize the WACs for assisted living. Making me cross-eyed.

That is too bad. I knida feel out on a limb in Assisted Living. I was lucky enough to attend an Assisted Living training put on by WHCA (washington Health CAre association) and got a lot of good information there. But I have no other resources to read, it's very frustrating.

If you have a PDA I recomend the free version of epocrates.com, nurse's version. (or if you have a computer at home, they have an on-line version that is also free). The PDA version is a great fast look up without flipping through a book and gives very specific info on what you need to teach/know about the drugs your giving. Also has a great multi-check so you can compare all those drugs your patient is on and look for intereactions!!!

http://seattletimes.nwsource.com/news/local/licensetoharm/

Well the reson this article made the front page is the the State of Oregon didn't take away the offender's CNA licence for over a year. (well according to the media, and we all know how reliable THAT is) In which time he was able to secure a new CNA licence in Washington. About 1-2 years after the conviction of 2nd degree rape in Oregon, he was discovered in Washington. Washington DID not take away his licence for nearly 2 years!!! He supposedly fled to Sri Lanka, so he was deemed not to be a threat. In actuallity he got a fake SS#, Drivers licence and started working as a NA, which dosn't require the same backround check as a CNA. At last I heard they where unable to catch him.

I agree! One teaching method I like to do with my caregivers is "reality switch". They get to sit in a wheelchair, drink a full glass of water, and try to get someone to help them. Or they get to be a guinea pig in transfers, hoyer lift training, and feeding so they know how their residents feel. Too bad we couldn't return the favor to the nurse who assulted this resident!!

sigh, it was supposed to be rely.... not reply.:trout:

I have been the DON for about 8 months up here in the Seattle area. I am having difficulty finding good resources to review for Assisted Living. Ifind myself haveing to reply on NH guidelines and policies and trying to adapt them to assisted living. Anyone have any good resources for the Assisted Living Nurses?

YES! Nurses are manditory reporters and above all PATIENT ADVOCATES! I personally find it appauling that anyone is put in this situation as a new grad nurse. And that ANY resident is "taken down". It suggests to me that the facility cannot meet that resident's needs. I know it's different in SNFs and NH, but in an Assisted Living the resident must be stable and predictible to be a resident under the DON's care. You can make an anounomous tip to the State if you truly feel your job/standing is in jepordy, though it won't have as much of an impact. Also you can contact the local omsbudsman. Studies have shown the 70++% of the time problem behaviors in residents are directly related to the CAREGIVER approach. Personally I hope the nurse got a nice bacterial infection when the resident bit her. Good on you to report it! It is very difficult to pluck up the courage in a new job and a new feild. PErsoanlly I think it is great haveing a mixed population of nurses in any nursing area. You have the new "book smarts" and the "teaching of lifetime" expereinces to help provide excellent nursing to our elders. Good luck .. HHC LPN!!! For you DON---> :trout:

Anyone in WA and OR probually saw the articles few weeks ago about licenced CNAs convicted as sex offenders in OR moving to WA and having there licence's re-issued. I unfortinatly hired one of these **** . Lucky for us, my administrator saw the person's photo in the paper and we escorted him out of the building. The freaky thing is that his background check had come back without a record!!!!!! In our investigation we found that he had an alias, had lied about his address, had a fake SS# and fake drivers licence. The ONLY red flag we got was when we decided to run his alias name against the CNA database, which we never do since we don't hire CNAs. The state healthcare body and the state legal offices don't communicate between eachother. I'm sure you can see how freaky this is. I also have a lot of guilt for being the one who hired him. Even though he had an excellet reference (which we checked all 3), had a freindly and charasmatic peronality and the residents loved him. The only red flag I had about him was a n incident I witnessed with the trading between shifts where he approahed a young pretty Caregiver in, for lake of a better explaination, a "Mac Daddy" personality (put his arm around her shoulders, swaggered, and said "Hey Girl" to her). Which just raised the hairs on my neck. (We found later that his sex crime was againat a younger patient at a hopsital.) After that I had started to phase him out of working with this caregiver and I had reduced him to 1/2 time since he was having other problems with his job. Not sure why I'm venting, rather then that I have to. LOL, I REALLY wanted him to cause a seene when we escorted him out, I was itching to thump him a bit. Very un-nursey caring I know, but I can't stand anyone that would take advantage of a sick person or a young person.

Before taking the DON position at an Assisted Living, I interviewed for Alzheimer's Director positions in Oregon/Washington, pay was varied between 45,000-55,000 a year. With the difficulties associated with the unit I hope you would have a good game plan to change the culture of the unit. Sounds like about 1/2 the staff need to be let go. I'm not sure how much expereince you have witht he Dementias, but I would contact the local Alzheimer's association and get training materials and re-educate your staff. Introducing a new Alzheimer's care paradigm like "the best freinds approach" or "the eden project might get the ball rolling. Also contact local SCU in the area to get help. I think if you accept the job you will have to lay down some rules to the staff about conduct. I found that "My way or the Highway" was effective. You are the nurse and know what the residents need, don't let the caregivers run your unit. I hope you do take the job, it sounds like those residents and families deserve better then what they have going on now.

If the DON is not helpful I would approach the omsbudsman and get them invoved. If it is hapening to you mother it is happening to other patients who are not A & O. Also, and LTC facility is licenced by the state. Make a complaint to the state if you don't get the responce you need to ensure the health and saftey of you parent and the other residents. Tracy, DON Assisted Living

I have worked as a CNA on a SNF, a RN in an Acute Care Hospital, a HH RN, and now as DON at an Assisted Living. Hated the hospital 1 RN, 1 CNA to 12 patients on a 12 hour NOC shift, on an overflow Truama unit. CNA at a SNF was frustration and the nurse where always over worked and understaffed. Home health I loved. Though I defianlty agree about the "red Flags" Kona2 brought up. Our HH agency was fairly well run. And if all you had where re-visits (not first time visits) the paperwork was acceptable and the home visit was about 30-45 minutes. Then there is the evil OASIS, which on AVERAGE took me 4 hour to complete (including the other admission details, med review, excetra). My company kept telling me that I should have the OASIS/home visit done in 2 hours. Though in hindsite compairing the OASIS to the MDS, I'd take the OASIS (at least all the questions where pertinate). If you really want to pursue a HH job, which I would recommend despite my rant above. MAke sure you find an agency that pays hourly, not by visit. Pays hourly for on-call and full salary for calls. Also look to be a case manager, it is much easier seeing the same patients weekly then seeting everyone elses patient (I was the weekend supervisior and 24 call person for the weekend for salary).

As a DON at an assisted living, I know how frustrating it is to teach carestaff how to approach residents correctly. Many of them come with preconceived notions of how to do it and cultural backgrounds that differ from ours. I'm not sure what state you are from, but in WA all carestaff is required to goto 2 days of Dementia and MEntal Health training and my facility has a follow-up dementia and mental health inservise weekly. IT is much more difficult in nursing home settings to provide the carestaff with inservices due to the high turn over. Try a few of the following. - Have her mental health re-evaluated by a GERATRIC Mental health provider (NOT THE PCP). She may have underlying conditions that require a change in meds. Sometimes a good Home HEalth Mental HEalth Nurse is avalible. - Try switching staff, if she refuses to get a shower from one CG, she may do a shower from another - LET HER REFUSE, she has a very specific reason for not wanting a shower, we just don't know why. If the CG push, most demented residents will push back. -reaproach 2-?? times. -Try being there during the showers to help guide the carestaff - "Bag" the shower idea and try a bag shower (black plastic bag with non-rinse soup, hot water, and towels/washcloths) Not quite as good as a real shower, but better then nothing. - Look into trasfering your Grandmother to a special care/Alzheimer's unit. Hope this might help a bit. Tracy

Funny you should mention. Since dropping my CNS program I have gone into the Assisted Living world. Never loved something so much in my life. I definatly recommend it. I think I will probually go back some day for a MS, ut probually in Nurse Management.

No I recieved no feedback. I have also since dropped my GEro CNS program d/t lack of interest in the job feild in the area (well at least no one is interested in hiring for a APN in the Dementia feild I choose to follow). Now they no longer offer the program. You might think of going into a NP program rather then a CNS program.

Guess there is another good reason to wear a sleep apnea mask.... no chewed up spiders in MY mouth. That is the nasties thing I have heard..... and how can they prove it!... Shudder :chair:

Well I am taking my degree at Oregon Health Science Univ where they offer a Gero CNS degree. Well they did anyway, they just cut 90% of the CNS degrees offered at OHSU, including Gero. The three remaining Gero CNS students have to take our degree by this spring or the classes we need will not be offered. Most of the CNS's I have meet working in Geriatric populations have a CNS in another feild (med-surg, mental health, AHI). We only had 4 classes offered specificaly for Geriatrics, the rest of our classes where general CNS classes. Quite often the instructor didn't know why the Gero students where in the class!

I will be graduating as a Gero CNS this June and have been looking around for a job, with little result since no one is posting for a Gero CNS. Anyone with ideas on how to find a job they aren't posting, but a CNS in Gero would be an asset? Also what salary should I be asking for?

I work in home health under salary. Our serivce area covers 3 counties and I can put approx 30-100 miles a day on my vehicle. We are usually given the equivalent of 5-6 visits a day (resumtion of care and start of care is considered 2 visits, driving over 60 miles is also considered a visit). I am paided approx 21.00/hr, but I am a relativly new nurse. Another salary HH agency near us starts their nurses at 23.75/hr. Truthfully though I rarly am done with a 5-6 patient day in 8 hrs, it is usually 9-10 depending on my drive time. Hope that helps a little.

Well considering the inserive I had on this issue last week in my home health agency, I think it is following nurses out of the hospitals. :chuckle