Pseudo nursing home: assisted living?

[amjowens]

I'm working at a place which really prides itself on the assisted living concept. In theory I think the idea is amazing. In action, I'm seeing that there's a lot of denial going on, and it's the staff (and ultimately residents) who suffer.

We don't have as many staff (one nurse for over 50 residents, and at night, 2 aides, and 3 or 4 on other shifts), and don't have resources because the admin. thinks the residents are independent. Some of them are, but there are a lot who are not. For some, they should have hoyer lifts, yet they don't even have an appropriate bed that lifts to a safe level for transfer! We have residents who need turned and repositioned every 2h, but I've noticed not even pillows or anything that gives a clue that it's being done. The needs of the residents are great, yet there isn't enough staff or support.

There's a high rate of turnover. I want to make it work, but there isn't flexibility in schedules, there isn't resources to care for residents, and the aides are all angry and overworked it seems.

I think I'd rather be in a nursing home that at least accepts that they need funding for things like assistive devices and has more than one nurse per shift working. I know things can be challenging in every environment, but I'd be happier if we could at least face issues, and not act like everything is rosy and wonderful when it's not.

[SuesquatchRN, BSN, RN]

It sounds as if these folks need skilled placement. We have an adult home, but residents must be ambulatory and require truly minimal assistance with ADL's.

[VivaLasViejas, ASN, RN]

This is why I left assisted living last year. We had 70 residents, 25 of whom should have been in a nursing home.........so what we were doing was running an ICF without ICF staffing, ICF resources, or ICF equipment. There were 15 sliding-scale diabetics, several 2-person transfers, several more who needed to be turned and changed Q 2 h, and still more who suffered from such severe dementia that they should've been in memory care or even a psych unit.

I was the ONLY nurse for all of these residents; not only that, but not a single one of my caregivers had so much as a CNA certification. So yes, the ALF concept is a nice one, but there are too many greedy corporations out there that will admit almost anything with a pulse, as long as it has money enough to pay for their services.......and the 'care' is all too often sorely lacking. I wouldn't take another ALF job for any amount of money now. But that's just me.

[absolutenurse]

Sounds like your assessor is not doing their job fully (RN or LPN?) The RCM/DRS has the right to say no to unsafe or too high care residents. Yes they become the badguy to the Admin. but the assisted living protocol is "stable and predicable" according to the nursing judgement of the facility. If a resident needs a hoyer then see if you can get home health involved. Your best resources in the assisted environment is Home Health, Hospice and Physical Therapy to help take the burden of assessing needs once there. I was recently the care manager at a private pay assisted living and won't do it again for a long time, so much politics and overwelming stress constantly when your not given proper help to take the non-nursing parts of the job out (ie staffing, scheduling, drama issues...) Sounds like your maybe part medicaid which is worse then private pay, still family should have the responsibility of providing pillows, toiletries... (at least where I was). Lastly, for your license sake, have your managment give you a copy of the disclosure statement, that's one the the first things state scours when they arrive, are there things on the statement that the facility says they don't do but you really do? (ie assistive device transfers, pureed diet, bedridden...) Hope I helped. I personally really like skilled nursing/LTC and hope to go back to that real soon.

[VivaLasViejas, ASN, RN]

The 'assessor' at my last facility was the SALES AND MARKETING DIRECTOR. Yes, a non-medical person was in charge of admissions. This girl would go and "evaluate" potential residents, then hand me their information with a flip, "Well, yes they have behavior problems, they're incontinent, they wander, their family is totally crazy and they've been thrown out of two facilities already, but we'll make it work, won't we?".