Should the following resident be in Assited living?

[Antikigirl]

We have a gent that came into our facility (assisted living) that was quite independant and was doing fine till about a month ago! He all the sudden started seeing Satan in his room, complaining that women were in his bed and got raped by doctors (docs?), started calling whom he thought were the police (which when we pressed redial one time wound up being a grocery store!), and just started taking out his clothing from a laundry hamper and urinating on them.

He complained of chest pain last week, and I sent him in to the ER no questions! I knew this was my only chance to get him really evaluated, and thought he would be put into a facility more suited for him! Nope, he came back after a week with a new diagnosis. CA mets of the brain and lungs, and quit a little list of psych disorders! OH goodie!!!!!! IN an assisted living facility???

SO we got hospice services for him..that is helpful. Yesterday however he about clubbed my head trying to get a CBG on him (thank goodness I didn't have to do an insulin...his CBG was fine)...he put up his fists at a CNA for just trying to help him get dressed, refused his medications, and wondered around the facility with a very unsteady gait..and wouldn't listen to us try to re-direct him to his room or even just to sit somewhere.

I used some "give the power to the patient" tricks I know and we finally got some medications to him (I simply asked him to see if he had time to take his medications, and we would return according to his schedule...that worked very well this time), and we got a haldol in him..no go..infact he started pill rolling big time..Okay psych meds not doing well! Holly cow why didn't the hospital keep him until meds were working or send him to a facility geared for this!!!!!! He is getting more aggressive, started talking to caregivers who have large breasts that they have them and that he likes them...and started self stim in the hallways under his trousers!

I told his hospice nurse and all she said was "be patient till the meds kick in"...BE PATIENT? Okay he is going to hurt one of my gals, me, or HIMSELF. He is not safe, will not listen, and we don't have any way to keep him from doing the things he is doing?!?!?! OH brother!

So now I get to wait till he hurts himself or one of us before I can ship him out one more time, and beg my admin to NOT let him come back. My DON is in full agreement with me!!!!! We can't handle this type of resident in assisted living!

What do you think? Is this yet another example of the 'gray areas' of assisted living that people should know!!!!! We are there simply to help apartment living of residents by doing meds, laundry, meals, and basic nursing PRN, and acute emergencies! THink this guy goes beyond that???

Oh and please feel free to vent about what type of patients you have at your facilites that shouldn't be there!!! Go for it..we all need to vent!

[Morning-glory]

I worked in a "retirement residence" that catered to the very posh for almost a year. They did a reno in the dinning room and spent $450 per chair. The price for all the renovations that were done was unbelievable. They could not, however afford to have the nursing staff that they needed. I had over a 100 residents that I cared for with only the help of one Aide on nights. 20 of these residents were assisted living. That 20 people for one woman to change 3 times a night. The call bell system was almost non-existant. One night, one of the ladies had a GI bleed. Blood all over the place. She had been telling the RPN's on the weekend that she was having rectal bleeding, but nobody had taken the time to go and see her in her apartment. Anyway, I get up there and she is lying down. There are several blood trails from the BR, evidence of her many trips unassisted. I call 911. There was no way for me to let the EMT's in, so I told them to break the damn door, and that I would take the crap for it. This lady lived to tell the tale, but I was "fired/I quit" over the door and other "issues". The paperwork was the most important thing. Patients be damned. The place looked good, and they paid good money to be there, but heaven help you if you got sick.

The paper that they were concerned about was the quarterly med orders and the MARs. No charting on the actual residents was done on a regular basis. I had some charts were no one had written anything in 5 years.

Most of these residents only needed to have their medications brought to them and a quick check overnight to make sure they were OK. But the AL floors (2 of them) were a different matter. Anyone had any kind of event and my night was shot. I didn't get their paperwork done, (that they should have been able to hire someone to do) and I was reprimanded for taking too much time with the residents. I had to medicate 60 of them in the morning before I left. (that was a riot). Prepouring meds was standard, presigning them too as the residents were spread over 9 floors. Nobody seemed to care that all of this was going on. I brought the union in, initiated changes, and got to the quit or be fired stage. I hated management, I feared for the residents whom I loved to death, but in the end, I began to doubt myself and my instincts. I got depressed, I got sick, I quit. I burnt that bridge big-time:angryfire . But I have survived. I'm now teaching in the clinical setting.

I occasinally meet up with some of the residents and coworkers from there. Things turned around after new owners came in. I still am not sure that any retirement residence is a good place to be, either as a nurse or a resident. Way too scary. All that money is spent on superfical things like drapes in the dinning room and a limo service to DR's appt's. I love the art and science of nursing, but the actual jobs can really drag you down.

That's my peice. I know it was long, but it still burns me to hear and experience that in Canada and the US, there are such places that exist at all.

[mattsmom81]

I have noticed patients coming into my acute care hospital from an ALF and have been amazed..there is no self care at all, many are bedfast and helpless. The whole concept of 'assisted living' seems to have gone out the window in my parts, they seem to use it as a euphamism for nursing homes. I don't know how the licensed staff cope with this..they are always crying for help so I'm guessing they can't keep nurses. Sad. I love the concept of assisted living...but why can't the administrators follow their own protocols??? I know the answer...$$$...but I can sure see the liability end of it too if policies are not followed and someone gets hurt.

[boulergirl, CNA]

At our ALF we just got a new nurse. When our former nurse left, she told us that the med techs would have to "step up to the plate" and help our facility run smoothly until the new nurse was hired. Umm, I'm sorry, WE'RE supposed to run things?? :uhoh21: She told us that since we'd handled things without a nurse before, we could do it again.