Skilled/assisted living/types of pts??

Specialties Geriatric


So i work in a higher end,

expensive (as in for the residents) assisted living facility with 80+ pts, night shift 11-7. There is always only one nurse on staff, in virginia we have licensed med techs who do meds and of course cnas.

We are not a skilled facility, and there are so many patients who belong in a skilled nursing home.

On the second floor we have at least 3 pts who cannot get up and use the bathroom by themselves, Or even walk.

god knows what would happen if there was a fire at night as it would only be me and one other cna on the 2nd floor to get them out, along w all the other pts.

We have had hospice pts with foleys, and they were all at least 2-3 assist.

I have looked but cannot find any info in state regulations as to types of pts assisted living facilities are supposed to have,

But what are other facilities like?

I feel like my facility will bring in patients staff can't handle just because of $$$$.

It is impossible to give some of these people the care they need, especially at night with limited staff.

Anyone else run into this problem?fa

Specializes in Emergency Nursing.

Its the same at my place really. Only difference is Im the only employee and there is about 30-35 residents. Some are completely dependent and some can be hospice that are completely bed bound at their last days. It just really depends.

Specializes in Gerontology, Med surg, Home Health.

This has been a problem for years. There aren't enough regulations in assisted living facilities so they can accept just about anyone they want. I ran a CCRC with all levels of residents. There were some people on the independent side who needed more assist than those on the skilled side...BUT they had lots of $$$$.

Specializes in LTC, assisted living, med-surg, psych.

My last ALF was like this......80+ residents, at least 30% of whom were nursing-home appropriate, and a full 50% of those should've been in memory care. We had people we literally had to spoon-feed, turn, and change every 2 hours. We had wanderers but NO alarms that would have alerted us to the fact that they were exiting the building. We had only 2 staff on NOC shift and at least five residents who were 2-person transfers, which of course meant that BOTH aides were stuck in one room and nobody else was available to answer call lights. Totally unsafe IMHO, but I wasn't the one who made the decisions as to whether not to admit these folks, or keep them long past the time they were appropriate for AL.

And I was the only nurse in the building.

Never again. :no:

I also work nights in an assisted living and there are only 2 people at night for 44 residents. We have about 10 total assist patients and most of the others are memory impaired. We have a couple that are independent. I always say I hope there is never a bad fire were we have to evacuate the building because I don't know how 2 people would be able to get them all out safely. I always feel horrible when someone calls and we both are in a room with someone and can't leave, I have to tell them we will get there soon. I feel the same about they just put people in the place for the $$$, we are a private pay community. I asked our director what where the rules of who could or couldn't come to our community and she told me that as long as someone don't need a RN 24 hours a day they could come. Then said even then we could get them hospice or home health RN to come in. Its horrible because we always look under staffed because according to state rules we only need a small amount of staff to care for the residents even though they need tons of care. We have lots of residents that need assistance in standing, 2-3 person assists, most can't bare weight, and the facility hates bringing lifts in so staff is putting their self at risk trying to lift patients 3x their own weight. Then the staff is getting yelled at by family members because it takes so long to answer call bells even though all the staff is in one room (there is only 3 staff at the most) caring for a total care patient. I feel like someone should do something before a resident gets hurt or staff person. There should be more regulations in place as to who they can admit and who they can't.

Specializes in retired LTC.

Too many times, I've also seen this type of practice in dedicated dementia/special memory care units. Pts LONG-PAST their appropriateness for the unit but retained there because of the wishes of the family (who're paying $$$ or other benefaction). What upset me was that the pts would only be moved off that unit to another, still within the same facility with same staff still avail. I couldn't understand why the reluctance/outright refusal and the admin's bend-over-backwards acquiescence at the risk of safety for all.

I once worked a boarding-home facility where residential criteria included that residents were ambulatory to participate in fire drills and could make steps to evacuate. By those standards, our elderly pts were marginally OK. But our facility was VERY OLD and dormitory style. The communal bathroom was down the hall.

When the fire bells rang off (and they did so frequently), all the LOLs first HAD TO PEE. They would all head towards the communal bathroom and a waiting crowd would form. There was no way to hurry them along for the fire drill!!! They reminded me of the Animal Channel's wildebeest all ganged up ready to cross the African river!

I used to think - what would happen if the roof was REALLY ON FIRE & collapsed? The firemen would find the victims all herded up outside the bathroom in a mass group.

I worked at a skilled nursing facility for about a year on nights. There where 120 beds, with 18 of the Short Stay (Hospital to Home) with 2 RN's and 6 CNA's so it sounds like the ratio isn't that different at the skilled level. 80% of our residents couldn't get out of bed on there own and none could do it safely.

Specializes in Nurse Consultation.

From an evidence based perspective, the steps in this research process to determine if there are situations of regulatory non-compliance at the facilities mentioned in this topic are to :

If the state has a licensing requirement then the facility is required to conspicuously post:

the license which identifies bed capacity and authorized level of care

the most recent re-licensure survey (often maintained in the library or at the lobby/foyer

complaint procedure which includes phone number of state licensing agency


Visit the state website and search for Assisted Living programs (Assisted Living Programs are regulated by the states) OR

The Assisted Living Federation of America lists the specific regulations for each state.

Call the help desk and ask how to access most recent re-licensure and /or

to speak with a nurse surveyor or

file a complaint specifying concerns (anonymous or by name)

Ask the question of concern to the nurse who will respond or research the question and get back to you


Assisted Living Programs mean that a residential or facility based program provides housing and supportive services or a combination of these services in a way that promotes optimum dignity and independence.

Health Care practitioners complete resident assessment tools (preadmission assessment, level of care scoring tool, functional assessment, 45 day RN assessment, quality assurance plan and meeting minutes) to determine the level of care (low :1 to high:3) and whether or not the prospective/current resident is a candidate for residing at the facility

Fire Drills and Disaster Drills are required components of surveys and require documentation and random staff interviews that identify a plan that has been practiced i.e. on a quarterly/monthly basis (fire drills) biannual (disaster drills) that addresses transport of level 2-3 residents to safety and evacuation routes

Below is a detailed overview of how assisted living facilities have evolved over the years, as well as some thoughts about the future of assisted living. This site is designed to be a helpful resource for any looking to learn more about what assisted living is, exactly, and the origins of this particular segment of elderly care.

Assisted Living is a type of elderly care that offers a level of attention and independence between those offered by nursing homes (which land on the higher end of the spectrum) and independent living (which would fall on the lower end).

By the late 1970s it was becoming apparent that the institutionalized setting of nursing homes was no longer acceptable for most aging seniors and their families. As advances in medicine allowed seniors to age in place, many were balking at the idea of nursing home placement. With rumors of mistreatment and neglect surrounding long-term care gaining more and more publicity, the need for change was evident.

Reference for article The History of Assisted Living (AL) - The Who, What, Where, When & Why of Assisted Living

Specializes in retired LTC.

Dear dragonheart - please please please!!! Please use normal size font. It's so hard to read the little print for the information that was very interesting & informative. But boy did I squint & struggle! TY in advance.

+ Add a Comment