What eveyone should know before working in an assisted living facility.

I was under the impression assisted living the residents were independent for the most part?

And it is NOT an isolated issue. It quite widespread in the field. And I believe it all boils down to $$$. - that is, making money for the company by admitting inappropriate residents or keeping declining residents when they are no longer appropriate for the facility.

Keeps the precious census up.

Yes my point for anyone who wants to work in an assisted living facility is that a lot of times it is harder because they don't have a lot of the things that skilled nursing does. And the pay is crap! Like 9 an hour if your lucky yea right lol

I was Wellness Director at a mid-sized ALF for right at a year. Between the 24/7 on call schedule, the regional manager who claimed if "(I) wasn't here at least 50 hours a week, (I) wasn't doing something right" despite only paying me for 40 hours/week (and that wasn't much!), and being encouraged to keep residents who had long since declined past the point we could care for them, I hit the door as soon as I could. Nursing Home Lite is absolutely correct.

I worked in a small 15 pt ALF during my last year in nursing school and for about 3 months as the RN once I graduated.. You're absolutely right about them keeping inappropriate residents and the work being hard & everyone is underpaid! I didn't know it was widespread though, I thought I was just at a bad facility. We had one total care pt.. She had been there for years and had declined (96 years old!); but she was private pay & had the largest private room/bath in the facility so they let her stay because the family liked her receiving "one on one care". Right... I couldn't take the stress of the RN position! Even before I was done with school I was the most educated person working in the facility & was doing the narc counts & keeping track of the MARS in between RN/LPNs visits. I worked 2nd m-f and the lady I trained to replace me had absolutely no clue about any of the meds, couldn't grasp the importance of doing daily weights or b/p/HR for certain meds, did not know how to do accuchecks or draw up insulin, and had no clue about PRNs even though the indication for the med was written on the MAR. I was terrified for the residents when I left.. ? I also felt that the legality of the whole thing was questionable the entire time I worked there, but at the time I had no other choice and had to work.

In 2012, my now deceased husband engineered an interview for me at what turned out to be an ALF. He was beside himself when I was unable to even get an interview after I graduated in 2010. He was at the Liver Transplant Center of Westchester Medical in New York and struck up a conversation with an LN who had accompanied a patient there. Long story short, he got me an interview. When I got there I was interviewed by 4 different people, the last 2 coming in together and looking extremely bored about the whole process. It was obvious to me that they either already had someone in mind or maybe the position was not even real. Anyhow, at the end, they told me that they had 100 residents but we're only licensed by the state for 40. Now after reading this, I understand. I am glad they did not hire me. I had no idea such crazy and dangerous practices were going on in ALF land. I do know that they are surveyed infrequently like once every 5 years. Question is, when surveyors do show up where do they hide the extra 60 people?

My mom was at an ALF for about 6 months & while in general it was good, we had problems when it came to her meds, specifically coumadin. Mom's inr is volatile & we check it ourselves each week (sometimes daily). Every time the MD would adjust or hold her dose, it was like pulling teeth to get the staff to medicate appropriately. At one point, we had told them to hold her dose as she hovered close to 4 & realized they continued to give it when her results kept climbing & were at 6. The nurse wanted a written order every time or said Mom had to refuse. Got a blank look when I asked her about "nursing judgment"?!?! Even a written letter from doc to adjust her dose per POA/family was not acceptable.

My mom was at an ALF for about 6 months & while in general it was good, we had problems when it came to her meds, specifically coumadin. Mom's inr is volatile & we check it ourselves each week (sometimes daily). Every time the MD would adjust or hold her dose, it was like pulling teeth to get the staff to medicate appropriately. At one point, we had told them to hold her dose as she hovered close to 4 & realized they continued to give it when her results kept climbing & were at 6. The nurse wanted a written order every time or said Mom had to refuse. Got a blank look when I asked her about "nursing judgment"?!?! Even a written letter from doc to adjust her dose per POA/family was not acceptable.

The reason for this is because none of the staff giving medicine are capable of using nursing judgement because they are not nurses, or usually even CNAs. They want those written letters because they have no autonomy to make clinical decisions because they are not medically trained. We need doctors orders to give pts tums. Like seriously, couldn't even give something PRN for fever of they didn't have it ordered.. Another reason I left the RN position... I could not educate them on things like this to a point where they'd understand :/

The reason for this is because none of the staff giving medicine are capable of using nursing judgement because they are not nurses, or usually even CNAs. They want those written letters because they have no autonomy to make clinical decisions because they are not medically trained. We need doctors orders to give pts tums. Like seriously, couldn't even give something PRN for fever of they didn't have it ordered.. Another reason I left the RN position... I could not educate them on things like this to a point where they'd understand :/

I beg to differ on the nursing judgment comment. It's one thing to "assess" the patient (which is what an RN should do) versus "hold" a medication. Without clear guidelines as noted in the physicians' order, it would be like I've made my self a doctor. Not good when it comes to keeping ones license.

Judgment on the other hand, comes into play for things like an infiltrated IV and you stop the IV pump to assess and most likely replace the IV then you resume the medication. That is not holding a medication (the IV), it's simply remedying an issue so the medication can safely be administered.

I beg to differ on the nursing judgment comment. It's one thing to "assess" the patient (which is what an RN should do) versus "hold" a medication. Without clear guidelines as noted in the physicians' order, it would be like I've made my self a doctor. Not good when it comes to keeping ones license.

Judgment on the other hand, comes into play for things like an infiltrated IV and you stop the IV pump to assess and most likely replace the IV then you resume the medication. That is not holding a medication (the IV), it's simply remedying an issue so the medication can safely be administered.

I disagree.

If I have orders to give insulin, but my patient's accucheck shows a blood glucose of 60, I will use my nursing judgment to hold the insulin as it is NOT appropriate (read: safe) for my patient at that time. Ditto if I have orders to give a blood pressure med to a patient whose BP is 60/40 at the time.

However, I won't just hold the med and continue about my day's activities...I will call the doctor and advise him/her of the patient's change condition, and also request parameters to be added to the med orders for future incidents of this nature.

As a nurse, it is my duty to use my nursing judgment to provide appropriate care to my patients. I don't want to be a robot, just handing out pills willy-nilly just because they were ordered.