What's It All About, ALFie?--Help and Support for Assisted Living Nurses

manyhatsrn53 · Jul 19, 2008

I left LTC about one year ago, after many years in every nursing role from staff nurse to DON to regional nursing consultant. AL is not stress free, but it is definitely less stressful than any nursing job I ever held in LTC. There is a certain amount of loneliness for me on the job because I am the only licensed person for a 70 unit ALF/Retirement community and I miss having other nurses to talk with about nursing. Here, we "assist" with medications and "assist" with ADLs. I have unlicensed medication assistants and resident assistants to provide care.

I would agree with earlier posters that a brand new nurse might get themselves into trouble in AL because of inexperience with assessing signs and symptoms of illness in elderly persons. These residents all look very healthy compared to what you see in the nursing homes. There are still many with complex medical issues and many have a fear of going to a nursing home if they reveal the extent of their health problems. I also find that since AL is generally private pay, many families and residents don't want to pay for higher service levels to receive the care and services they need. Census is an issue here, just like in LTC. There is pressure to admit residents who may not be appropriate for AL, not just from the corporate level but also from families who prefer to see their loved one in this setting rather than a nursing home.

Overall, I think AL is a good industry for a seasoned LTC nurse who is tired of dealing with tons of paperwork and unreasonable surveyors every three months.

lexibear99, LPN · Nov 12, 2008

I have been a LPN for 18 years and I have a interview tomorrow morning at a new retirement community opening in my town in December. They have assisted living along with other styles. I am currently working in ltc and really want out! Another nurse where i currently work had an interview monday and she said they didn't discuss salary as they said they were not sure what the pay would be, they also told her that they expected the LPN's and CNA's to clean the apartments top to bottom once a month. I don't have a problem with that but she said it was not for her. My question is, right now I make 20.35/hr, anyone have any idea what ALF's pay?

mavlvn · Dec 12, 2008

I Quit a Assisted living postion, simply I was so stressed I forgot what year I was born and could not rememeber my age. I walked into a real mess the care givers off the street and passing MEDS. One error after another. The

Charts were not audited and 4 years behind. New move in assesments and reassesments had to be done. Being on call 24/7 and being told I had to work as a caregiver 15 hours a week, plus my job. Staffing and scheduling .All the inservices, then Dementia Nurse quit and I had her JOB on top of that. I just could not do it. too much. I was the 11th Nurse in 1 year. They wined and dined me to get me I relocated. To start there. Never again It left a bad image for me. So forget assisted living or is it:sniff: this company?? Are they all like this????

Any one work for Merrill Gardens????

lexibear99, LPN · Feb 17, 2009

I am currently working at a alf that has been open about 1 month. Brand new beautiful facility! My question is what kind of activities do you do with the residents? What meds are in lock up? Everything seems so murky compared to waht I was used to in nursing home setting. Any ideas would be greatly appreciated. We do have medication assistants, we have an LPN and a CNA on the shift right now, we have about 16 independant and 6 assisted in the facility. What jobs are you responsible for? Do you have dietary and housekeeping on 2nd shift? All kinds of questions!! Thanks everyone!

blue280 · Mar 18, 2009

Hi Lexibear99, I find my residents LOVE to reminisce! Talk about anything from the past. Having babies and talks of weddings are popular. We have an activity dept that does alot with our residents. Many different kinds of crafts, knitting, ect. They also love to listen to music, we have muscians from the community come in and play. And every Saturday, they love to watch Lawrence Welk.

As far as med lock up, I am in a large CBRF (114 residents) and we keep all the medication that we give in a locked room. Our state regs require any Scheduled II meds also be locked in a cabinet or a lock box that is permanently affiixed to a wall. Some of our residents keep control of their own medications and keep them in their room.

I am the RN clinical health services coordinator (fancy name for nurse manager but nurse manager is too clinical sounding) I oversee a staff of about 45 people, nurses, caregivers ect. I wear a pager 24/7 and I absolutely love what I do! If I can help with any of your questions, just let me know

Emerld2000 · Mar 24, 2009

Hi everyone I haven't been on in a while and so glad I founf this thread. I currently work as a NUrse Manager in a ALZ ALF we have two faclities and hold a total 36 residents. I love my job and wouldn't change it for the world. We have two amazing NP that make visits/rounds and I have learned a ton for them. IM incharge of almost everything ie. contacting MD, MARS, new orders all the wasy down to fire drils and ordering TP. Does anyone elso do the pill boxing system out there?

lexibear99, LPN · Apr 2, 2009

The meds that we give our residents come in bubble paks like in the nursing home. We are such a brand new facility that at this moment we only have a DON/Nurse Manager, 3 FT LPN's and 2 PT LPN's and about 6-7 FT and PT CNA's. We have assisted living in the back of the building and independent living in the front. We have 14 AL residents right now and about 25 independent. Right now we have 1 LPN and 1 CNA per shift except 11-7 which is one LPN. Until we get a few more residents, the LPN and CNA are responsible for heating and serving the meals, laundry, cleaning apratments and the building, activities and the LPN has med passes. It is a nice variety but I will be glad when we are able to bring on housekeeping and more dietary help!

Long Term Care Columnist / Guide · Apr 2, 2009

Yours is a fortunate facility indeed..........I was not only the DON but the only licensed nurse for up to 70 residents, about a third of whom would have been better off in a nursing home. I was on-call 24/7/365 for three solid years, which was OK for the first couple but burned me out eventually. That's how I wound up back in LTC as a charge nurse, where I knew there were resources to care for people who were in such bad shape (two-person transfers, severe dementia, total care etc.). But I'm happy for you, it sounds like your staffing is much better than average. Good luck!

pielęgniarka, RN · Apr 7, 2009

I would like to apply for a job in assisted living! I think I would really enjoy it, I've worked in geriatrics for many years, I like the old folks :-) feel confident about my assessment of illness in the elderly and with time management.

I am trying to devise a list of questions to ask at any upcoming job interviews. Most of these are based on the posts I read here, so thanks! What would you add or change regarding the following list?

1. What are some details of the job, what would I be responsible for?

2. Who do I answer to, who answers to me?

3. What would a "typical" day would look like for the RN position?

4. What is the ALF residents' acuity -- what is the max level of care here?

5. On call hours? Other RN's?

6. How often does RN work the floor?

7. What is the 'call in' policy for the aides? Mandation? Find own replacement?

8. Do any physicians or nurse practitioner's come on rounds?

Thanks for reading!

~Sara

RN007 · Apr 23, 2009

Great post, Sara. I am hoping to get an interview with an ALF and appreciate your list of questions. I am filling out an application (taking a cover letter/resume to attach) tomorrow and am hoping to show my face. I would appreciate any good thoughts, Karma, energies and prayers you good people are willing to send.

ohlpn · May 27, 2009

I've been an LPN in ALF for 3 years after retiring from a skilled nursing home position after 13 LOOOONNNNGGGG & painful years. This past year I was "asked" to return to a "part time position" as an RA (resident Assosiate) in order to retain employment hours. In other words, I had to go from $19 an hour (LPN wages) to $12 (top aid wages) an hour if I wanted more than 3 days a pay period.

I am just curious if other nurses have had to accomodate the "corporate machine" in this way. Our ALF has gone from 25 residents to 44 residents since January of this year. We have not been given any more nursing or RA hours or staff since corporate implemented these changes. Staff is resigning at phenominal rates & the company is unwilling to fill these positions. Unfortunately, those of us that have been loyal & stayed with the company through thick & thin are being worked to the bone!

At 62 years old (& in compromised health....diabetes related conditions) am I really being taken advantage of, as many of my co-workers suggest? Unfortunately, if I don't continue like this for the next 2 or 3 years I'll have to become a Walmart greeter until

I'm dead!

Just a rant, friends. I think I REALLY know what to do...

Long Term Care Columnist / Guide · May 27, 2009

I've been an LPN in ALF for 3 years after retiring from a skilled nursing home position after 13 LOOOONNNNGGGG & painful years. This past year I was "asked" to return to a "part time position" as an RA (resident Assosiate) in order to retain employment hours. In other words, I had to go from $19 an hour (LPN wages) to $12 (top aid wages) an hour if I wanted more than 3 days a pay period.
I am just curious if other nurses have had to accomodate the "corporate machine" in this way. Our ALF has gone from 25 residents to 44 residents since January of this year. We have not been given any more nursing or RA hours or staff since corporate implemented these changes. Staff is resigning at phenominal rates & the company is unwilling to fill these positions. Unfortunately, those of us that have been loyal & stayed with the company through thick & thin are being worked to the bone!
At 62 years old (& in compromised health....diabetes related conditions) am I really being taken advantage of, as many of my co-workers suggest? Unfortunately, if I don't continue like this for the next 2 or 3 years I'll have to become a Walmart greeter until
I'm dead!
Just a rant, friends. I think I REALLY know what to do...

I think you know too. :specs:

But you shouldn't have to become a Wal-Mart greeter, or flip burgers, or wait tables until it's time to retire. With your years of experience, you should be able to find something in nursing that won't do you in physically; you could try an MDS coordinator position with a nursing home, or work in a clinic for example. Almost anything would be better than what you're putting up with now...........you need to RUN, not walk, away from that company (and then quietly report the understaffing to the state).

Good luck to you!