Who's responsibility is it.........

[fournee, LPN]

Hello Nightengales...

I currently work parttime at an Assistant Living Facility. Been here 2 years and i do love what I am doing. My issue is always with management in regards to policies/rules. Residents are admitted who should not be here. We are not a locked building so residents are free to come and go, a few of their families don't want them to leave. Some residents have dementia and wander frequently. Some have gotten out and we were able to notice they were gone quickly and we were able to talk them back home or call 911. We are on a pretty busy city street. Recent incident...Building director told family that we have 24 hour nursing care and that we can watch their mother, so the family took out of a nursing home and brought her here. She left facility twice, was combative a few times and she has an unsteady gait. She is on hospice also. We do not have nursing 24 hours, we have only 3 CNA's when nurse is off duty. Over 100 residents. We can not afford to have a sitter with this woman. Who is responsible for this resident? If resident left building without us knowing and something bad happened to her,while I am on duty, will it be my fault? We can not keep an eye on all residents. We have 3 patio doors that lead to parking lot and street. We have a receptionist at our front door only, not the patio doors.

[Anonymous1257]

Huge liability issue, call every manager and corporate officer you can find and chart each phone call. if she wanders into traffic and the family is litigious, you can bet you'll be in their cross hairs at some point.

[ktwlpn, LPN]

This is the biggest issue with assisted living,IMHO.AL's are not regulated like LTC's are.Many will accept residents they are ill equipped to care for just because the resident has money.As soon as that runs out the family will be told to find alternate placement pronto.You potentially have a big problem.Go up your corporate chain of command if you can afford to loose your job.

[fournee, LPN]

Thank you so much. I will definitely chart everything from here on out.

[fournee, LPN]

That's what I'm afraid of. Thank you. I will dot and cross everything.

[KellyRN2013]

This question is asked a lot! I work as a DON in an assisted living facility so I completely understand what you are talking about. Does your facility have a wander guard system? If so, I would go talk to your DON or administrator about that for the safety of the residents. I would also document EVERYTHING as the others have said. you need to cover your butt so that if something did happen to this resident then they would know that the situation has been addressed many times with no changes in the outcome. Everytime the resident tries to wander outside the chart it, everytime the resident actually escapes the building then chart it, everytime the resident becomes combative then chart it. I would also call the MD to make the MD aware and make sure you chart that well with every detail. The MD will write orders for a screening for long term care if you keep calling them about issues with the residents. Also, if you address that she is a safety risk for the facility the docs will usually jump on that immediately. I would also call the family everytime the resident does anything in regards to the topics listed above. If the DON, administrator, family, or MD Will NOT do anything then I would call APS. You just have to make sure everything is documented well and thoroughly. Also, if you are not allowed to call the MD or family then report it to your charge nurse and document it each time that you reported the situation to the charge nurse. I have had some resident's like this as well. I am not sure which state you are in but In VA the acquity of residents in AL now are very high! They stay in AL until they meet nursing home criteria and the highest level in our facility the resident's need help with bathing, dressing, incontinence, we take them to and from the dining room and we also feed some of them. That is our level 4 before transfer to the nursing home. I am sorry you are going through this but I completely understand because I have been through it as well. You need to document and notify the family each time so that your license is not on the line and it shows that you followed your chain of command. I hope you get somewhere with this in your facility and encourage other nurses to document what happens on their shifts as well so that it doesn't look like its just one nurse documenting. Please let me know if you need help with anything!