Working as a CNA in SNF vs. Assisted Living

Davey Do · Apr 7, 2022

Much more experience will be gained through working in SNFs compared to assisted living.

SNFs are more medically oriented, whereas assisted living is basic ADLs. I have worked SNFs as a CNA, LPN, and RN, and did HH assisted living visits as an RN. The difference is like being on the front-line trenches in comparison to babysitting.

Good luck in your endeavors, FutureRNMatt!

Jedrnurse, BSN, RN · Apr 7, 2022

Like in almost any other situation, a lot will depend on how well managed the facility is. If you're looking for the most exposure to skilled nursing issues, e.g. dressings, tube feeding, equipment etc, a SNF will generally be better for you.

**LibraSunCNM, BSN, MSN, CNM** · Apr 7, 2022

Assisted living facilities are very tricky. Many, although not all, are notorious for accepting patients who really aren't appropriate for their minimal level of care, and who actually belong in long-term care. As a CNA in an ALF you may find yourself having a lot of patients who need more care than you have capacity for. But it really is facility dependent.

amoLucia · Apr 7, 2022

Go SNF!!!!!

Am assuming that you're a guy??? You will be the facility DRUDGE.

The one to be dead-weight lifting a non-assistive 250lb pt. Without any staff assistance or any devices.

ADVICE - run away far, far away and run fast, fast!

DO NOT let the Asst Facility schmooze you with promises, promises, and more promises. Oh, they'll want you - to be the pack-mule. So they'll promise you the sun & the moon. (I bet they'll drool over).

Seriously, even in LTC, you're still THE GUY. Folks still tend to think of you as an 'orderly'. So you'd still get a workout. But thinking, a CNA job should be more realistically balanced for you in a SNF.

Like others have said, you'll see more hands-on 'nursing skills. The variety will be greater. And staff may be more open & receptive to a student. Likewise, you prob will work with other males (who'll understand my 'orderly/pack-mule' comment'. Depending on the number of pts & staff, you may have better chances at overtime and selective scheduling (MAYBE!). Also, female pts are pretty much getting used to male staff for personal care.

Go SNF! And welcome to AN.

Long Term Care Columnist / Guide · Apr 17, 2022

On 4/7/2022 at 10:25 AM, LibraSunCNM said:

Assisted living facilities are very tricky. Many, although not all, are notorious for accepting patients who really aren't appropriate for their minimal level of care, and who actually belong in long-term care. As a CNA in an ALF you may find yourself having a lot of patients who need more care than you have capacity for. But it really is facility dependent.

You got THAT right. I thought it was bad when I was winding down from my position as the DNS for an assisted living facility in the 2010s. It was at a time when ALFs were experimenting with various resident mixes and bringing in wanderers, severe dementia, and younger residents with serious psychiatric issues. We didn’t increase staffing or pay the workers more, but TPTB decided to fill my building with nursing home-eligible residents such as the fellow with Parkinson’s who needed a Hoyer lift (there were only two aides at night, and we couldn’t take them both off the floor at the same time). Or the poor woman who “fell” at least once a shift despite many, many interventions. Or the 55-year-old guy with severe schizoaffective disorder and psychosis who would use a lighter to burn his inner thighs and put out cigarettes on his arms. And time after time when I’d veto a prospective resident, I was basically told to figure out how to take care of them.

Most of my aides weren’t even CNAs, either. They were almost universally young, and they were taught the basics of nursing care but none of them were nurses and some of them we literally hired off the street. They were expected to manage ADLs for up to 20 medically complex individuals every shift. A few who showed promise and were interested in medications we elevated to med aide positions…and doesn’t THAT make your sphincter slam shut! These kids were even giving insulin!

And what was I doing when all this was going on? I was delegating tasks of nursing care to these folks, like SQ injections for B12 and Lovenox, wound care (although I brought in home health for decubs and other skilled interventions like wound vacs), even tube feeding. It was an expectation of my employers (I worked in several facilities) and until I collapsed under the weight of fears for my license, I went along with the program.

I wouldn’t do it again. It wasn’t so bad 20 years ago, when most of our clientele were walkie-talkies who only needed help with bathing and dressing, and perhaps a wheelchair or walker to get them to the dining room. But it went bad, and by the time I left ALF nursing it was getting out of control thanks to the corporate interests that ran everything. And now, from what I hear around AN, it’s considerably worse. Nope, won’t do it.

K. Everly, BSN, RN · Apr 17, 2022

I was a CNA in SNF in a locked dementia unit for 3 years prior to becoming an RN. I got a lot of good experiences and it's a big reason I became a nurse. I'm certain my experience there was more helpful than my experience in ALF would have been.

BUT, I do want to highly recommend you consider a hospital CNA position. I work in a hospital as an RN now, in inpatient rehab, and some of my other peer new grad RN coworkers were CNAs in the hospital and it shows. They have a lot more experience when it comes to transferring pt's around multiple lines and pumps (something you won't see as much of in SNF and almost none of in ALF). They are also really good at learning how to move new patients since they see a high turn-over in patients, where as in ALF or SNF we got to know our long term patients and their transferring/care needs super well, but I don't feel I had to be nearly as adaptable.

Be prepared to put your foot down as a male CNA when it comes to doing all the heavy lifting (if you are a guy). A lot of the women CNAs are awesome and super strong, but some will look to exploit a male CNA to do all the heaviest work and it's not really fair if it becomes a pattern.

Jedrnurse, BSN, RN · Apr 17, 2022

6 hours ago, VivaLasViejas said:

You got THAT right. I thought it was bad when I was winding down from my position as the DNS for an assisted living facility in the 2010s. It was at a time when ALFs were experimenting with various resident mixes and bringing in wanderers, severe dementia, and younger residents with serious psychiatric issues. We didn’t increase staffing or pay the workers more, but TPTB decided to fill my building with nursing home-eligible residents such as the fellow with Parkinson’s who needed a Hoyer lift (there were only two aides at night, and we couldn’t take them both off the floor at the same time). Or the poor woman who “fell” at least once a shift despite many, many interventions. Or the 55-year-old guy with severe schizoaffective disorder and psychosis who would use a lighter to burn his inner thighs and put out cigarettes on his arms. And time after time when I’d veto a prospective resident, I was basically told to figure out how to take care of them.

Most of my aides weren’t even CNAs, either. They were almost universally young, and they were taught the basics of nursing care but none of them were nurses and some of them we literally hired off the street. They were expected to manage ADLs for up to 20 medically complex individuals every shift. A few who showed promise and were interested in medications we elevated to med aide positions…and doesn’t THAT make your sphincter slam shut! These kids were even giving insulin!

And what was I doing when all this was going on? I was delegating tasks of nursing care to these folks, like SQ injections for B12 and Lovenox, wound care (although I brought in home health for decubs and other skilled interventions like wound vacs), even tube feeding. It was an expectation of my employers (I worked in several facilities) and until I collapsed under the weight of fears for my license, I went along with the program.

I wouldn’t do it again. It wasn’t so bad 20 years ago, when most of our clientele were walkie-talkies who only needed help with bathing and dressing, and perhaps a wheelchair or walker to get them to the dining room. But it went bad, and by the time I left ALF nursing it was getting out of control thanks to the corporate interests that ran everything. And now, from what I hear around AN, it’s considerably worse. Nope, won’t do it.

Are there ANY accreditation bodies responsible for licensing ALFs? If so, how can they ethically allow this to continue?

Long Term Care Columnist / Guide · Apr 18, 2022

On 4/17/2022 at 5:45 AM, Jedrnurse said:

Are there ANY accreditation bodies responsible for licensing ALFs? If so, how can they ethically allow this to continue?

Yes, they are licensed by the state if they accept federal funds. But unless there is a complaint, it’s two years between surveys, instead of annually like SNFs and nursing homes. That’s a long time for the facility to fill the rooms with NH-level residents, like wanderers (the doors aren’t locked), people who have severe dementia, even those who are quadriplegic or have psychiatric illnesses such as schizophrenia or personality disorders. Does that make any sense?! No? That’s what happens when profits become more important than patients. ?

**LibraSunCNM, BSN, MSN, CNM** · Apr 20, 2022

On 4/18/2022 at 5:43 PM, VivaLasViejas said:

Yes, they are licensed by the state if they accept federal funds. But unless there is a complaint, it’s two years between surveys, instead of annually like SNFs and nursing homes. That’s a long time for the facility to fill the rooms with NH-level residents, like wanderers (the doors aren’t locked), people who have severe dementia, even those who are quadriplegic or have psychiatric illnesses such as schizophrenia or personality disorders. Does that make any sense?! No? That’s what happens when profits become more important than patients. ?

My grandma was in a Brookdale assisted living years ago. I'll never forget going to visit her there and attending "happy hour" with her, where the residents could have a glass of wine or beer and a dude came and sang some truly awful torch covers. The director of activities gave a whole speech in the middle, advertising the referral bonus they were offering that month. As in, telling this group of elderly dementia patients to recruit their friends to come live at Brookdale so they themselves could get a month of free rent in return. I was only 19 at the time but I was so puzzled as to what was happening and why this woman seemed oblivious to the fact that none of these residents were capable of anything close to this. And then, of course, the poor staffing there led to my grandmother wandering outside, falling in the parking lot, breaking a hip, and being sent to an actual LTC for the rest of her life. Which, thankfully, was actually extremely well run. Older, no-frills, but actually well-staffed with competent workers. We didn't realize at the time how horrible a reputation Brookdale had, but I warn any and everyone who has a family member they're looking to get into AL to stay away. And of course, there are many other poorly run AL chains out there. It's disgraceful how little our society cares about its elderly.

Long Term Care Columnist / Guide · Apr 20, 2022

7 hours ago, LibraSunCNM said:

My grandma was in a Brookdale assisted living years ago. I'll never forget going to visit her there and attending "happy hour" with her, where the residents could have a glass of wine or beer and a dude came and sang some truly awful torch covers. The director of activities gave a whole speech in the middle, advertising the referral bonus they were offering that month. As in, telling this group of elderly dementia patients to recruit their friends to come live at Brookdale so they themselves could get a month of free rent in return. I was only 19 at the time but I was so puzzled as to what was happening and why this woman seemed oblivious to the fact that none of these residents were capable of anything close to this. And then, of course, the poor staffing there led to my grandmother wandering outside, falling in the parking lot, breaking a hip, and being sent to an actual LTC for the rest of her life. Which, thankfully, was actually extremely well run. Older, no-frills, but actually well-staffed with competent workers. We didn't realize at the time how horrible a reputation Brookdale had, but I warn any and everyone who has a family member they're looking to get into AL to stay away. And of course, there are many other poorly run AL chains out there. It's disgraceful how little our society cares about its elderly.

You are absolutely right about Brookdale. I worked for them for a whole three months and I was miserable. I had to help serve lunch to the residents with a napkin over my arm instead of doing nursing; I didn’t really mind but I did mind what it stood for. I also had to do sales pitches whenever someone came to look at the facility, to help persuade them to join our happy family of residents. I didn’t appreciate having to do that, I was a NURSE, not a salesperson!

So yeah, out of the three months I worked for Brookdale, I was miserable for 2 3/4 of it. Never again, even if by some miracle I were able to go back to nursing..