Assisted Living Today, October 2000 Issue What should be the Role of the Nurse in Assisted Living? By Rose Lochmann, MSN, RN Nurses and nursing concepts are becoming an integral part of the assisted living industry. More states are developing regulations for assisted living and are demanding higher levels of sophistication in supervising residents' medical needs. Increased competition and resident's desire to stay in their current settings is also pressuring administrators to constantly grapple with rising acuity levels. As assisted living communities are gaining more experience, they are hiring nurses and targeting frailer populations.. Facing these changes, many in the assisted living industry are considering the best role for a nurse in their communities. For example, when should an assisted living community hire a nurse? How can costs be kept at reasonable levels? How is the social/residential model preserved when nursing concepts are introduced? These are compelling questions. The answers are multidimensional and fraught with powerful implications at every turn. For example, how do you incorporate nurses in your program, and what wellness services should you offer? What will be required to prevent more regulatory intrusions, and how do you address the growing medical needs of your residents? First, let's examine the basic functions of the nurse. In assisted living, nurses do not usually perform "hands on" nursing. Their primary responsibilities include:  Assessment  Case management  Medication management oversight  Training of non licensed personnel  Oversight of quality assurance In addition, nurses play an important role in the development of well-written and accurate individualized service plans. The service plans are essential to efficiently and effectively manage resident care needs. These plans include realistic goals, suggested actions to reach these goals, implementation of these activities and evaluation of the results. Specified re-evaluations are included in the plans to closely monitor changes in a resident's condition. Since these changes can occur rapidly, assessment and re-assessment by a nurse is vital. Although residents and their families recognize that assisted living is a residential setting, they often misinterpret the role of the nurse. In these early days of role definition, the residents, and sometimes residentsÕ families, expect the nurse to do "hands on" nursing. This leaves nurses presently spending most of their time managing the expectations of residents and their families. The nurse's role and responsibilities are usually addressed, but rarely in adequate measure, through the admission agreement. It is critical that the admission agreement and resident handbook provide information on what services will be provided by nursing personnel. These documents need to clearly articulate to the prospective resident and family the roles and responsibilities of any nurses on staff. In addition, the resident-care coordinator, whether a nurse or not, should be involved and contribute to the development of the marketing material to ensure that the there are no inconsistencies in expectations. Once the nurse's role in assisted living becomes better understood, the primary role of the nurse will be to train and supervise staff, oversee the functions described above and manage resident and family expectations. The tendency to assign a nurse other non-nursing administrative functions is best resisted as it dilutes the effectiveness of the nurse's contribution. When there is not a nurse on staff, nursing functions are often accomplished by forming alliances with health care personnel. For example, an alliance can be established with a nurse who can teach the staff the basic principles identified above and assist the administrator/management staff in setting up the systems necessary to conduct each function. The administrator must be able to understand and implement these fundamental functions. It is also the administrator's responsibility to ensure that monitoring procedures are in place to refine and improve these systems once they are established. If a community decides not to have a nurse on staff, the functions described above then fall on the resident-care services coordinator. Non-licensed personnel would then approach these tasks solely from a case management perspective and any nursing issues would be the responsibility of outside services. As seniors age in place, having a licensed nurse on staff, either on a full-time or part-time basis, will become increasingly common. In addition, it will become imperative for assisted living communities to establish alliances with health care professionals such as nurses, pharmacists, physicians, physical therapy vendors, home health agencies, and hospices. These alliances will function as mutual referral sources to meet individualized needs and can be drawn upon for education of staff, often a regulatory requirement. It seems increasingly clear that the industry is faced with the question of how much and when, not if, it will provide for the nursing needs of its seniors. As advances in health care allow longer lives and demographics change the landscape of how services are offered to seniors, the role of the nurse in assisted living is being dynamically defined. Nursing has a long history of adapting to changing environments. Nurses have evolved from initially taking care of the elderly at home to a highly institutional setting. They can now return to a setting where dignity, autonomy and choice can be better preserved. Rose Lochmann, MSN, RN, is CEO of A.L.Wizard, an assisted living software company. She can be reached at 888/440-0566 or by email at info@alwizard.com © Copyright 2007, A.L.Wizard. All Rights Reserved.