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 residentsŐ 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.
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