Why Your Assisted Living Nurse Doesn't "Nurse"
When John returned to his assisted living residence with doctor's instructions that his leg wound be treated and re-bandaged daily his family was astounded when the nurse said she would not be able to give John his treatments. "Why," they wondered, "did the facility make a big deal of having a nurse on staff if she doesn't do anything?"
Many families look for an assisted living residence with a nurse on staff because they want their senior to have immediate access to medical care if needed. A "nurse on duty" gives a welcome sense of security to anxious family members already feeling guilty about having to make the move to assisted living.
If there is an assisted living nurse on duty, why can't she provide nursing care?
The assisted living nurse is generally hired to provide two things to assisted living residents: 1) Trained eyes to make observations and assessments, and recommendations to seek medical care if appropriate; 2) Medication monitoring.
Most nurses are licensed to provide care under the supervision of a physician or other independently licensed medical provider. Because the nurse does not work under the professional oversight of the resident's physician, the nurse is not permitted to provide actual skilled nursing care. S/he may provide some emergency care, and can make recommendations about whether a resident should go to the emergency room or follow up with a personal physician.
The assisted livng nurse is also usually responsible for insuring that residents' medications are properly organized, dispensed and recorded. Licensing regulations usually provide that s/he can delegate some of this responsibility to properly trained lower level employees, but s/he retains responsibility for managing residents' medications.
If an assisted living resident needs nursing care, the facility nurse will also be involved in deciding whether that care may be provided at the residence. If a resident needs short term care, such as John's wound, which is expected to heal with proper care, she will assist the resident and family to get care from a licensed home care agency. The agency nurse will visit John in his room and treat the wound under the direct supervision of the resident's doctor.
If a resident needs long term nursing care the facility nurse will help determine whether the resident may remain with private nursing care, or whether the level of care needed means a move to a skilled nursing facility.
Every state has their own codes, laws and regulations covering assisted living. Some are very detailed, and others are dismayingly thin. Because assisted living is designed to provide support with daily living needs, to our knowledge no state requires that an asisted living residence have a nurse on staff.
Increasingly, larger residences are hiring nurses to complement what they can offer to their residents. However, unless they also provide skilled nursing care those that do will generally have a nurse on staff only 8 hours daily during the week. Many split their nurse's time between several facilities. Some residences simply have a nurse "on call."
While the amount of care needed by the average assisted living resident is rising, assisted living was never designed to provide medical care. Most state regulations are quite clear that assisted living residences are not licensed to provide nursing care. This is why your assisted living residence does not have a doctor on staff and the nurse is prohibited from offering hands-on nursing to residents.
Because the nurse can use trained medical judgment it is still reassuring to know that there is a nurse on staff. When you are evaluating an assisted living community for your older loved one be sure to ask specifically what medical services their nurse is permitted to provide. Ask about the days and hours the nurse is on site and whether s/he is "covering" more than one facility. Ask also what provisions the residence has if the nurse is out ill, on vacation, or leaves permanently.