Assisted Living - Dangerous, Deceiving and Dysfunctional Part 1

I have been an RN for over 40 years. I have worked in Assisted Living Facilities (ALFs). As an agency nurse and as a Director of Nursing (DON).

The Assisted Living Facility where I worked as a Director of Nursing was a very upscale facility. I was the fifth DON hired in a period of 6 months. This was a very large facility and I found many things wrong with the building and the way things were done.

I found myself working 16-hour days. There were times that I even stayed overnight to work with the night staff and do training. The Administrator of the building said that I was the first DON that actually did hands-on care. I trained the staff and addressed the complaints of the clients.

It was an overwhelming position. During my first day on the job, while I was in orientation… an elderly gentleman I’ll call “Ted” entered the very high-class dining room. The other residents insisted he be removed because he had a foul smell.

I approached Ted and encouraged him to return to his room with me. The aides that assisted me warned me not to enter his room, that it was dirty and foul smelling. What I found was shocking.

Ted was a hoarder. He hoarded used toilet paper. I found that he had frequent bouts of incontinence, and dried stool was found on his bed and his furniture. He refused to shower and allow his clothes to be changed.

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I discovered that Ted had an attorney that monitored his money, but did not come to visit. I learned that there was no training for the staff on how to handle this type of client. There was another issue that became apparent – the financial aspect. No one had approached the attorney about increasing Ted’s level of care.

I was successful at getting Ted into a routine where he was showered and his room cleaned. I was able to discuss with the attorney the need to get Ted placed in another facility. One that could better meet his needs.

My last day on this job, was not a planned day. For the first time in my career, I actually walked out of the building. I repeatedly asked for more help in the building. I was aware that there were clients I had not seen, and needed attention. I will never know how right I was.

My last morning started very early. I went in to the back door of the memory care unit to see how the staff was doing. I found them all sleeping on the job. I was faced with having to fire that whole staff.

The morning went downhill from there. As I was making my rounds, I found a very large man on the floor in the bathroom. After calling 911, I learned that someone had mistakenly discontinued his insulin. I encouraged the family to have him placed in a skilled nursing facility.

As I was finishing my rounds, I came across a sweet man with dementia that wanted me to meet his wife. I was surprised to find that his wife was on hospice and not able to do anything for herself. Care was provided for her during the day through the hospice agency.

But there was no one to help her after 3:00 PM until 7:00 AM the next morning. This sweet old man could barely care for himself, let alone his wife all those hours. No one had ever made me aware of this situation. I was told it would require moving the wife to a higher level of care, financially. Then she would have the care she needed.

Late morning included a meeting with the administrator… and the very angry daughters of a 97-year-old man. He had become very ill over the long holiday weekend while his daughters were all away at the shore.

This gentleman had severe shortness of breath and swollen legs. to the point where he could barely walk. When I called the daughters about his condition… they insisted that they did not want him sent out to the hospital.

When I explained his condition was very bad and I was concerned. I suggested that if they were not going to seek treatment for him, they should consider hospice.

The family contacted hospice. Hospice contacted the primary care physician and services were started. It is important to understand that a death in an Assisted Living Facility requires an investigation. Unless an individual is on hospice.

After returning from their holiday weekend the daughters decided to take their father to his heart specialist. The specialist put a defibrillator into her father.

The daughters accused me of getting a kickback for referring to hospice. At that moment, I walked out of the building, never to return. My nursing license was on the line and her comments were the straw that broke the camel’s back.

I have more to share. This will be a series of 4 articles. Please come and share your thoughts. Tomorrow-Part 2.