Assisted Living: Increased Need for Nurses

Assisted living is a relative newcomer to the world of elder care, but it’s changed a lot in the span of a few decades. In fact, some elder care experts note that the assisted living population may look a lot like the nursing home population of a couple decades ago. No longer is assisted living primarily a social model; resident needs often go well beyond personal care.

States set different requirements with regard to who can be maintained in assisted living and who must be discharged to a setting that provides a higher level of care. Some states allow for quite a bit of skilled nursing to be delivered in an assisted living setting, but even those that don’t can find themselves in a conundrum: People who move into assisted living are generally elderly – often well into their 80s at the time of move-in – and how they present on a particular day may be very different from how they present a few months or years later. Allowing residents to stay — being insufficiently apprised of their condition — can lead to some ugly situations: unnecessary worsening of health conditions and even deaths.

One way that assisted living communities around the nation are handling the situation: They’re hiring more nurses!

The Many Roles of Assisted Living Nurses

Nurses who work in assisted living do many things. They may administer medication or supervise medication administered by nursing assistants (and indeed supervise the medication program).

Assisted living nurses assess residents at the beginning and on an ongoing basis. They help create service plans for individual residents and evaluate the continued appropriateness of the plan.

Often the role entails coordinating healthcare services that are provided through different sources. Some states are restrictive about the nursing services that can be delivered by assisted living staff. At the same time, they may allow for additional services to be provided for by an outside organization. One service that is universally allowed even when others are disallowed: hospice. Stakeholders don’t want people in their final months of life to have to be uprooted.

Assisted living facilities may maintain ties with trusted home health organizations for various other services. Assisted living nurses may also need to be in regular contact with physicians. Assisted living facilities – and well-constructed partnerships — can be among the tools hospitals use to reduce re-admission.

In some cases, the nurse will act as a direct care provider. States may allow intermittent skilled nursing services or a set number of service hours per week; they may allow facilities to apply for waivers to retain residents whose needs they are confident they can continue to meet. Some states license high acuity assisted living. Can an assisted living nurse administer insulin for a resident who is unable to self-administer? In some places, yes.

Wisconsin is among the states that allow quite a bit of skilled nursing to take place in an assisted living setting. One well-known facility, for example, lists oxygen therapy, colostomy care, and catheter care among the services.

Facilities have different focuses. Not all want to provide the level of medical care legally allowable under their state’s highest license. Even when the facility focuses on personal care, resident assistants will need some level of supervision. Medication reminders and oversight are typically considered personal care. Assistance with mobility and hygiene takes a measure of skill as does managing residents’ emotional needs. Memory loss and dementia typically fall under the assisted living banner though a facility may need a higher license.

One thing assisted living facilities can’t afford to do: let people stay beyond the time they are equipped to handle their needs. When discharge or transfer is necessary, someone too must coordinate that.

If the facility has a population of relatively independent elders, there may be a number of programs designed to promote wellness. The nurse may have a large role in coordinating programming. Chronic disease management can be an important component.

One common duty is making rounds and staying on top of resident health. In addition to the less formal routine assessment, there will typically be more formal assessments to do periodically (and paperwork to complete).

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Levels of Care

Facilities may provide different levels of assisted living. So, too, they may provide assisted living as part of a continuum of care.

Many assistant living facilities are part of continuing care retirement communities. In many cases, a resident who can no longer be cared for at the assisted living level can be moved to a skilled nursing facility.

There will likely be independent living units on the campus. Some residents in independent living may be more like those in assisted living in years past. Facilities don’t want to make the mistake of admitting residents to independent living who are in fact not independent. Again, there is an assessment component. Not surprisingly, some nurses work across different levels of care.

Nursing Preparation

Some nursing duties can be handled by an LPN while others require an RN’s expertise. RNs typically have education that better prepares them to carry out comprehensive assessment, though LPNs may be very involved in the process. In a large facility there may be multiple layers of oversight. The state may mandate that an RN have responsibility for teaching aides to administer medication. In some places, LPNs progress to positions of responsibility such as wellness director. Again there will be some difference from state to state.

Assisted living nurses need to be knowledgeable not just of the needs of an aging population but of the system they are a part of. The facility itself should be on top of regulations, but this is not a given. Often, though, the organizations themselves realize that regulations are not sufficient to care for the population they are no seeing. One well-known organizations noted in 2015 that they had moved to an all-nurse care model.

Some nurses pursue certifications in assisted living. The American Assisted Living Nurses Association offers a certification examination. There are four main content areas: primary care, health problems, professional issues, and organizational and health policy. One will find links to resources on the website ( Other professional organizations offer relevant continuing education courses.

Nurses working in assisted living settings have many options for career growth. One of these being moving into the administration side of the business in a role as a nursing home administrator. This type of career ladder progression may require additional experience and education, such as earning a Master’s in Nursing Administration.

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