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The role of nurses in assisted living facilities: Paper

INTRODUCTION:

Nurses are very important practitioners in the area of assisted living facilities (ALFS). They show this through their efforts to enhance both the nursing and medical care available to residents. Thus, they play numerous roles, as they can act as part registered nurse (RN), Part care manager, and part primary care provider. This can enhance the attractiveness of Assisted Living Facilities (ALFS) to residents and also enable these people to remain in a facility longer. Due to the roles performed by nurses today, there has been every need for a high demand for nurses in Assisted Living Facilities and other settings.

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According to Gerard J, Kane, Radosevich DM, etal, most recently, favorable legislation and documented positive outcomes related to the involvement of Nurse Practitioners includes a reduction in hospitalizations and improved management of chronic care. To this end, we shall explore vividly the roles of Nurses in Assisted Living Facilities taking into cognizance their duties as related to the topic in question.

THE ROLES AND RESPONSIBILITIES OF NURSES IN ASSISTED LIVING FACILITIES.

The expansion of roles and responsibilities of Nurses since the early 70s cannot be overemphasized. When these professionals were first introduced into nursing facilities to enable access to medical services and to aid the duties of attending physicians, it became quite obvious that they have multifunctional roles to play in the Health System and even beyond.

According to Resnick B, Bonner; “in the late 80s, fee-for-service medical groups began using Nurse Practitioners to provide collaborative primary care facilities, including the provision of acute episodic care as well as chronic care management. The above assertion is an eye-opener to the fact that nurses play multifunctional and invaluable roles in Assisted Living Facilities. We notice even a dual role of nurses in Assisted Living Facilities when the same nurse takes charge of both acute episodic care as well as chronic care management when carrying his/her primary care duty”.

Nurses in most cases in Assisted Living Facilities substitute for physicians. This is because in most cases they go far into carrying out the necessary job which a physician is supposed to carry out. This helps a lot in Assisted Living Facilities. Because registered nurses are not many most of the times, the multifunctional roles of single nurse become the answer and he/she is seen carrying out series of roles relating to Assisted Living Facilities. According to Ellen Farrel, and Richard Stefanacci, “One of the reasons for the multifunctional roles of nurses is their ability to leverage their time in a facility by serving both roles.” An example of Maryland is typical here. Here, a registered nurse is referred to as a ‘Delegating Nurse” who takes charge of the clinical activities within ALF. In relation to their roles in Assisted Living Facilities, Nurse practitioners must be knowledgeable in other to be able to carry out their duties much more effectively. By so doing he/she must be wide in the principles of case management, principles of adult education. He must know something on legal/ethical issues of teaching/delegating. It is also by knowing the requirement when delegating nursing function that he/she could carry out his roles appropriately. He should know what and what that are involved in the delegation of medication as well as medication administration. By knowing this, he would be sure of what he can do as part of his duties, should be put in an administrative position. This shows the invaluable nature of the roles he/she tends to perform in Assisted Living Facilities. Since his roles may extend to how to teach the medication administration programme in Assisted Living Facilities, he must try as much as possible to be knowledgeable so as to enhance his teaching ability since this too forms part of his duties and roles. While carrying out their duties, nurses are required to visit the facility every forty-five days. He/she has variance of duties to perform during these visits. One of such duties is the assessment of the environment to ensure that the living area is free and safe. Thus, it is appropriate for each resident.

He should carry out a complete physical assessment of the resident. This is referred to as head to toe assessment.

He/she is to draw up a record review to show that each resident receives necessary medical care and to show if there have been any recent medical appointments or medication changes.

It is equally his/her role or duty to document all the findings hence residents’ healthcare providers be notified of any changes or significant findings.

The nurses in his roles should equally be able to observe and assess medication storage. The question should be whether these medications are stored appropriately or not. He/she must ensure that narcotics are locked or better still double locked as demanded by the laws. The labeling of medication must be appropriately done showing the residents name, direction on how to use, and an expiration date. He/she must ensure that no medication expires before use. He/she must ensure that medication assistants are knowledgeable in the process of administering all medicine and ensuring that all drugs are given in a safe and appropriate manner.

The role of nurse in Assisted Living Facilities can equally be seen from the angle of the depended number of people living in ALFS; it is pertinent to note that about 33,000 ALFS, aged 65 or older live in such area as private or shared units. Known by different names such as board and care homes, all ALFS provide congregate meals, laundry and housekeeping activities. Virtually, they provide health monitoring and assistance with activities of daily living (ALDS). The combination of these house-hold cares and medical services offered in the house by nurses establish a concrete reason why one should conclude that they perform several and serious roles in Assisted Living Facilities. It is often believed that approximately, 60% of residents and assistance when it comes to the issue of Assistance with the activities of Daily Living. It is equally said that 75 percent need assistance with medications. Current estimates thus suggest that 50% of residents in ALFS have Alzheimer disease, or dementia, and the number of residents with dementia is expected to grow. Approximately, 25% of ALFS have a dedicated Alzheimer or dementia unit. ALF residents take more medications, including psychotropic agents, than nursing home residents. Amorally, 11% of residents are transferred to a hospital, 26% die in the facility and 24% to 40% are discharge to a long-term care facility. The above discussion shows the nursing care in Assisted Living Facilities. This equally shows the various roles, duties and responsibilities nurse shoulders in Assisted Living Facilities. John A. Hartford in American Journal of Nursing.

According to Hawes, C. etal (2000) as reported on a nationally representative sample survey of staff and residents at 300 ALFS. The writer classified the Assisted Living Facilities as either low or high services and minimal or high privacy facilities. To this end, it is clear and reasonable to state that the roles of nurses in Assisted Living Facilities have been dichotomized into high services and minimal or high privacy facilities and vice versa. A low service ALF provide housekeeping and personal assistance services, 24hr oversight, and at least two meals a day. High service is the same as low service but with the addition of one full time RN. Minimal – privacy ALFS featured apartments shared by at least three residents, and in high – privacy ALFS 80% to 100% of the occupants lived alone. From the research and findings, forty percent of residents of high privacy and high service ALFS felt they were in a poor or fair health and their greatest concern were staff shortages and high turnover. Going by the analogy of this research, staffing experience become another paramount thing that enhanced proper management of difficult behavior of individuals in Assisted Living Facilities. Due to the immeasurable roles and tasks of nurses in Assisted Living Facilities it is natural to say that they should be able to manage property such situation as identifying side effects of antipsychotic drugs. At least they should know how to manage difficult behavior such as not cooperating in daily care activities like bathing. They should equally be able to manage appropriately the issue of ageing in Assisted Living Facilities. With this, nurses would be able to carry out their duties and roles much more effectively.

Generally, the workload for nurses in most cases is much as a particular nurse could assist 14 residents. However, this workload is often not regarded as heavy to them even though they engage in tasks such as laundry, meal services and housekeeping. This is because; most nurses have signed to carry out humanitarian service instead of the financial gain. Despite poor pay and few opportunity for growth, most nurses in Assisted Living Facilities are satisfied with work confronts them as their working conditions. Thus, the duties and roles of nurses in Assisted Living Facilities (ALF) are the permanent thing here and not the remuneration as the case may be.

According to Kraditor K, etal in Assisted Living Sourcebook. “Close to1million older adults (65 and older) lived in one of approximately 33,000 assisted – living facilities in 2001. In 2000, 40% of assisted – living facilities employed residence nurses (RNS) who were either directly employed by the facility or contracted in performing their duties; the Assisted Living Facilities residents took an average of six medications per day in 2000. In 2000, 24% of Assisted Living Facilities residents took nine or more medications per day. This scenario presented above from the fast facts of Kraditor presents without doubt, the changing faces of nurses’ intervention in Assisted Living Facilities. As seen from the first situation presented in the scenario, the employment of RNS gradually improves on the lives of the Assisted Living Facilities residents. Thus they started with the intake of the average of six medications per day in 2000 and then stepped up in the same year when 24% of Assisted Living Facility residents took nine or more medications per day. This is obviously a clear result as well success recorded by the nurses in carrying out their roles in relation to Assisted Living Facilities”.

As the role of Assisted Living Facilities (ALFS) continue to evolve, nurses are undergoing adequate staffing as it is one of the major ways that health issue can be properly tackled especially in relation the issue of Assisted Living Facilities (ALFS). Due to the enormous roles and duties of nurses in Assisted Living Facilities (ALFS) there has been urgent need for sufficient staff to meet residents scheduled and unscheduled needs at least 24hrs a day. This will enhance in the roles and duties of nurses in Assisted Living Facilities, since registered nurses be much more available and their responsibilities which vary from state to state can include so much, such as performing assessment on admission and periodically, medication review, resident assessment regarding a reported charge in physical condition and mental status, weight or cognitive changes, care plan development. Nurses in ALFS would equally perform much more duties like wound care, glucose meter and vital sign readings, oxygen administration, injections, and ostomy care. In some cases, these activities can be delegated to unlicensed staff; however in few cases certified personal care aide is required. However, irrespective of the fact that ALFS nurses have helped greatly in the area of health, it is often difficult recruiting and retraining new nurses to step up the roles and responsibilities as well as effective health results. This is because salaries and benefits are not attractive if compared with local health service wages.

A 2001 unpublished survey by the American Assisted Living Nurses Association showed that approximately 50% of RNS working in ALFS have worked in nursing homes. Turnover, at 45% is higher among RNS, followed by burse assistants and LPNS, at approximately 35%.

Conclusively thus, it is pertinent to note that for the roles, duties and responsibilities of nurses in Assisted Living Facilities (ALFS) to be stepped up, there is every need to work on the salary structure, favorable and conducive atmosphere too should be created and more nurses be recruited into the same field. It is only with this that the health condition and other related assistance can become much more effective in Assisted Living Facilities (ALFS). With these serious medical attention would be given to residents in different directions buttressing the fact that nurses in Assisted Living Facilities (ALFS) has multifunction roles to play in the lives of residents. It is therefore necessary to conclude that the roles and responsibilities of nurses in Assisted Living Facilities (ALFS) cannot be overemphasized as they can be seen from various angles which cut across favorable legislation, part care management and part primary healthcare provisions. Through the assistance of nurses, the ALFS can be made more attractive to so many residents.

REFERENCES

1)         American Assisted Living Nurses Association (2001) Unpublished.

2)         Ellen Farrell, NP, Richard Stefanacci (2005) The Role and Responsibility of Nurse in

ALFS. Assisted Living Consult.

3)         Garrard J, Kane RL, Radosevich DM, etal (1990) Impact of Genatric  Nurse

Practitioners on Nursing Home Residents’ Functional Status, Satisfaction, and Discharge Outcomes. Medicare.

4)         Hawes, C. etal’. (2000) High service or High privacy Assisted Living Facilities, Their

Residents, and Staff, Results from a National Survey. Rockville, MD: US. Department of Health and Human Services.

5)         Http://www.aspe.hhs.gov/datcp/reports/hshp.htm.

6)         Kane RL, Gerard J, Skay CL, etal (1989) Effects of a Geriatric Nurse Practitioner on

process and outcome of Nursing Home Care. AMJ Public Health.

7)         Kraditor K etal (2001) Assisted Living Source Book. Facts and Trends.

Washington DC: National Centre for Assisted Living.

8)         Rapp MP; (2003) Opportunities for Advance Practice Nurses in the Nursing Facility.

JAMDA.

9)         Resnick B, Bonne, A. (2003). Collaboration: Foundation for a successful practice.

4: 344-349.

10)       (www.gericalls.com) Gericalls.

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