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Todd Stein After employing relatively few nurses just two years ago, the assisted living industry is slowly becoming a hiring hot spot for those in search of more rewarding work, if not better pay. "We’re seeing an ever-increasing number of assisted living facilities hiring nurses," said Sandra Flores, RN, executive director of the American Assisted Living Nurses Association. "The residents are saying … they want a residential model of care so it feels like home, but with a nurse present." Assisted living is an industry term encompassing a wide range of long-term care facilities. Residents pay rents ranging from $1,500 to $4,500 per month for shared or private rooms. In return, they can get 24-hour assistance with activities like bathing, dressing, and taking medications. Originally intended for highly ambulatory people, the facilities are increasingly moving toward a healthcare delivery model, taking on more acutely ill patients in need of tube feeding or supplemental oxygen, and patients with Alzheimer’s. Some facilities are even contracting for outside hospice care. Opportunities for RNs Virtually nonexistent before the 1990s, assisted living facilities numbered 11,472 in 1998, with nearly 560,000 residents nationwide, according to a study by the Department of Health and Human Services. The furious pace of growth has left many urban areas with a surplus of beds, at least for the short term. Yet industry experts say the market saturation has not affected nurse hiring because stiff competition for residents has forced providers to raise the level of health care offered. Plus, the fundamentals haven’t changed—Americans 85 and older are still the fastest growing segment of the population. In Texas, nurses who work in assisted living facilities just got a boost from the state Legislature. Senate bill 93, passed in April, allows RNs and LVNs at the facilities to deliver any care covered by their licenses. Before the change, assisted living residents who needed help with something as simple as changing a dressing had to contract with a home health nurse, even if the facility had a nurse on staff. Industry representatives believe the change in the law will spur an increase in nurse hiring at the mostly privately owned residential facilities. Less enthusiastic is Stephanie Tabone, RN, director of practice for the Texas Nurses Association, who cautions that a hiring boom "remains to be seen." But the new state law, she said, does at least open up new opportunities for nurse entrepreneurs who "contract with three or four [assisted living] facilities, make the rounds, troubleshoot, and help people out." Not what you’re used to Nursing in an assisted living facility is noticeably different from other settings. Because residents contract through Medicaid or their own health insurance with outside home health nurses and other health professionals to meet most of their medical needs, the staff nurse’s job centers on administrative, supervisory, and assessment duties. Because most assisted living nurses work without medical supervision, nurses fresh out of school are unlikely job candidates. Most apt to be hired are those with experience in quality improvement, medical assessment and oversight, training of unlicensed caregivers, administration, and, of course, geriatrics. In many large facilities, RNs fill supervisory and training roles while LVNs or CNAs deliver the hands-on care. In rare cases, nurse practitioners are hired to make diagnoses and render care under the direction of an off-site geriatrician. Flexibility is the key It helps to be flexible, industry experts say. Not only are the industry’s rules and regulations changing rapidly, but the whole focus of control is different in assisted living. Here, the patient is the boss. "Nurses are used to supporting the care for a patient who’s dependent on them, but in assisted living the resident is as independent of the nurse as possible," said Judith Kiriloff, education coordinator for the Assisted Living Federation of America’s ALFA University, which prepares nurses for entry into the industry. "The nurse has to be willing to accept no for an answer. You can’t go hide that pill in the applesauce." Nurses in assisted living facilities must often be willing to accept lower pay compared with other settings. The average salary for an RN working in an assisted living facility was $19.49 an hour, according to a 1998 study by the National Center for Assisted Living. For LVNs, the average salary is $15 an hour. Yet some may find the work’s rewards outweigh the loss of income. "The advantage to assisted living is that you’re able to work with the same residents for years, being there through all the stages of their acuity levels and working toward improving the quality of their lives," said Linda Abel, regional health care specialist for Alterra, one of the largest providers of assisted living in the nation, with 27 facilities in Texas alone. "It’s personally rewarding as a nurse and as a human being." |
