Assisted-living facilities offer care to residents who need help with their activities of daily living (ADL), such as bathing, dressing, and eating. Care is generally provided by certified nursing assistants (CNAs), a position that is sometimes identified as a care assistant or nurse’s aide.
Assisted-living facilities do not provide the same level of healthcare that residents of nursing homes need. The facilities provide safe living environments for older adults who can function with some degree of independence if they receive help with their ADLs. Because assisted-living residents do not require the same around-the-clock medical monitoring and skilled nursing care as nursing home patients, an assisted-living facility does not usually have a large number of nursing professionals on staff. Nurses nevertheless play a significant role in caring for residents of assisted-living facilities.
While nursing homes are subject to both federal and state regulation, assisted-living facilities are only regulated by state law. Licensing and regulation, including requirements related to professional nursing care, therefore vary from state to state.
Nursing Staff in Assisted-Living Facilities
Different assisted-living facilities offer different levels of care. Some confine their services to assistance with ADLs. Some offer intermittent nursing services. Some contract with residents to provide a higher level of skilled nursing care. Regulations may limit the level of care a facility can provide unless it is licensed to provide a higher level of care.
While the majority of daily care is provided by CNAs, many assisted-living facilities also employ licensed practical nurses (LPNs). An LPN will typically administer medication and first aid. When facilities employ an LPN, the LPN is often responsible for supervising CNAs, monitoring the health of residents, and updating their health records.
Assisted-living facilities generally employ at least one registered nurse (RN), often in the position of Director of Nursing. The RN supervises any LPNs the facility may employ. If the facility employs no LPNs, the RN supervises CNAs.
Not all facilities employ an RN. Some states only require assisted-living facilities to employ an RN if they are licensed to provide greater care than assistance with ADLs. Small facilities sometimes employ a part-time RN. In some states, facilities are allowed to contract with an RN, who must be available on-call at all hours.
Some facilities allow residents to employ a private nurse. In some states, a private nurse can only be used to provide short-term care, such as recovery after a hospitalization. Other states allow a private nurse to provide continuous care in an assisted-living facility.
State regulations usually allow assisted-living residents to administer and have custody of their own prescription medications, provided a doctor has determined that they are competent to do so. State regulations typically allow any staff member to help residents self-administer medications when self-administration is permitted. Help provided by CNAs may include providing medication reminders, reading labels, opening containers, checking a self-administered dosage against the label, and observing the resident take medication.
When residents cannot self-administer their medications, regulations typically require the medication to be administered by a physician or a licensed nurse. Some state laws prohibit assisted-living staff members from administering certain medications. For example, an Illinois law required residents of assisted-living facilities to hire a private healthcare professional to administer sliding-scale insulin, even if members of the facility’s nursing staff were competent to do so. Residents were forced to move to nursing homes when they could not find a licensed professional who was consistently available to administer insulin. Fortunately, Illinois recently repealed the law.
Seniors who are considering a move to an assisted-living facility should make sure that the facility will meet their needs. Some residents will be well served by CNAs. Others might need the assistance of nursing staff. Seniors should inquire about the availability of nursing staff if their health conditions may require the regular attention of a licensed professional.