Assisted Living -Dangerous, Deceiving and Dysfunctional Part 1

With over four decades of dedicated experience as a Registered Nurse, my professional journey has traversed a range of healthcare environments, most notably Assisted Living Facilities (ALFs). During this time, I fulfilled roles both as an agency nurse and as a Director of Nursing (DON). My extensive tenure in the field has provided me with insights and experiences that are both enlightening and transformative.

One chapter of my career unfolded within a prestigious Assisted Living Facility, where I undertook the esteemed position of Director of Nursing. Amid the splendor of this upscale establishment, I became the fifth individual to step into the role of DON in a mere span of six months. Entrusted with overseeing the well-being of a sprawling community, I discovered a multitude of areas demanding attention, both in the physical infrastructure and the operational procedures.

These challenges necessitated my relentless commitment, often translating into 16-hour workdays and even overnight stays to collaborate with night staff and conduct training sessions. My proactive approach to hands-on care stood out to the building's Administrator, who noted my unique dedication in this regard. My responsibilities extended beyond administration; I devoted time to training staff and resolving client concerns, ensuring the facility operated at its best.

The role I undertook was nothing short of overwhelming. On my inaugural day during the orientation phase, a poignant encounter with an elderly gentleman, whom I shall refer to as "Ted," left a lasting impression. Ted's entry into the refined dining hall sparked unrest among fellow residents due to an unpleasant odor he carried. I engaged Ted, persuading him to accompany me back to his quarters. Despite the warnings of aides who advised against entering his room, I ventured in and was confronted with an astonishing sight.

Ted was a hoarder, his collection of used toilet paper revealing an underlying issue of incontinence. The traces of dried stool on his bedding and furniture bore testament to his predicament. Ted's aversion to personal hygiene and change of attire posed a unique challenge that necessitated immediate attention.

Further exploration revealed that Ted had legal representation overseeing his financial matters, yet the absence of comprehensive care training for the staff hindered addressing his specific needs. The situation highlighted a broader financial aspect, as his attorney had not been approached to adjust his care plan.

My efforts bore fruit as I established a structured routine for Ted, ensuring his personal hygiene and living conditions improved significantly. Collaborating with his attorney, I facilitated his transition to a more suitable facility capable of providing the requisite level of care.

However, my tenure also saw my share of poignant moments and challenges. The discovery of staff negligence in the memory care unit marked a low point. This, coupled with instances of medical oversight and inadequate care, underscored systemic issues requiring resolution. The emotional account of a dementia-afflicted resident caring for his ailing wife after hours further accentuated the facility's limitations and the need for comprehensive care solutions.

The complexities of end-of-life scenarios and decision-making were a constant, exemplified by the case of a critically ill 97-year-old resident. His daughters, away for a holiday weekend, grappled with healthcare choices, culminating in a clash between their wishes and medical expertise. This episode culminated with my decision to step away from the facility, as the balance between professional responsibility and ethical considerations teetered on a precipice.

This narrative is the precursor to a series of articles where I shall delve deeper into the multifaceted realm of Assisted Living Facilities. Each article will unveil new layers of insight and experiences that have indelibly shaped my perspective. I extend an invitation to join me as we embark on this journey of exploration and reflection. Stay tuned for Part 2, as we continue to unravel the intricate tapestry of life and care within these unique establishments.

PBS Front Line special Life and Death In Assisted Living

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