Upon returning to campus, the most common back-to-school question I was asked was: “What did you do over the summer?” In short, I would always respond: “I worked as a Certified Nursing Assistant (CNA), without being a CNA.” While this description confused my peers, this was the best way to summarize my summer job.
Essentially, my summer position had me caretaking for dementia patients in an assisted living facility in my hometown. The living community included a wide range of residents — from those who were able to get up by themselves, to others who needed assistance from multiple staffers to accomplish everyday tasks such as getting dressed.
I, having known no better, thought this was normal for an assisted living home. Nonetheless, as my coworkers complained about their backs hurting, arms being strained and legs aching, I came to realize this is what should be expected of a skilled nursing, not an assisted living home.
Although the two might seem similar, assisted living and skilled nursing facilities are fairly distinct from one another. An assisted living home is supposed to be a place where the residents are predominately independent, but there is help available when needed. It is meant to be more of a community to help with daily tasks, such as providing rides and helping with laundry.
In contrast, a skilled nursing facility is equipped with the technology and certified staff to aid in almost all tasks — from dressing in bed to helping with rehabilitation. As this is a quickly progressing disease, the course of dementia in a person can play out in a matter of months, and a facility should have the technology in order to support this. To attain proper care, dementia patients should really only be in a skilled nursing facility.
For example, a sit-to-stand is a common piece of equipment found in many nursing facilities. With this device, an immbobile resident can be safely supported and transferred from one seated surface to another. Considering the extensive training needed for use, most assisted living facilities don’t have the luxury of obtaining these devices.
In my facility, the “technology” was three women trying to haul a 180-pound man from his bed to his wheelchair. This should not be the norm for dementia patients who are immobile. This system is both unsafe for untrained staffers, like myself, and the residents.
The difficulty arises in that most of the residents that first arrive at the assisted living facility are almost fully functioning. Many can walk independently, verbalize their needs and engage with other residents. This is typically known as the middle-stage of dementia, and it can last for many years. The problem becomes that residents in many assisted living facilities don’t just leave when their condition gets worse.
The decline from middle to late stages is dramatic. In the late stage of dementia, many patients lose their ability to walk, communicate and perceive the world around them. Late stage dementia residents require round-the-clock care — from brushing their teeth to feeding.
At this stage, residents need to be relocated to a facility that can offer better, more personalized care. Nevertheless, most families are reluctant to relocate their loved ones, and getting residents evicted is no light-hearted task. On numerous occasions, I have sat in meetings where my co-workers and I explain how a resident is too difficult to assist for the care we can offer, but oftentimes, our management turned a blind eye to this issue, not wanting to deal with the paperwork or lost revenue.
Ultimately, there is a very blurred line of who needs to be moved out from assisted living and who doesn’t. According to the Compendium of Residential Care and Assisted Living Regulations and Policy, assisted living facilities must not house residents who need more than one caregiver to help assist with everyday tasks and who are a risk to themselves if they continue living there.
The policy is clear cut and yet the power to evict residents is in the hands of the assisted living facility management. I had many residents who needed two to three staff to move them, however, these residents continued to live-in as my management overlooked my own and my fellow coworkers' many complaints.
As I spent early mornings breaking my back to care for these residents, I tried time and time again to brainstorm a solution for how an assisted living facility can best care for those who are not ambulatory. After working at this facility for three months, I finally realized, there isn’t.
It is not plausible for those with dementia to live at an assisted living facility like mine without violating many codes. Proper care can not be provided without the appropriate training and technology to do so. Assisted living can be the answer for a short while, but it is not a permanent solution.
Dementia residents who have progressed in their condition need highly personalized, one-on-one care. It pained me to see residents who needed more attention unable to get it. This is not because the staff, including myself, didn’t try. Late stage dementia patients need to be moved to skilled nursing facilities. We owe it to our loved ones to do so.
Celia Giles is a sophomore pursuing a degree in pre-nursing. Do you agree with her perspectives on the needed care for dementia patients? Send all comments to firstname.lastname@example.org