Defining staff roles in the Assisted Living Facility (ALF) is paramount to providing quality care to residents and family members. Determining which model your ALF adheres to, whether medical or social, will be a factor when defining staff roles. In many assisted living facilities, employee nurses manage services provided by the facility, but does that make the setting a medical model? If the facility staff coordinates medical issues, what are the social responsibilities? Whether the ALF is viewed as primarily medical or social by residents, their families, staff, and the administrators can affect perception of quality and affect the definition of staff roles.
There are different opinions as to how much an ALF is intended to serve advanced medical needs. Obviously there are limits defined in the law and the rule. However, with the option of aging in place, expansion of these limits is possible. The reality is that most people do not experience a simple journey from needing minimal assistance with home health services to advanced care with hospice services in a simple well defined path. Usually, it is like a tilt a whirl where you are not sure if you are going forward, in a circle, or backwards. Caring for people is as individual as people are. So, how do you define staff roles?
When a resident or family signs a contract to live in and receive services from an assisted living facility, it lists items that have to do with activities of daily living such as: mobility assistance, bathing and dressing, and assistance with self-administration of medications. Most residents benefit from the social components, but some are admitted for the services that are more defined. If they just needed socializing, they would probably live in an independent living facility. You can take the medical model away and only be a social model, but you cannot take the social support way from meeting medical needs.
It is relatively easy to meet the minimum requirements of activities in an assisted living, but meeting the social needs is a greater task. Administrators and staff work hard to meet the social needs of a wide range of resident types. Some people have cognitive deficits and yet have very high social needs, while others have more physical needs and yet desire and deserve their social needs met as well.
So how do you define the staff’s role? Look at your facility’s mission, contract, and guidelines. Develop your staff roles reflective of your mission. Then define the roles based on the services in your contract and guidelines. Every role or task that is completed should incorporate dignity and respect for the resident as the base to build on. Regardless of the license or technical skill a staff member has, a passion for care-giving is a must. As the resident ages in place and requires more medical services whether provided by a facility staff member or third party service provider, their social needs must be supported.
So, who is responsible to provide for the social needs? The answer should be simple, all staff are responsible. Years ago, when in school, people were taught that you don’t form relationships with your residents because that would be considered unprofessional. But in the assisted living setting, it is all about relationships. It is not to cross the line and interfere with their privacy or impose your opinions on the resident. It is about taking a sincere approach to interacting with the residents. Getting to know who they are and their preferences in order to meet their needs and expectations. If you have a maintenance person who gets the job done, but misses the opportunity to be a part of the conversation and spend time with a resident who enjoys maintenance items, quality suffers.
The role of the staff can be perceived differently from one resident or family member to another. If the resident or family member is accustomed to having a licensed nurse to be able to assist with management of as needed medications, they may feel the resident aide is not fulfilling their responsibilities if they do not assist with determining if a resident needs medications. Educating residents and families is crucial in making sure expectations of the staff member are within scope and practice. Sometimes, it is misinterpreted that resident aides are nurses. Initial and ongoing education is key in clarifying staff roles.
Therefore, make a list of assigned duties for each staff member that reflects your facility’s mission. Educate your residents, families and staff on the services and guidelines for your facility, but also seize the opportunity to support social and emotional care. It is true that workforce is a challenge, but when hiring, take the potential candidate into the area where the residents live to see if they respond to the people in a caring professional manner. Emphasize the fact that greeting residents and speaking kindly in a respectful manner is part of the role of each person that has the opportunity to work with the residents.
An ALF is definitely not a facility where the focus is breathing, circulation, and vital signs only. It is about people living and being cared for in a home like setting by caregivers. Make sure these concepts are intertwined in the staff’s role.