American Assisted Living Nurses AssociationOFFICIAL SECTION OF THE OFFICIAL SECTION OF THE

American Assisted Living Nurses Association

AALNA Represents Assisted LivingNurses at U.S. Senate Special

Committee on Aging Assisted LivingRoundtableJosh Allen, RN

On March 15, 2011, the United States Senate Spe-cial Committee on Aging hosted a roundtablemeeting entitled “Assisted Living at the Dawn ofAmerica’s Age ‘Wave’: What Have StatesAchieved and How Is the Federal Role Evolving?”The roundtable panel included representatives ofstate regulatory and licensing agencies; federalofficials from CMS, HHS, and HUD; industry rep-resentatives; and advocates. As evidence of thecritical role nurses play in shaping the future ofassisted living, American Assisted Living NursesAssociation (AALNA) was invited to participateon the distinguished panel of experts.

After opening remarks from the committeechairman, Senator Herb Kohl, and ranking mem-ber Senator Bob Corker, the 3-hour roundtablediscussion focused on three primary areas: qual-ity and oversight; affordability and reimburse-ment; and access and discharge issues. As theconversation around these broad topic areasevolved, a number of issues relevant to assistedliving nursing were addressed by various panel-ists, including the role of nurse delegation, theuse of medication aides, staff training, and levelsof care.

Based on feedback from our members, AALNAadvocated for the need to avoid any hard “ceil-ing” on levels of care that make it difficultfor residents to “age in place.” Rather we em-phasized the importance of an ongoing serviceplanning process in which nurses work collabo-ratively with residents, their families/responsibleparties, physicians, and other stakeholders toindividualize the plan of care in way that maxi-mizes residents’ abilities to remain in their cho-sen assisted living community for as long aspossible.

Participants were asked to prepare written re-sponses to questions from the committee in ad-vance of the roundtable. Below are severalpertinent excerpts from AALNA’s responses tothese questions. Our full prepared statement

Geriatric Nursing, Volume 32, Number 3

can be accessed at http://www.alnursing.org/resources/scoa.pdf.

Regarding core philosophy, essential ser-vices, and key characteristics of assistedliving:

Assisted living is a consumer-directed model

of care. Rather than designing and deliver-ing housing and services in a “cookie-cutter”

approach that responds to a federal man-date, assisted living listens to and reacts

to what the consumer is asking for. This

can be seen in newer assisted living devel-opments that are designed from the ground

up with wireless Internet connections

through the community, and existing com-munities that are adding “Internet” cafes to

the common spaces. It is also seen in the

delivery of care in a way that is more pri-vate and respectful of the wishes of the in-

dividual. For example, rather than pushinga large hospital-like medication cart into

a dining room where the delivery of medica-

tions is on display for all to see, assisted liv-ing nurses instruct their staff to deliver

medications in the privacy of the resident’s

room or apartment or to discretely bringthem to the dining room in an individual

medication container if necessary or to

have residents stop by the “Wellness Cen-ter” to pick up and take their medications

in privacy.Independence and choice are the watch

words of most, if not all, of the training

modules available in the assisted living in-dustry. Policies, procedures, and training

are based on the encouragement of the res-

ident to continue to participate in their carethe fullest extent physically and cognitively

possible and to foster wellness at all times.

Regarding “aging in place”:

Assisted living nurses, the professionals who

frequently hold the responsibility of oversee-ing the care of assisted living residents, over-

whelmingly support the concept of “aging in

place.” This is rooted in the fundamental con-cept that an assisted living community is the

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resident’s home; it is not a “facility.” Assistedliving nurses believe in working with their res-

idents, the residents’ families, providers, med-

ical professionals, and state regulators, to findaway to allow a resident to remain in the assis-

ted living community throughout their life-

span, or as long as the resident so desires. Bydeveloping resident-centered service plans

that tailor care and services to the uniqueneeds of the individual, this goal is often

achievable.

Should a transfer to a higher level of care berequired or ordered by a physician, the assisted

living community has a responsibility assist

the resident and/or family to find the mostappropriate setting for the resident, in accor-

dance with his or her needs and preferences.

Regarding affordability andreimbursement:

The AALNA represents nurses working in as-sisted living at the community, regional, and

corporate levels. As such, our emphasis is on

nursing practice and direct resident care con-cerns, not on the broader affordability and

Medicaid issues raised in questions 6-16. Forthat reason we are not offering a specific

response to each of these questions.

However, we do recognize that nurses canand do have a direct impact on affordability

in many very practical ways. Staffing and

related expenses account for a large percent-age of the operating budget for any assisted liv-

ing community, and licensed nurses routinely

command higher wages than do other mem-bers of the resident care team. As nurses we

recognize that this has an impact on the abilityto operate affordable assisted living programs

with appropriate levels of quality care and

nursing oversight. However, several innova-tive care practices have evolved in assisted liv-

ing and have been actively embraced by

assisted living nurses to help overcome afford-ability challenges. A primary example of this is

the use of medication aides/techs to assist in

the delivery of medications.Over 80% of assisted living residents require

assistance with medications and take an aver-age of almost nine medications per day. The

volume of medications to be delivered on

adaily basis can quickly becomea tremendousdrain on staffing and other resources. In more

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traditional “health care” settings (e.g., nursinghomes, hospitals, etc.), medications are typi-

cally administered only by licensed nurses.

In assisted living communities, however,non-nurse medication aides/techs are often

responsible for administering or assisting res-

idents with their medications. Over 83% ofAALNA members report using medication

aides/techs to assist residents with medica-tions. Several recent studies have shown that

medication aides/techs have an error rate

that is no higher than when medications aredelivered by licensed nurses in the same set-

ting.1,2 Nurses play an important part in

maximizing the role of medication aides/techs through supervision, delegation, and

training. This is just 1 example of how

nurses, and the assisted living industry asa whole, have developed innovative models

of delivering care in ways that save moneyand make the best use of available resources.

By continuing to revise and revamp old care

delivery models and develop new ones, assis-ted living nurses are actively working to meet

the needs of all assisted living residents in

a way that is safe, effective, practical, andaffordable.

This roundtable isa signal that the federal govern-ment, and in particular the Special Committee onAging, continues to look closely at assisted livingand how well this model is meeting the needs ofour rapidly aging population. AALNA takes seri-ously our responsibility to represent the voice ofassisted living nurses as these national policy dis-cussions continue to evolve. Most important, weare proud to serve our members by workingtogether toadvocate forqualitycareofour residentsthat emphasizes choice, dignity, and independence.

A video of the full roundtable discussion canbe accessed at http://aging.senate.gov/hearing_detail.cfm?id5331935&

About AALNA

The AALNA is the only national nonprofit asso-ciation dedicated exclusively to nursing in assis-ted living. Operated by nurses, and for nurses,the mission of AALNA is to promote effectivenursing practices in assisted living such thatnurses as well as residents benefit. Learn moreabout AALNA at www.alnursing.org.

Geriatric Nursing, Volume 32, Number 3

References

1. Center for Excellence in Assisted Living. Medication

Management inAssistedLiving. (2008).Retrieved fromhttp://

www.theceal.org/reports.php. Cited November 21, 2010.

2. Center for Excellence in Assisted Living and the

University of North Carolina at Chapel Hill. Research

Brief: Medication Administration in Assisted Living.

(2009). Retrieved from http://www.theceal.org/reports.

php. Cited November 21, 2010.

Geriatric Nursing, Volume 32, Number 3

JOSH ALLEN, RN, is the President of the American Assisted

Living Nurses Association, Napa, CA. Josh is a registered

nurse with over 17 years of experience in assisted living and

residential care.

0197-4572/$ - see front matter

� 2011 Mosby, Inc. All rights reserved.

doi:10.1016/j.gerinurse.2011.04.007

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