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

American Assisted Living Nurses Association

Assisted Living Nursing Scope ofPractice

Josh Allen, RNPresident, American Assisted Living

Nurses Association

The role of the nurse in assisted living continuesto evolve along with the industry as a whole. Asresidents demand increasing levels of care andservices, providers are continuously adoptingthemodel tomeet the consumer’s needs and pref-erences. Provision and/or coordination of health-care services is a key part of these services, andincreasingly this responsibility falls to the nursein assisted living, as evidenced by a recent Na-tional Center for Assisted Living report, whichfound that 94% of providers who responded toa performance measures survey have “a licensednurse available to staff and residents 24 hoursper day.”

The challenge for both providers and nurses isto clearly identify the role of the nurse in his/herassisted living community. In 2007, AALNA setout to define the scope of practice for assisted liv-ing nurses. What follows is an adapted excerptfrom the full Scope and Standards of Assisted

Living Nursing Practice.1

Introduction

The Scope and Standards of Assisted LivingNursing Practice was written with several pur-poses in mind: (1) to describe the ethical obliga-tions and duties of the assisted living nurse; (2)to guide the practice and conduct of the assistedliving nurse; and (3) to articulate the assisted liv-ing nurse’s understanding of the professionscommitment to healthcare, nursing, and society.

Written in 2007, the scope and standards for as-sisted living practice reflect a relatively new nurs-ing practice specialty that did not exist 15 yearsago. Often compared to a nursing home nurse,particularly with regard to these practitioners’relative isolation from collegial and interdisci-plinary/interprofessional discourse, the assistedliving nurse is an even more autonomous deci-

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sion maker and manager of care and systemscompared to the acute care nurse.

The nursing role may be a joint role as adminis-trator/wellness coordinator, generally overseeingthe well-being of the residents. An additional orindependent rolemight be that of a consultant, re-viewing health records and guiding unlicensedstaff in optimization of residents’ function andquality of life, monitoring residents’ chronic ill-ness status, or making assessments during acutechanges of condition.

Scope of Practice

The increased need for affordable care of olderadults and the consumer demand for supportivecare in the least restrictive environment are thehallmarks of assisted living. The ongoing provi-sion of social and health-related services and ep-isodic acute care and monitoring with skillednursing typify the assisted living environment.The scope of assisted living practice is best un-derstood in the context of science and theoriesof aging, the pervasive and destructive myths ofaging that work against “successful aging.” Theguiding principles of assisted living nursing prac-tice are a unique blend of gerontological and ad-ministrative nursing.

Science, Theories, and Mythsof Aging

Assisted living nursing is shaped by the sci-ence and theories of aging that guide practice.Given the growing body of knowledge about ag-ing, there are persistent myths about aging thaterode optimism, outlook, and quality of life forthe older adult. Hence, the assisted living nurseneeds to be as informed about prevailing scienceand evidence-based knowledge as about the mis-perceptions about aging that work against theolder adult’s self-care abilities and independentdecision making.

The science of aging describes an irreversibleand inexorable process, yet most older adultsage with their functional abilities e mental,physical, psychosocial e essentially unimpaired.Despite scientific evidence, the myth persists

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that aging means frailty, senescence, and impair-ments. The expectation among older adults thatpain is a natural accompaniment or conse-quence of aging requires constant vigilance, sothat appropriate pain relief liberates the individ-ual to pursue their pleasures and preferences.Concomitant with the myth that most olderadults will become “senile” (i.e., cognitively im-paired) is the expectation that they will becomeincontinent. These perceptions create an imageof the older adult as a drain on society’s dwin-dling purse and causes intergenerational conflictregarding resource allocation. Although agingis a complex interaction of biopsychosocialchanges, including role and identity changes, itdoes not automatically mean that depression isa normal state for most older adults, anotherpervasive myth. The lack of appropriate assess-ment, diagnosis, monitoring, and appropriatepharmacological and nonpharmacological inter-ventions (e.g., social network re-building), islikely contributing to the alarmingly high num-bers of community-dwelling older adults report-edly depressed.

The anthropological literature convincinglydemonstrates that older adults, in virtually all so-cieties and ethnic/cultural groups, want to con-tinue their participation in and contribution tothe common good as well as to their families.Older adults have a keen sense of social respon-sibility; many would like to participate in re-search but are prevented from doing so froma paternalistic viewpoint that is out of step withthe older adult’s feeling of altruism. This, then,is the social surround of assisted living in thelong-term care continuum. Not sick, or unstableor fragile enough to require the skilled nursingand medical oversight of nursing home care,the older adult in assisted living receives theamount and type of care needed to optimize func-tion and quality of life (e.g., assistance with per-sonal care, supportive daytime activities).

The assisted living nurse has the specializedskills to manage this type of person-centeredcare planning within the larger context ofcommunity level. This requires specialized un-derstanding of the associated ethical issuesneeded to meet the challenge of personal needsin the context of a community. Responsibilitiesof the registered nurse in assisted living prac-tice, based on experience, knowledge, andskills in care of the older adult, include butare not limited to:

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� Assessment related to function and physicalstatus of the resident on admission, duringacute changes in condition, and annuallyfrom the admission date;

� Care planning: using information gathered dur-ing the assessment process, development ofa care plan, communication of the care to theresident, proxy, and other relevant membersof the healthcare team; oversight of care imple-mentation by assistive staff; recognition of de-viation from plan;

� Medication management: testing of indivi-dual residents to determine ability for self-administration of medication, oversight ofmedication storage and administration;

� Development and oversight of a health promo-tion and disease prevent programs that includeadministration of immunizations as appropri-ate, development of protocols for infectiousdisease management such as flu outbreaks,herpes zoster, C. difficile, and tuberculosis asrelevant to the site;

� Development and oversight of a philosophy ofcare that is focused on optimizing function ofall residents through physical activity and exer-cise activities;

� Development and oversight of protocols for de-termining resident capacity, identification ofa proxy, and establishment of end of life carepreferences;

� Accountability for care practices (self and as-sistive staff) and that care will be providedwith the best interest of the resident in mindto ensure the prevention of complications andthe highest possible function and quality oflife of the individual;

� Ongoing in-service for all staff as relevantto the needs of the residents and thecommunity.

Principles of Assisted LivingNursing

Assisted living nursingpractice requires aholis-tic approach in order to optimize and maintain, ifnot improve, an older adult’s function, indepen-dence, and engagement with the environment,and, with others, maximize well-being and qualityof life. The practice of nursing in assisted living isdriven by the residents’ preferences, supportingthem in their choices. The nurse’s role incorpo-rates a variety of activities such as counseling,

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health educator, direct clinical care (e.g., woundmanagement), medication management, andhelping older adults access thehealthcare system:

� Collaborating with the older adult in planning,guiding, and managing his or her care;

� Promoting and assisting the older adult tomaintain his or her maximum physical, mentaland psychosocial function and to reduce risk ofinfection, trauma, and mistreatment;

� Advocating within the healthcare system andin society for appropriate policies that respectand value the older adult;

� Educating older adults about their options forquality of care and quality of living;

� Maintaining and building practice skills andcompetencies.

About AALNA

The American Assisted Living Nurses Asso-ciation is the only national nonprofit associa-

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tion dedicated exclusively to nursing inassisted living. It is operated by nurses, fornurses. The mission of AALNA is to pro-mote effective nursing practices in assistedliving such that nurses as well as residentsbenefit. Learn more about AALNA at www.

alnursing.org.

Reference

1. Scope and Standards of Assisted Living Nursing Practice.

2007.Retrieved fromhttp://www.alnursing.org/alnursecert/

SCOPE_AND_STANDARDS_FINAL2_09-19-06.pdf. Cited

May 24, 2011.

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.2011.06.007

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