Nursing at an assisted living facility vs. a nursing home

Though many people think of the hospital as a typical nursing work environment, the reality is that nurses work in a variety of settings. According to Nurse Journal, “Nontraditional nursing jobs provide many rewarding opportunities to work outside hospital settings, in other clinical environments, such as nursing homes and community out-patient clinics, or in administrative or educational positions.”

One such option for many nurses is the residential care industry. The National Institute on Aging describes how as people age, they often find that “support from family, friends, and local programs may not be enough. People who require help full-time might move to a residential facility that provides… the long-term care services they need.” Assisted living and nursing homes are two of these housing options that provide a wide range of support, from housing, meals, and housekeeping to extensive personal care and medical services. Many nurses choose to spend all or part of their careers in these environments. This blog post looks at some of the characteristics and challenges of working in assisted living vs. nursing home care.

Nursing in assisted living

The National Institute on Aging offers that “Assisted living is for people who need help with daily care, but not as much help as a nursing home provides… Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities.”

According to Herzing University, “In an assisted living community, nurses and other healthcare professionals provide 24-hour supervision and a variety of personal care and health services for residents. As demand for long-term healthcare services increases, many assisting living providers are dealing with workforce shortages, particularly for registered nursing roles.” The nursing roles in assisted living range from registered nurses (RNs) and licensed practical nurses (LPNs) to certified nursing assistants (CNAs) and nurse practitioners (NPs). As for the level of care in an assisted living facility, it is not as intense or advanced as a nursing home, where residents need more support and may have health conditions with greater acuity.

Herzing University suggests the following potential areas where assisted living nurses may provide residents with assistance:

• “Personal care. A nurse or CNA can help disabled or physically impaired residents with daily needs such as bathing or dressing.
• Medication management. Nurses can help residents monitor and manage their pain levels. They may also assist with the administration of medicine, or supervise residents to ensure they take their medications as prescribed.
• Memory care. Nurses may provide individualized care for residents with Alzheimer’s, dementia, or related illnesses. This could include pain management and psychiatric care, as well as general assistance during meals and social activities.
• Exercise and general wellness. A nurse might help residents create a wellness program to maintain or improve their health or mobility. They may also assist residents with physical therapy or rehabilitation exercises, as prescribed by a physical therapist.
• Corresponding with family members. Nurses may also regularly correspond with a resident’s family members. They help the family understand their loved one’s evolving needs and level of care and keep them informed in the event of any emergencies.”

When it comes to stress, assisted living can present some challenges. The COVID-19 pandemic’s outsize impact on residential care communities has made them a hard place to work, adding to preexisting pressures stemming from staffing shortages, increased residential demand, and a growing population needing more assistance. When pandemic conditions abate in the future, it may be that assisted living will be a less stressful work option again in residential care.

Nursing in nursing homes

According to the National Institute on Aging, “Nursing homes, also called skilled nursing facilities, provide a wide range of health and personal care services. Their services focus on medical care more than [just assistance]. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available… Some people stay at a nursing home for a short time after being in the hospital. After they recover, they go home. However, most nursing home residents live there permanently because they have ongoing physical or mental conditions that require constant care and supervision.”

Assistedliving.org offers that “A nurse in a nursing home facility has many responsibilities. They have the task of not only caring for the elderly residents, they are also in charge of other employees and have to make sure the operation runs smoothly. Caring for the elderly in a nursing home is a huge responsibility as many of the residents need some type of medical attention.”

The same source tells readers, “Depending on the level of care rendered to its residents, the nursing home may employ all three nursing types or sometimes just CNAs and one or two registered nurses. In any case, each type of nurse has their own job description and different level of responsibility.” In addition, “Aside from their supervisory role, RNs have specific jobs to do. They are also responsible for the total care of the residents by initiating treatment plans and administering medicine. They also prepare IVs, draw blood, give injections, and taking vital signs. Their nursing responsibilities go even further as they are required to monitor the health of their patients and to make sure they are getting the proper care. In addition, an RN is responsible for interacting with the patient’s family by reporting any changes in the patient’s health or living situation.”

Assistedliving.org advises that “being an RN, LPN, or CNA in a nursing home is a big responsibility as both the patient’s health and well-being are the prime concern. Some of these patients cannot care for themselves and they are totally dependent on the staff for their care. A nursing-home nurse not only needs the proper education and degree for the job, they also need to be totally dedicated as their job can be a very demanding one.” In addition to other considerations, nursing homes are governed by far more stringent regulations than assisted living facilities.

As for disadvantages of working as a nurse in a nursing home, the Houston Chronicle lists lower salaries than for other care settings, emotional stress from caring for patients needing lots of assistance and dealing with families who question care, and the physical demands of transferring mobility-impaired residents. Once you add the stress of COVID-19 and its outsize impact within long-term care facilities, it’s clear nursing homes can be a more challenging work environment than assisted living.

HealthStream solutions for the long-term care workforce

There is a long list of challenges facing skilled and long-term care (LTC) providers. Turnover rates, for example, for clinical care in nursing homes range from 55 to 75 percent, with rates among Certified Nurse Assistants (CNAs) approaching 100 percent in some areas. With consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for the assisted living and long-term care workforce.