As noted in Mitty's article, some assisted living facilities have units for patients with Alzheimer disease and dementia. For four years I've been fighting the notion that people with dementia advanced enough to require locked units have the ability to direct their own care. These patients need more than just a little help with activities of daily living and social stimulation.

Nebraska law doesn't require the presence of licensed nursing personnel in assisted living facilities. Residents receive medications from "medication aides" -who must complete a 40-hour course, be at least 18 years old, have a "good moral character," and apply for registration (renewable triennially), which includes a fee. Of course, some assisted living facilities hire RNs and LPNs, but the Nebraska Board of Nursing has this interpretation regarding regulations: "Facility staff cannot provide complex nursing interventions. If a resident requires complex nursing interventions, the resident or his or her designee assumes the responsibility for arranging for the resident's care through private duty personnel, a licensed home health agency, or a licensed hospice agency."1 This seems to indicate that if a resident aspirates, falls, or has a stroke, the facility's RN or LPN shouldn't do anything because such actions would qualify as "complex nursing interventions." This is irresponsible.

I've worked to organize various nursing and consumer groups in Nebraska to advocate legislation requiring RN oversight in dementia units, as well as licensed nursing personnel on at least one shift in facilities with more than 15 residents and aides with at least eight hours of training in care of people with Alzheimer disease and dementia. The only progress we've made is in the length of training required of medication aides: they must now complete 40 instead of 20 hours.

Rosalee C. Yeaworth, PhD, RN, FAAN

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