1 the nursing assistant in long-term care define the following terms: long-term care care for...

1The Nursing Assistant in Long-Term Care

Define the following terms:

Long-term care

care for persons who require 24-hour care and assistance.

Length of stay

the number of days a person stays in a healthcare facility.

Terminal illness

a disease or condition that will eventually cause death.

Chronic

refers to the fact that a disease or condition is long-term or long-lasting.

Diagnosis

physician’s determination of an illness.



Home health carecare provided in a person’s home.

Assisted livingfacilities where residents live who need some assistance; they do not usually require skilled care.

Adult daycarecare given at a facility during daytime hours; generally for people who need some help but are not seriously ill or disabled.

Acute carecare performed in hospitals and ambulatory surgical centers.

Skilled caremedically necessary care given by a skilled nurse or therapist.



Subacute carecare performed in either a hospital or a traditional nursing home.

Outpatient carecare usually provided for less than 24 hours for persons who have had treatments or surgery requiring short-term skilled care.

Rehabilitationmanaged by professionals to restore a person to the highest possible level of functioning after an illness or injury.

Hospice carecare for individuals who have six months or less to live; provides physical and emotional care and comfort.


1. Compare long-term care to other healthcare settings

Discuss the different healthcare settings. Briefly emphasize aspects of long-term care, including:• Reasons why people live in LTC facilities• Common conditions in LTC• The fact that LTC facilities are residents’ homes



activities of daily living (ADLs)personal dailycare tasks, such as bathing, dressing, caring for teeth and hair, toileting, eating and drinking,walking, and transferring.

culture changea term given to the process of transforming services for elders so that they are based on the values and practices of the person receiving care; core values include choice, dignity, respect, self-determination, and purposeful living.


2. Describe a typical long-term care facility

The following services are commonly provided at LTCFs:• Assistance with personal care• Physical, occupational, and speech therapy• Wound care• Care of different types of tubes and catheters (a thin tube inserted into the body that is used to drain fluids or inject fluids)

• Nutrition therapy• Management of chronic diseases



REMEMBER:There different models of LTC facilities. Some may include dementia or assisted living wings.



Think about this question:Why do you think care might be changing to reflect the residents’ individual psychosocial needs?



Medicarea federal health insurance program for people who are 65 or older, are disabled, or are ill and cannot work.

Medicaida medical assistance program for low-income people.


3. Explain Medicare and Medicaid

Define Medicare and Medicaid.

The Nursing Assistant in Long-Term Care

Transparency 1-1: Facts About Medicare

• For 65 or older or disabilities and illnesses • Part A pays hospitals, skilled nursing facilities,

hospice care, and some home health care. • Part B pays doctors’ services and other medical

services and equipment. • Part C allows private health insurance companies to

provide Medicare benefits. • Part D helps pay for medications prescribed for

treatment.


3. Explain Medicare and Medicaid

Remember these facts about Medicaid:• Medicaid is funded by the federal government and each state

• Eligibility for long-term care coverage under Medicaid is determined by income and special circumstances

• People must qualify

Under Medicare and Medicaid• Long-term care facilities are paid a fixed amount for services

• Services based on the resident’s needs upon admission



Chartingwriting down important information and observations about residents.


4. Describe the role of the nursing assistant

How can NAs provide services for residents?• Performing assigned nursing tasks• Providing personal care or assisting with self-care



Think about these questions:• Which tasks do NAs typically perform?• Are there tasks NAs do not perform? What are they?


4. Describe the role of the nursing assistant• What are some typical NA duties?• Feeding residents• Helping with toileting and elimination• Assisting with mobility• Keeping living areas neat and clean• Encouraging residents to eat and drink• Caring for supplies and equipment• Helping residents dress• Making beds• Giving back rubs• Helping with mouth care



There are some tasks that NAs are generally not allowed to do:• Giving medications• Inserting or removing tubes• Changing sterile dressings• Giving tube feedings

REMEMBER:NAs are the “eyes and ears” of the healthcare team.



Care plana plan developed for each resident to achieve certain goals; it outlines the steps and tasks that the care team must perform.


5. Describe the care team and the chain of command

Think about these questions:• What is the purpose of the care plan?• How and why is each care plan different?


5. Describe the care team and the chain of command

REMEMBER:Activities not listed on the care plan must not be performed.


5. Describe the care team and the chain of commandWhat are the roles of each of the following team members?• Nursing Assistant• Registered Nurse• Licensed Practical Nurse/Licensed Vocational Nurse• Physician or Doctor• Physical Therapist• Occupational Therapist• Speech Language Pathologist• Registered Dietitian• Medical Social Worker• Activities Director• Resident and Resident’s Family



Chain of commandthe line of authority in a facility that helps make sure that residents get proper health care.

Liabilitya legal term that means someone can be held responsible for harming someone else.

Scope of practicedefines the things that healthcare providers are legally allowed to do and how to do them correctly.


Transparency 1-2: Chain of Command


5. Describe the care team and the chain of commandREMEMBER:• Some tasks are never performed by NAs.• NAs must never honor a request to do something outside their scope of practice; such requests must be reported to the nurse.



Policya course of action that should be taken every time a certain situation occurs.

Procedurea method, or way, of doing something.


6. Define policies, procedures, and professionalism

These are common policies and procedures in facilities:• All resident information is confidential. • Resident’s care plan must be followed.• NAs only perform tasks in job descriptions. • NAs report changes/observations to nurse. • Personal problems must not be discussed with residents or families.

• Gifts and money cannot be accepted from residents or families.

• NAs must be dependable.



REMEMBER:• Ask questions or review your facility’s procedure manual when you are unsure about care.

• If you do not understand a policy at your facility, ask questions until you do understand.



NAs can maintain professional relationships with residents by• Being positive• Doing only assigned tasks• Keeping resident information confidential• Being polite and cheerful• Never discussing personal problems• Not using profanity• Listening• Calling resident by proper name• Explaining care• Following care practices


6. Define policies, procedures, and professionalismNAs can maintain professional relationships with employers by• Completing duties • Following policies/procedures • Documenting and reporting care • Communicating problems • Asking questions • Taking directions and criticism • Being clean and neatly dressed and groomed• Being on time • Notifying if absent • Following chain of command • Participating in education programs • Being a role model for the facility


Transparency 1-3: Qualities of Great Nursing Assistants

Nursing assistants must be• Compassionate• Honest• Tactful• Conscientious• Dependable• Respectful• Unprejudiced• Tolerant



Think about this question:Can you think of examples of how each quality of a great nursing assistant pertains to care of residents?



Ethicsthe knowledge of right and wrong.

Lawsrules set by the government to help people live peacefully together and to ensure order and safety.


7. List examples of legal and ethical behavior and explain Residents’ Rights

Remember these guidelines for legal and ethical behavior: • Be honest at all times.• Protect residents’ privacy.• Keep staff information confidential. • Report abuse or suspected abuse of residents, and assist residents in reporting abuse if they wish to do so.

• Follow the care plan and your assignments.



Remember these guidelines for legal and ethical behavior (cont’d.): • Do not perform any task outside your scope of practice.

• Report all resident observations and incidents to the nurse.

• Document accurately and promptly.• Follow rules on safety and infection control (outlined in Chapter 2).

• Do not accept gifts or tips.• Do not get personally or sexually involved with residents or their family members or friends.



Think about this question:What each of these guidelines mean for your behavior on the job?



Omnibus Budget Reconciliation Act (OBRA)law passed by the federal government that includes minimum standards for nursing assistant training, staffing requirements, resident assessment instructions, and information on rights for residents.

Citein a long-term care facility, to find a problem through a survey.



Residents’ Rightsnumerous rights identified in OBRA that relate to how residents must be treated while living in a facility; they provide an ethical code of conduct for healthcare workers.

Informed consentthe process in which a person, with the help of his doctor, makes informed decisions about health care.



Remember these important points about OBRA: • Sets minimum standards for NA training • Requires regular in-services for NAs • Establishes state registry of NAs • Includes increased minimum staff requirements • Sets resident assessment requirements (MDS) • Includes changes in survey process • Establishes Residents’ Rights


Transparency 1-4: Residents’ Rights

Residents have a right to• Quality of life• Services and activities to maintain a high level of

wellness• Be fully informed regarding rights and services• Participate in their own care• Make independent choices• Privacy and confidentiality• Dignity, respect, and freedom• Security of possessions• Be informed of and consent to transfers and

discharges• Voice complaints• Have visits



Think about this question:Look at the bulleted list on page 11 of your textbook. Can you think of other ways NAs can protect residents’ rights?


Handout 1-1: Decision Quiz

Choices I have made today include1.

2.

3.

4.

5.

6.



REMEMBER:Everyday decisions may not seem that important because you are able to make them.



Think about these questions:• What if you were not able to make all of your own choices?

• Why do you want to make your own decisions?



REMEMBER:Making decisions about our own lives is a very important part of being an adult. Residents’ Rights guarantee that residents can continue to make many decisions about their own lives.



Neglectharming a person physically, mentally, or emotionally by failing to provide needed care.

Active neglectpurposely harming a person by failing to provide needed care.

Passive neglectunintentionally harming a person physically, mentally, or emotionally by failing to provide needed care.

Negligenceactions, or the failure to act or provide the proper care, that result in unintended injury to a person.



Malpracticeinjury to a person due to professional misconduct through negligence, carelessness, or lack of skill.

Abusepurposely causing physical, mental, or emotional pain or injury to someone.

Physical abuseany treatment, intentional or not, that causes harm to a person’s body; includes slapping, bruising, cutting, burning,physically restraining, pushing, shoving, or rough handling.



Psychological abuseany behavior that causes a person to feel threatened, fearful, intimidated, or humiliated in any way.

Verbal abusethe use of language—spoken or written—that threatens, embarrasses, or insults a person.

Assaultthe act of threatening to touch a person without his or her permission.

Batterytouching a person without his or her permission.



Sexual abuseforcing a person to perform or participate in sexual acts against his or her will; includes unwanted touching, exposing oneself, and sharing pornographic material.

Financial abusethe act of stealing, taking advantage of, or improperly using the money, property, or other assets of another person.

Domestic violencephysical, sexual, or emotional abuse by spouses, intimate partners, or family members.

Workplace violenceverbal, physical, or sexual abuse of staff by residents or other staff members.



Involuntary seclusionseparating a person from others against the person’s will.

Sexual harrassmentany unwelcome sexual advance or behavior that creates an intimidating, hostile, or offensive working environment; includes requests for sexual favors, unwanted touching, and other acts of a sexual nature.

Substance abusethe use of legal or illegal drugs, cigarettes, or alcohol in a way that is harmful to the abuser or to others.


Transparency 1-5: Suspicious Injuries



Signs of abuse to observe and report:• Yelling obscenities• Fear, afraid to be alone• Poor self-control• Constant pain• Threatening to hurt others• Withdrawal or apathy



Signs of abuse to observe and report (cont’d.):• Alcohol or drug abuse• Anxiety, stress• Low self-esteem• Mood changes, confusion, disorientation• Private conversations not allowed or family member always present

• Resident reports of questionable care



Signs of neglect to observe and report:• Pressure sores• Unclean body• Body lice• Unanswered call lights• Soiled bedding or briefs• Poorly-fitting clothing• Refusal of care



Signs of neglect to observe and report (cont’d.):• Unmet needs relating to hearing aids, glasses, etc.• Weight loss• Poor appetite• Dehydration• Fresh water or beverages not being passed each shift


Handout 1-2: Who is Vulnerable to Abuse or Neglect?

Some people are more vulnerable to adult abuse or neglect than others. They include•Elderly•Physically ill or disabled•Developmentally disabled•Mentally ill or disabled•People with communication problems, such as hearing, speech, and vision impairments


Handout 1-2: Who is Vulnerable to Abuse or Neglect? (cont’d.)

All of these people have a few things in common that make them so vulnerable. They are often unable to stand up for themselves, or report abuse or neglect to others. They may not even understand that they have rights. Often these people can be much more demanding to care for, which increases the stress that caregivers have to deal with.

Caregivers may not have been properly trained to care for these particular people, and they may not understand why these people behave the way they do. Caregivers may also be overworked, tired, stressed, and unappreciated, on top of caring for someone who requires so much time and energy.


Handout 1-2: Who is Vulnerable to Abuse or Neglect? (cont’d.)

These are the people who most need your help in protecting themselves. They may not be able to speak for themselves, but the signs of abuse and neglect may speak volumes for them, if you just know how to recognize these signs.



Think about these questions:• How are Residents’ Rights related to abuse? • What action should an NA take if abuse is seen or suspected?



REMEMBER:• NAs must never abuse residents in any way, and must try to protect residents from others who abuse them.

• Reporting abuse is not simply an option; it is the law.

• Always follow the chain of command when reporting abuse.



Ombudsmanthe legal advocate for residents; helps resolve disputes and settle conflicts.

Confidentialitythe legal and ethical principle of keeping information private.

Health Insurance Portability and Accountability Act (HIPAA)a federal law that requires health information be kept private and secure and that organizations must take special steps to protect this information.



REMEMBER:• HIPAA applies to all healthcare providers.• All healthcare workers must follow HIPAA regulations no matter where they are or what they are doing.

• Penalties may be imposed for not adhering to HIPAA.



Think about this question:Look at the guidelines for protecting residents’ privacy on pages 16 and 17 of your textbook. • Can you think of any other ways in which breaches in confidentiality might occur?

• How would you prevent them?


8. Explain legal aspects of the resident’s medical recordReasons for careful charting:• Ensures clear communication• Legal record• Protects NA and employer from liability• Provides up-to-date record


8. Explain legal aspects of the resident’s medical recordGuidelines for documentation:• Write notes immediately after care.• Think before writing. Be brief and clear.• Only write facts, not opinions.• Write neatly with black ink.• Draw one line through mistakes, mark “error,” and initial (see figure 1-18 in text).

• Sign full name.• Document per care plan.


8. Explain legal aspects of the resident’s medical recordREMEMBER:If care is not documented, legally speaking it was not performed.


Transparency 1-6: Military Time



Minimum Data Set (MDS)a detailed form with guidelines for assessing residents in long-term care facilities; also details what to do if resident problems are identified.


9. Explain the Minimum Data Set (MDS)

Why is the Minimum Data Set (MDS) important?• Helps nurses complete resident assessments accurately

• Details what to do if resident problems are identified

• Must be completed for each resident within 14 days of admission and again each year

• Must be reviewed every three months• New MDS must be done when there is any major change in the resident’s condition


9. Explain the Minimum Data Set (MDS)

REMEMBER:NAs’ reporting is important in the MDS process. It can trigger a new MDS to be completed.



Incidentan accident or unexpected event during the course of care that is not part of the normal routine in a healthcare facility.

Sentinel eventan accident or incident that results in grave physical or psychological injury or death.


10. Discuss incident reports

The following events are considered incidents: • Falls• Something broken or damaged• Errors in care • Requests outside scope of practice• Injuries • Sexual advances or remarks • Accusations against staff • Unsafe situations • Blood or body fluids exposure


10. Discuss incident reports

Remember these guidelines for incident reporting: • Tell what happened. • Tell how the person tolerated the incident. • State facts only. • Do not write about anything in the incident report on the medical record.

• Describe action taken. • Include suggestions for change.


Chapter 1: Exam

Multiple Choice. Choose the correct answer.1. Which of the following healthcare settings is for people who

will die in six months or less? (A)Hospice (B) Long-term care (C) Assisted living (D)Acute care

2. Which of the following statements is true of long-term care? (A) People with terminal illnesses do not live in

long-term care facilities. (B) Most conditions in long-term care facilities are

chronic.(C) People who live in long-term care facilities are

never able to return home. (D)Long-term care takes place in a person’s home.


Chapter 1: Exam (cont’d.)

3. A resident has purchased a special gift for her nursing assistant, Sarah. How should Sarah respond? (A)Refuse but thank her for thinking of her (B)Accept because Sarah does not know her facility’s

policy on gifts (C)Accept and ask the resident not to tell anyone (D)Refuse and tell her that her employer is very unfair

about employees accepting gifts from residents

4. A ______ is a method or way of doing something. (A)Policy (B)Procedure (C)Survey (D)Cite



5. Medicare is (A) A medical assistance program for low-income

people (B) A program that pays for 100% of healthcare costs

for all people who are enrolled in it (C) A health insurance program for people who are 65

or older or younger people who are disabled and ill (D)Never used to pay for long-term care

6. Which member of the care team diagnoses disease and prescribes treatment?(A) Nursing assistant (NA)(B) Resident(C) Physician (MD)(D)Dietitian (RD)



7. Which of the following care team members are licensed professionals who delegate jobs to nursing assistants?(A) NAs, nurses(B) Resident’s family(C) Nurses, PTs, OTs(D)NAs, physicians

8. Which of the following statements is true of residents being a part of the care team?(A) Residents cannot make their own decisions.(B) Residents are not care team members.(C) Residents should not try to make choices about

the care they want to receive.(D)The care team revolves around the resident and his or

her condition, treatment, and progress.


Chapter 1: Exam (cont'd.)

9.Which of the following statements is true of a nursing assistant’s responsibilities if an activity is not listed in the care plan?(A) The NA should not perform the activity if it is

not listed on the care plan.(B)The NA should perform the activity if he or she

believes it is best for the resident.(C)The NA should only perform the activity if the

resident says he wants it performed.(D)The NA should consult other NAs to see if they

would perform the activity.



10.What is one reason why reporting a resident’s changes and problems to the nurse is a very important role of the nursing assistant?(A)The care plan must be updated as the resident’s

condition changes.(B)Reporting changes is not a task that the NA performs.(C)Depending on the resident’s changes, the NA can decide

if she wants to work that day or not.(D)The NA can decide what medication to prescribe for the

resident’s current condition.



11. Which of the following is a typical task that an NA performs?(A) Changing a sterile dressing

on an open wound(B) Helping residents with

toileting needs(C) Administering medication(D)Prescribing treatments

12. Which of the following tasks is outside the scope of practice for an NA?(A) Giving a resident a bath(B) Giving an injection of

medication(C) Helping a resident eat

dinner(D)Transferring a resident from the bed to a chair



13. A professional relationship between an NA and a resident includes:(A)Telling the resident about problems with the supervisor(B) Calling the resident

“Dearie” and “Sweetie”(C) Letting a resident know if

the NA is in a bad mood(D)Keeping resident information confidential

14. Which of the following is an example of a professional relationship with an employer? (A) Documenting carefully (B) Never bothering the nurses

with questions(C) Trying not to be late more

than twice a week (D)Talking about the management behind their backs



15.What does the chain of command do? (A)It determines which residents go in which rooms. (B)It determines which shift an NA works.(C)It describes the care plan for each resident. (D)It helps protect nursing assistants and their employers

from liability.

16.What should a nursing assistant do if she suspects a resident is being abused? (A)She should ask another resident if he thinks that person is

being abused. (B)She should ask her family and friends for advice. (C)She should report it to the nurse immediately and let

him/her handle it from there. (D)She should do nothing since someone has probably already

reported it.


Chapter 1: Exam (cont'd.)17. When a nursing assistant is

performing a procedure on a resident, he should(A) Try to distract the resident

so he/she won’t know what the NA is doing (B) Explain the procedure fully

before performing it (C) Wait until the resident is

sleeping before the NA starts the procedure (D)Watch TV or talk to the resident’s roommate so the resident

doesn’t become self-conscious

18. Which of the following is a requirement of OBRA? (A) Resident assessments must be

completed on a few residents. (B) Nursing assistants must have

at least 45 hours of training. (C) States cannot keep a current

list of nursing assistants in a state registry. (D)Nursing assistants must have at least 75 hours of training.



19. For a nursing assistant, confidentiality means: (A) Not telling the nurse about

possible abuse of a resident (B) Never documenting resident

problems (C) Keeping private things private (D)Sharing information with the nursing assistant’s own family

20. Why was HIPAA created? (A) To keep health information

private and secure (B) To help ombudsmen monitor care

in facilities (C) To show nursing assistants how

to report abuse in facilities (D)To prevent neglect of residents


Chapter 1: Exam (cont'd.)21. You are the nursing assistant

for a resident who is paralyzed on her right side from a recent stroke. Some of her family members are visiting and one of them turns to you and says in a loud voice, “She looks so stupid with half of her face drooping down like that. Isn’t there something you can do to fix that?” What kind of abuse is this? (A) Physical abuse (B) Psychological abuse (C) Sexual abuse (D)Involuntary seclusion

22. If you make a mistake in documenting care, you should:(A) Erase it.(B) Draw one line through it,

and write the correct word(s).(C) Use correction fluid.(D)Discard the chart and start over.



23. A resident’s protected health information (PHI) may be shared with:(A) Other residents in the

facility(B) Only those who need the

information for care or processing of records(C) The nursing assistant’s

family and friends(D)Anyone who asks

24. Which of the following is an example of physical abuse?(A) Stealing from a resident(B) Failing to give a resident

needed care(C) Shoving a resident(D)Threatening a resident



25.What is the term for the person assigned by law to be the legal advocate for residents?(A)Activities Director(B)Ombudsman(C)OBRA(D)Occupational Therapist

26.Which of the following shows the correct conversion of 9:00 p.m. to military time? (A)2300 hours (B)2100 hours (C)2400 hours

(D)2000 hours

1 the nursing assistant in long-term care define the following terms: long-term care care for...

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