Long-Term Care Length of Stay Terminal Illness Chronic: Define The Following Terms

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The 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
physicians determination of an illness.
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Home health care
care provided in a persons home.
Assisted living
facilities where residents live who need some assistance; they
do not usually require skilled care.
Adult daycare
care given at a facility during daytime hours; generally for
people who need some help but are not seriously ill or
disabled.
Acute care
care performed in hospitals and ambulatory surgical centers.
Skilled care
medically necessary care given by a skilled nurse or therapist.
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Subacute care
care performed in either a hospital or a traditional nursing
home.
Outpatient care
care usually provided for less than 24 hours for persons who
have had treatments or surgery requiring short-term skilled
care.
Rehabilitation
managed by professionals to restore a person to the highest
possible level of functioning after an illness or injury.
Hospice care
care for individuals who have six months or less to live;
provides physical and emotional care and comfort.
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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
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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 change
a 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.
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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
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REMEMBER:
There different models of LTC facilities. Some may include
dementia or assisted living wings.
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Think about this question:

Why do you think care might be changing to reflect the
residents individual psychosocial needs?
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Medicare
a federal health insurance program for people who are 65 or
older, are disabled, or are ill and cannot work.
Medicaid
a medical assistance program for low-income people.
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3. Explain Medicare and Medicaid
Define Medicare and Medicaid.
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.
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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 residents needs upon admission
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Charting
writing down important information and observations about
residents.
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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
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Think about these questions:
Which tasks do NAs typically perform?
Are there tasks NAs do not perform? What are they?
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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
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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.
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Care plan
a plan developed for each resident to achieve certain goals; it
outlines the steps and tasks that the care team must
perform.
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5. Describe the care team and the chain of command
What is the purpose of the care plan?
How and why is each care plan different?
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REMEMBER:
Activities not listed on the care plan must not be performed.
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What 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 Residents Family
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Chain of command
the line of authority in a facility that helps make sure that
residents get proper health care.
Liability
a legal term that means someone can be held responsible for
harming someone else.
Scope of practice
defines the things that healthcare providers are legally
allowed to do and how to do them correctly.
Transparency 1-2: Chain of Command

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REMEMBER:
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.
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Policy
a course of action that should be taken every time a certain
situation occurs.
Procedure
a method, or way, of doing something.
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6. Define policies, procedures, and professionalism
These are common policies and procedures in facilities:
All resident information is confidential.
Residents 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.
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REMEMBER:
Ask questions or review your facilitys procedure manual when
you are unsure about care.
If you do not understand a policy at your facility, ask
questions until you do understand.
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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
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NAs 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
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Can you think of examples of how each quality of a great nursing
assistant pertains to care of residents?
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Ethics
the knowledge of right and wrong.
Laws
rules set by the government to help people live peacefully
together and to ensure order and safety.
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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.
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Residents Rights
Remember these guidelines for legal and ethical behavior
(contd.):
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.
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Residents Rights
What each of these guidelines mean for your behavior on the
job?
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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.
Cite
in a long-term care facility, to find a problem through a
survey.
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Residents Rights
numerous 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 consent
the process in which a person, with the help of his doctor,
makes informed decisions about health care.
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Residents Rights
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
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Residents Rights
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 include

1.
2.
3.
4.
5.
6.
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Residents Rights
REMEMBER:
Everyday decisions may not seem that important because you
are able to make them.
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Residents Rights
What if you were not able to make all of your own choices?
Why do you want to make your own decisions?
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Residents Rights
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.
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Neglect
harming a person physically, mentally, or emotionally by
failing to provide needed care.
Active neglect
purposely harming a person by failing to provide needed
care.
Passive neglect
unintentionally harming a person physically, mentally, or
emotionally by failing to provide needed care.
Negligence
actions, or the failure to act or provide the proper care, that
result in unintended injury to a person.
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Malpractice
injury to a person due to professional misconduct through
negligence, carelessness, or lack of skill.
Abuse
purposely causing physical, mental, or emotional pain or
injury to someone.
Physical abuse
any treatment, intentional or not, that causes harm to a
persons body; includes slapping, bruising, cutting,
burning,physically restraining, pushing, shoving, or rough
handling.
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Psychological abuse
any behavior that causes a person to feel threatened, fearful,
intimidated, or humiliated in any way.
Verbal abuse
the use of languagespoken or writtenthat threatens,
embarrasses, or insults a person.
Assault
the act of threatening to touch a person without his or her
permission.
Battery
touching a person without his or her permission.
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Sexual abuse
forcing a person to perform or participate in sexual acts
against his or her will; includes unwanted touching, exposing
oneself, and sharing pornographic material.
Financial abuse
the act of stealing, taking advantage of, or improperly using
the money, property, or other assets of another person.
Domestic violence
physical, sexual, or emotional abuse by spouses, intimate
partners, or family members.
Workplace violence
verbal, physical, or sexual abuse of staff by residents or other
staff members.
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Involuntary seclusion
separating a person from others against the persons will.
Sexual harrassment
any 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 abuse
the 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

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Residents Rights
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
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Residents Rights
Signs of abuse to observe and report (contd.):
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
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Residents Rights
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
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Residents Rights
Signs of neglect to observe and report (contd.):
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? (contd.)
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? (contd.)
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.
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Residents Rights
How are Residents Rights related to abuse?
What action should an NA take if abuse is seen or suspected?
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Residents Rights
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.
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Ombudsman
the legal advocate for residents; helps resolve disputes and
settle conflicts.
Confidentiality
the 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.
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Residents Rights
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.
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Residents Rights
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?
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8. Explain legal aspects of the residents medical record
Reasons for careful charting:
Ensures clear communication
Legal record
Protects NA and employer from liability
Provides up-to-date record
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Guidelines 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.
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REMEMBER:
If care is not documented, legally speaking it was not performed.
Transparency 1-6: Military Time

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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.
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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 residents condition
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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.
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Incident
an accident or unexpected event during the course of care
that is not part of the normal routine in a healthcare facility.
Sentinel event
an accident or incident that results in grave physical or
psychological injury or death.
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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
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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.
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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 persons home.
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Chapter 1: Exam (contd.)
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 facilitys 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
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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)
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7. Which of the following care team members are licensed professionals
who delegate jobs to nursing assistants?
(A)NAs, nurses
(B)Residents 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.
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Chapter 1: Exam (cont'd.)
9.Which of the following statements is true of a nursing
assistants 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.
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10.What is one reason why reporting a residents changes and problems
to the nurse is a very important role of the nursing assistant?
(A)The care plan must be updated as the residents condition
changes.
(B)Reporting changes is not a task that the NA performs.
(C)Depending on the residents 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 residents
current condition.
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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
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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
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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.
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17.When a nursing assistant is performing a procedure on a resident, he
should
(A)Try to distract the resident so he/she wont 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 residents roommate so the resident
doesnt 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.
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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 assistants 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
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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. Isnt
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.
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23.A residents 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 assistants 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
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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

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1

The Nursing Assistant in Long-Term Care

The following services are commonly provided at LTCFs:

Think about this question:

Transparency 1-1: Facts About Medicare

For 65 or older or disabilities and illnesses

Under Medicare and Medicaid

Transparency 1-2: Chain of Command

Transparency 1-3: Qualities of Great Nursing Assistants

Nursing assistants must be

Transparency 1-4: Residents Rights

Residents have a right to

Handout 1-1: Decision Quiz

Choices I have made today include

Transparency 1-5: Suspicious Injuries

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

Some people are more vulnerable to adult abuse or neglect than

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

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

Transparency 1-6: Military Time

2. Which of the following statements is true of long-term care?

4. A ______ is a method or way of doing something.

6. Which member of the care team diagnoses disease and prescribes

8. Which of the following statements is true of residents being a part of

12.Which of the following tasks is outside the scope of practice for an

14.Which of the following is an example of a professional relationship

16.What should a nursing assistant do if she suspects a resident is being

18.Which of the following is a requirement of OBRA?

20.Why was HIPAA created?

22.If you make a mistake in documenting care, you should:

24.Which of the following is an example of physical abuse?

26.Which of the following shows the correct conversion of 9:00 p.m. to

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