CNA Abuse, Neglect, and Mandatory Reporting 5

Question 1

At 6:15 PM, a CNA finds a resident with a fractured wrist and fresh bruises on her forearm. The resident says another staff member 'grabbed her hard' during toileting. Under federal long-term care rules (Elder Justice Act / 42 CFR 483.12), what is the latest time this allegation must reach the administrator and the state survey agency?

Accepted Answer

By 8:15 PM the same evening, because the allegation involves abuse and serious bodily injury

Answer

Federal rules require allegations of abuse, and suspected crimes that cause serious bodily injury, to be reported to the administrator and the state survey agency within 2 hours. The 24-hour window applies only when there is no abuse allegation and no serious bodily injury. The 5-working-day deadline is for the facility's investigation report, not the first report. Reporting can't wait for anyone to decide whether the resident is believable.

Question 2

A cognitively intact resident tells a CNA, 'My son has been using my debit card to pay his rent. Please don't tell anyone. He'll stop visiting if he gets in trouble.' What is the CNA's most appropriate response?

Accepted Answer

Tell the resident gently that this can't be kept secret, then report it right away as suspected financial exploitation

Answer

Misusing a resident's money without permission is financial exploitation, which is a form of abuse, and CNAs are mandatory reporters. A CNA must never promise to keep suspected abuse secret. The resident's right to manage their own money doesn't cancel the duty to report a reasonable suspicion. The CNA also shouldn't investigate or confront the suspected abuser. That job belongs to the facility and the authorities.

Question 3

A resident shouted at staff during breakfast. A nurse tells the CNA, 'Keep him in his room for the rest of the day with the door shut, and no activities, so he learns his lesson.' This instruction is best classified as:

Accepted Answer

Involuntary seclusion, a form of abuse the CNA should refuse to carry out and report

Answer

Involuntary seclusion means separating a resident from other people or from their room against their will, and using it as punishment makes it abuse. An order from a nurse doesn't make it legal. The CNA should refuse, keep the resident safe, and report it right away. A planned, supervised separation can be allowed when it's part of a therapeutic care plan, but punishment never is.

Question 4

A CNA's coworker takes a phone photo of a resident with dementia who has fallen asleep with food on her face. The coworker sends it to a private group chat of staff friends, without the resident's name, 'just as a joke.' How should the CNA view this?

Accepted Answer

Mental abuse that must be reported, because demeaning photos shared on social media or messaging apps count as abuse

Answer

CMS guidance says that taking or sharing photos or recordings that demean or humiliate a resident is mental abuse. It doesn't matter whether the image is shared publicly or privately, or whether the resident's name is included. Abuse doesn't require physical contact or harm the resident knows about. It must be reported right away, not saved for a later meeting.

Question 5

During morning care, a CNA finds a palm-sized bruise on the inner thigh of a nonverbal resident who uses a total lift. Nobody saw an injury happen, and the resident can't explain it. The CNA thinks the bruise probably came from the lift sling. What should the CNA do?

Accepted Answer

Report it right away as an injury of unknown origin, describing exactly what was seen without guessing the cause

Answer

An injury counts as being of unknown origin when nobody saw it happen and the resident can't explain it. It becomes suspicious when it's in an area that isn't usually exposed to injury, like the inner thigh. Injuries like this must be reported right away. The CNA's guess about the sling doesn't remove the duty to report. Investigating or deciding the cause belongs to the facility, not the CNA. Waiting delays protection for a resident who may be a victim.

CNA Practice Test

CNA Practice Test

CNA Abuse, Neglect, and Mandatory Reporting 5