CNA Abuse, Neglect, and Mandatory Reporting 6

Question 1

A mentally competent resident tells you that her adult son has been using her debit card without her permission. She begs you not to tell anyone, saying, "He's all I have, and I don't want him in trouble." What is the most appropriate action?

Accepted Answer

Tell her you can't keep this secret, then report it right away to your charge nurse or administrator according to facility policy

Answer

Mandatory reporting does not depend on the resident's consent. Suspected financial exploitation (misappropriation) must be reported right away, even when a competent resident asks you not to. Never promise to keep abuse secret. Gently tell the resident that you have to report it, then follow the facility's chain of reporting. Waiting to collect more proof delays protection. Sending her to the bank on her own shifts your legal duty onto a possible victim.

Question 2

Under the federal Elder Justice Act reporting rules for long-term care facilities, if a covered staff member has a reasonable suspicion that a crime has happened against a resident AND it caused serious bodily injury, what is the maximum time allowed to report it to the State Survey Agency and local law enforcement?

Accepted Answer

2 hours

Answer

Section 1150B of the Social Security Act (added by the Elder Justice Act) requires a report within 2 hours when a suspected crime caused serious bodily injury. When there is no serious bodily injury, the limit is 24 hours. Facilities may not retaliate against staff who report. Each covered individual has their own personal duty to report, so telling someone else does not necessarily satisfy it.

Question 3

A resident with dementia keeps wandering into other rooms during the evening shift. A frustrated coworker walks him back to his room, says, "Since you can't behave, you're staying in here for the rest of the night," and holds the door shut whenever he tries to leave. This is best classified as:

Accepted Answer

Involuntary seclusion, which is a form of abuse

Answer

Involuntary seclusion means separating a resident from other residents, or confining them to their room, against their will or the will of their legal representative. CMS classifies it as abuse. Here the confinement is also punitive ("since you can't behave"), which makes it worse. Charting it does not make it acceptable. Proper approaches include redirection, finding the unmet need behind the wandering, and calling the nurse for a care-plan review.

Question 4

You find a male resident with mild cognitive impairment touching the breasts of a female resident who has advanced Alzheimer's disease. She is not resisting. What is the correct response?

Accepted Answer

Separate the residents right away, make sure the female resident is safe, and report it immediately as possible sexual abuse

Answer

Consent requires the capacity to understand and agree to the activity. A resident with advanced Alzheimer's disease generally cannot give valid consent, so not resisting is not the same as consenting. Resident-to-resident sexual contact without capacity to consent must be treated as possible sexual abuse: protect the resident, separate the two, and report immediately. Residents do have a right to intimacy, but only when both people can consent. Asking her about consent cannot produce a reliable answer.

Question 5

A coworker shows you a video in a private group chat. It shows a confused resident struggling to get dressed, with laughing emojis added. The coworker says it was only shared with three staff friends and has already been deleted. What is the correct conclusion?

Accepted Answer

It is mental abuse and must be reported, whether or not it was deleted or how many people saw it

Answer

CMS guidance says that taking or sharing photos or recordings of residents that demean or humiliate them, on any social media or messaging platform, counts as mental abuse. A small private audience and later deletion do not change that, and neither does whether the resident knows about it. It also violates the resident's privacy and dignity rights and HIPAA. The CNA must report it right away.

CNA Practice Test

CNA Practice Test

CNA Abuse, Neglect, and Mandatory Reporting 6