CNHA Ethics and Legal Issues 2 — Questions and Answers
Question 1: The Long-Term Care Ombudsman Program serves what primary function in nursing facilities?
- Conducting the annual state inspection surveys of facilities
- Investigating Medicare billing complaints against providers
- Advocating for the rights and quality of life of long-term care residents (Correct answer)
- Providing mandatory staff training on regulatory compliance standards
Correct answer: Advocating for the rights and quality of life of long-term care residents
The Long-Term Care Ombudsman Program is federally mandated under the Older Americans Act to investigate complaints and advocate for the rights and interests of nursing home residents.
Question 2: When a nursing home resident is determined to lack decision-making capacity, who is typically authorized to make healthcare decisions on their behalf?
- The nursing home administrator as the responsible party
- The attending physician based on their clinical judgment
- A legally appointed guardian or designated healthcare proxy (Correct answer)
- The facility's ethics committee by majority vote
Correct answer: A legally appointed guardian or designated healthcare proxy
A legally appointed guardian or designated healthcare proxy has the legal authority to make healthcare decisions for a resident who lacks decision-making capacity.
Question 3: A valid Do Not Resuscitate (DNR) order in a nursing home must be:
- Verbally authorized by the resident or surrogate and documented within 30 days
- Written, signed by the physician, and consistent with the resident's advance directive or expressed wishes (Correct answer)
- Approved by the facility's ethics committee before it can be implemented
- Renewed monthly and countersigned by the administrator to remain legally valid
Correct answer: Written, signed by the physician, and consistent with the resident's advance directive or expressed wishes
A valid DNR order must be in writing, signed by the physician, and reflect the informed wishes of the resident or their authorized surrogate decision-maker.
Question 4: Which federal law protects nursing home employees who report violations of resident rights or care standards from employer retaliation?
- The Americans with Disabilities Act (ADA)
- The Fair Labor Standards Act (FLSA)
- Section 1150B of the Social Security Act (Correct answer)
- The Family and Medical Leave Act (FMLA)
Correct answer: Section 1150B of the Social Security Act
Section 1150B of the Social Security Act provides whistleblower protections for employees of long-term care facilities who report suspected abuse, neglect, or exploitation of residents.
Question 5: A nursing home administrator has an undisclosed financial interest in a pharmacy that supplies medications to their facility. How should this situation be characterized and handled?
- A permissible professional arrangement that requires no disclosure to the governing body
- A conflict of interest that must be disclosed to the governing body and managed appropriately (Correct answer)
- A standard business practice explicitly allowed under Medicare billing rules
- An anti-kickback violation that should remain confidential to avoid regulatory scrutiny
Correct answer: A conflict of interest that must be disclosed to the governing body and managed appropriately
A financial interest in a supplier creates a conflict of interest that must be disclosed to the governing body and managed according to the facility's conflict of interest policy.
Question 6: Under the Elder Justice Act, nursing homes that receive federal funds must report which of the following to law enforcement?
- Any medication errors that result in resident hospitalization
- Reasonable suspicion that a crime has been committed against a resident (Correct answer)
- All falls resulting in injury requiring medical treatment
- Family complaints about quality of care received by their loved one
Correct answer: Reasonable suspicion that a crime has been committed against a resident
The Elder Justice Act requires facilities receiving federal funds to report reasonable suspicion of a crime committed against a resident to law enforcement and the state survey agency.
Question 7: Which document outlines the minimum standards for ethical conduct expected of licensed nursing home administrators?
- The CMS Conditions of Participation (CoPs) for long-term care
- The NAB Code of Ethics for Licensed Nursing Home Administrators (Correct answer)
- The State Operations Manual (SOM) Appendix PP
- The Medicare Provider Agreement signed upon certification
Correct answer: The NAB Code of Ethics for Licensed Nursing Home Administrators
The National Association of Long Term Care Administrator Boards (NAB) Code of Ethics establishes the professional ethical standards expected of licensed nursing home administrators.
CNHA Ethics and Legal Issues 2
The Long-Term Care Ombudsman Program serves what primary function in nursing facilities?