CSA Adult Care Planning 5 — Questions and Answers
Question 1: An 82-year-old client lives alone and has increasing difficulty preparing meals and managing finances but has no physical limitations. Which care setting is LEAST appropriate at this stage?
- Home with Meals on Wheels and a bill-pay service
- Home with a part-time IADL support aide
- Skilled nursing facility (Correct answer)
- Independent living community with optional services
Correct answer: Skilled nursing facility
A skilled nursing facility is designed for individuals requiring 24-hour skilled medical or rehabilitative care—it would be inappropriate for someone whose only limitations are IADL-based.
Question 2: What distinguishes palliative care from hospice care?
- Palliative care is only for cancer patients; hospice is for all terminal diagnoses
- Palliative care can be provided alongside curative treatment at any stage; hospice requires forgoing curative treatment (Correct answer)
- Palliative care is exclusively inpatient; hospice is exclusively home-based
- There is no meaningful distinction—the terms are interchangeable
Correct answer: Palliative care can be provided alongside curative treatment at any stage; hospice requires forgoing curative treatment
Palliative care provides comfort-focused symptom management concurrently with curative or life-prolonging treatments at any disease stage, while hospice requires electing comfort-only goals when prognosis is 6 months or less.
Question 3: The Spousal Impoverishment Protection provision under Medicaid is designed to:
- Ensure the institutionalized spouse retains all marital assets
- Protect a minimum level of income and assets for the community spouse when the other enters a nursing home (Correct answer)
- Require both spouses to spend down all assets before either qualifies for Medicaid
- Transfer financial responsibility for nursing home care to adult children
Correct answer: Protect a minimum level of income and assets for the community spouse when the other enters a nursing home
The Spousal Impoverishment Protection rules allow the community (at-home) spouse to retain a Community Spouse Resource Allowance (CSRA) and a Minimum Monthly Maintenance Needs Allowance (MMMNA) of income.
Question 4: A CSA is working with a family from a culture that views nursing home placement as abandonment. What is the most appropriate approach?
- Educate the family that nursing home placement is medically necessary and proceed
- Acknowledge cultural values, explore culturally congruent alternatives, and involve the family in shared decision-making (Correct answer)
- Defer all decision-making to the eldest male family member as is the cultural norm
- Document the family's refusal and close the case
Correct answer: Acknowledge cultural values, explore culturally congruent alternatives, and involve the family in shared decision-making
Culturally competent care requires acknowledging the family's values, exploring home-based or community alternatives, and collaboratively developing a plan that respects both safety and cultural identity.
Question 5: Which of the following is the PRIMARY purpose of an elder law attorney in the adult care planning process?
- Providing emotional support to caregiving families
- Handling legal documents such as advance directives, powers of attorney, and Medicaid planning (Correct answer)
- Conducting geriatric functional assessments
- Coordinating home health and community services
Correct answer: Handling legal documents such as advance directives, powers of attorney, and Medicaid planning
Elder law attorneys specialize in legal planning for older adults, including advance directives, guardianship, special needs trusts, and Medicaid asset protection strategies.
Question 6: Which condition would most likely qualify a senior for Medicare's home health benefit?
- Needing help with grocery shopping and cooking
- Being homebound and requiring skilled nursing wound care after a hospital discharge (Correct answer)
- Feeling lonely and needing companionship services
- Wanting supervision overnight due to a fear of falling
Correct answer: Being homebound and requiring skilled nursing wound care after a hospital discharge
Medicare home health requires the patient to be homebound and need part-time or intermittent skilled nursing or therapy services ordered by a physician.
Question 7: A senior's care plan includes a POLST form. Which statement about POLST is most accurate?
- POLST is a legal document that replaces the need for a healthcare proxy
- POLST translates a patient's treatment wishes into actionable medical orders valid outside the hospital (Correct answer)
- POLST applies only to patients in skilled nursing facilities
- POLST is only valid during an inpatient hospital stay
Correct answer: POLST translates a patient's treatment wishes into actionable medical orders valid outside the hospital
A POLST (Physician Orders for Life-Sustaining Treatment) is a portable medical order set that travels with the patient across care settings and instructs emergency responders on resuscitation and treatment preferences.
CSA Adult Care Planning 5
An 82-year-old client lives alone and has increasing difficulty preparing meals and managing finances but has no physical limitations.
Which care setting is LEAST appropriate at this stage?