1 The Nursing Assistant in Long-Term Care 1. Define important words in this chapter accountable answerable for one’s actions. activities of daily living.

1The Nursing Assistant in Long-Term Care

1. Define important words in this chapter

accountable answerable for one’s actions.

activities of daily living (ADLs) personal daily care tasks, including bathing, skin, nail, and hair care, walking, eating and drinking, mouth care, dressing, transferring, and toileting.

acute care24-hour skilled care for short-term illnesses or injuries; generally given in hospitals and ambulatory surgical centers.

adaptive devicesspecial equipment that helps a person who is ill or disabled perform ADLs; also called assistive devices.



adult daycarecare given to adults at a facility during daytime work hours.

assisted livinga residence for people who require some help with daily care, but who need less care than a long-term care facility offers.

assistive devicesspecial equipment that helps a person who is ill or disabled perform ADLs; also called adaptive devices.

care teamthe group of people with different kinds of education and experience who provide resident care.



chain of commandthe order of authority within a facility.

charge nurse (nurse-in-charge) a nurse responsible for a team of healthcare workers.

chronicthe term for an illness or condition that is long-term or long-lasting.

citein a long-term care facility, to find a problem through a survey.



conscientious guided by a sense of right and wrong; principled.

continuity of care coordination of care for a resident over time, during which the care team is always exchanging information about the resident and working toward shared goals.

courteous polite, kind, considerate.

delegationtransferring authority to a person for a specific task.



dementia a serious, progressive loss of mental abilities such as thinking, remembering, reasoning, and communicating.

diagnosis the identification of a disease by its signs and symptoms and from the results of different tests.

empathetic identifying with and understanding another’s feelings.

first impressiona way of classifying or categorizing people at the first meeting.



functional nursingmethod of care assigning specific tasks to each team member.

holisticcare that involves the whole person; this includes his or her physical, social, emotional, and spiritual needs.

home health carecare that takes place in a person’s home.

hospice carecare for people who have approximately six months or less to live; care is available until the person dies.



inter-generational caremixing children and the elderly in the same care setting.

Joint Commissiona not-for-profit organization that evaluates and accredits different types of healthcare facilities.

length of staythe number of days a person stays in a healthcare facility.

liabilitya legal term that means a person can be held legally responsible for harming someone else.



licensed practical nurse (LPN) or licensed vocational nurse (LVN)licensed nurse who has completed one to two years of education; LPN/LVN administers medications, gives treatments, and may supervise daily care of residents.

long-term care24-hour care provided for people with ongoing conditions who are generally unable to manage their ADLs.

nursing assistantperson who performs assigned nursing tasks and gives personal care.

outpatient carecare usually given for less than 24 hours to people who have had treatments, procedures, or surgery.



pet therapythe practice of bringing pets into a facility or home to provide stimulation and companionship.

policya course of action to be followed.

primary nursingmethod of care in which the registered nurse gives much of the daily care to residents.

procedurea method, or way, of doing something.



professionalismthe act of behaving properly for a certain job.

registered nurse (RN)a licensed nurse who has completed two to four years of education; RNs assess residents, create the care plan, monitor progress, provide skilled nursing care, give treatments, and supervise the care given by nursing assistants and other members of the care team.

rehabilitationa program of care given by a specialist or a team of specialists to restore or improve function after an illness or injury.

residenta person living in a long-term care facility.



resident-focused caremethod of care in which the resident is the primary focus; residents and their families actively participate in care, and their choices are honored by caregivers whenever possible.

sandwich generationpeople responsible for the care of both their children and aging relatives.

skilled caremedically-necessary care given by a skilled nurse or therapist.

subacute carecare for an illness or condition given to people who need less care than for an acute (sudden onset, short-term) illness or injury but more than for a chronic (long-term) illness.



team leadera nurse in charge of a group of residents for one shift of duty.

team nursingmethod of care in which a nurse acts as a leader of a group of people giving care.

trustworthydeserving the trust of others.


2. Describe healthcare settings

Nursing assistants have a very important job and many career opportunities. Your work will make a difference in the lives of many people. Facts about long-term care (LTC):• Long-term care facilities provide 24-hour skilled care.• Long-term care assists people with ongoing, chronic medical

conditions.• Other terms for LTC facilities include the following: nursing

homes, nursing facilities, skilled nursing facilities, extended care facilities



Define the following terms:long-term care

24-hour care provided for people with ongoing conditions who are generally unable to manage their ADLs.

skilled caremedically-necessary care given by a skilled nurse or therapist.

chronicthe term for an illness or condition that is long-term or long-lasting.

residenta person living in a long-term care facility.



REMEMBER:• The LTC facility is the resident’s home.• The resident’s room must be treated with respect.



Think about this question:How would you feel if someone touched your personalbelongings or moved your things around without asking?



Define the following terms:assisted livinga residence for people who require some help with daily care, but who need less care than a long-term care facility offers.home health carecare that takes place in a person’s home.adult daycarecare given to adults at a facility during daytime work hours.sandwich generationpeople responsible for the care of both their children and aging relatives.



Define the following terms:inter-generational caremixing children and the elderly in the same care setting.acute care24-hour skilled care for short-term illnesses or injuries; generally given in hospitals and ambulatory surgical centers.subacute carecare for an illness or condition given to people who need less care than for an acute (sudden onset, short-term) illness or injury but more than for a chronic (long-term) illness.outpatient carecare usually given for less than 24 hours to people who have had treatments, procedures, or surgery.



Define the following terms:rehabilitationa program of care given by a specialist or a team of specialists to restore or improve function after an illness or injury.hospice carecare for people who have approximately six months or less to live; care is available until the person dies.pet therapythe practice of bringing pets into a facility or home to provide stimulation and companionship.


3. Explain Medicare and Medicaid

Medicare is a health insurance program for people• who are 65 or older• who are under 65 but are disabled and cannot work

Medicare will only pay for care that it deems medically necessary.

1 The Nursing Assistant in Long-Term Care

Transparency 1-1: Facts about Medicare and Medicaid

Medicare• Medicare is for people 65 or older and people under 65 who are

disabled and cannot work.• Part A helps pay for care in a hospital or skilled nursing facility

or for care from a home health agency or hospice.• Part B helps pay for doctor 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.

Medicaid• Medicaid is a medical assistance program for low-income

people.• People qualify based on income and special circumstances.


4. Describe the residents for whom you will care

REMEMBER:Understanding each individual in your care is far more important than understanding facts about the entire population.


Transparency 1-2: Residents in LTC Facilities

Residents in LTC facilities• Over 88% are over 65.• Over 71% are female.• More than 85% are Caucasian.• About 1/3 come from a private residence.• Over 64% come from a hospital or other facility.


4. Describe the residents for whom you will care

Define the following terms:length of stay

the number of days a person stays in a healthcare facility.dementia

a serious, progressive loss of mental abilities such as thinking, remembering, reasoning, and communicating.


5. Describe the nursing assistant’s role

Define the following terms:nursing assistant person who performs assigned nursing tasks and gives personal

care.activities of daily living (ADLs)

personal daily care tasks, including bathing, skin, nail, and hair care, walking, eating and drinking, mouth care, dressing, transferring, and toileting.



Common nursing assistant tasks include:• Serving trays and feeding residents• Helping residents dress and undress• Bathing, shaving, and shampooing residents• Bedmaking• Tidying living areas• Measuring vital signs, including temperature, pulse,

respiration, blood pressure and observing and reporting pain levels



Common nursing assistant tasks include (cont’d.):• Helping residents with toileting• Assisting with mouth care• Giving back rubs• Observing and reporting changes in conditions and

complaints• Helping residents move safely around facility• Caring for equipment



Tasks which nursing assistants usually do not perform include:• Giving medications• Inserting or removing tubes• Giving tube feedings• Changing sterile dressings



REMEMBER: Nursing assistants can have different titles, such as nurse aide, patient care technician, health care assistant, etc.


6. Discuss professionalism and list examples of professional behaviorDefine the following term:professionalism

the act of behaving properly for a certain job.


6. Discuss professionalism and list examples of professional behavior

Understanding how to be professional is a key step to success for a nursing assistant.

Professionalism has to do with behaving properly on the job.



As a nursing assistant, you must practice the following professional behavior:

• Be neatly dressed, groomed, and clean.• Do not discuss personal problems with residents.• Be at work on time and avoid unnecessary

absences.• Never leave work early without permission.• Do not report to work under the influence of drugs and/or

alcohol• Keep a positive attitude.• Do not gossip about co-workers.



Professional behavior for nursing assistants (cont’d.):• Be polite and respectful.• Address residents and visitors in the way they wish to be

addressed.• Do not curse.• Keep resident information confidential.• Follow procedures and policies.• Report problems to your supervisor.• Maintain educational requirements.



Professional behavior for nursing assistants (cont’d.):• Ask questions when you do not understand something.• Be honest and document carefully.• Accept and learn from constructive criticism.• Do not accept tips or gifts.• Be loyal to your facility and be a good role model.



REMEMBER: Whenever you are unsure about care, be sure to ask questions or to review the policy manual about policies or procedures you do not understand.


7. List qualities that nursing assistants must have

Think about these questions:The best nursing assistants have certain traits. As you review these traits, ask yourself, “Do I have these traits?” and, “Is there a way I can better develop them?”



Define the following terms:trustworthydeserving the trust of others. conscientiousguided by a sense of right and wrong; principled.courteouspolite, kind, considerate.empatheticidentifying with and understanding another’s feelings.



Define the following terms:accountableanswerable for one’s actions.



Nursing assistants should be:• Patient and understanding• Honest and trustworthy• Conscientious• Enthusiastic• Courteous and respectful



Nursing assistant traits (cont’d.):• Empathetic• Dependable and responsible• Humble and open to growth• Tolerant• Unprejudiced



Think about these questions:Choose one of the qualities that nursing assistants must have. Can you imagine a situation on the job where that quality is needed? Can you describe a time that you used that quality in a previous job, or in your personal life?


8. Discuss proper grooming guidelines

Making a good first impression is very important, and proper grooming is an essential part of making a good first impression.

Do these things to be properly groomed:• Keep uniform clean and neat.• Bathe and wear deodorant every day.• Brush teeth at least twice a day.• Avoid strongly-scented items.• Keep hair neatly tied back.


Do these things to be properly groomed (cont’d.):• Keep beards trimmed and neat.• Apply makeup lightly.• Keep nails short, filed, and clean. Do not wear artificial

nails.• Keep shoes and laces clean and in good condition.• Wear as little jewelry as possible, except for a simple

waterproof watch and identification badge.



REMEMBER:Keep in mind that residents may be allergic to certain scents. Heavy perfumes or scents should be avoided. This is an important part of meeting residents’ needs.



9. Define the role of each member of the care team

Define the following terms:care team

the group of people with different kinds of education and experience who provide resident care.

registered nurse (RN)a licensed nurse who has completed two to four years of education; RNs assess residents, create the care plan, monitor progress, provide skilled nursing care, give treatments, and supervise the care given by nursing assistants and other members of the care team.



Define the following terms:diagnosis

the identification of a disease by its signs and symptoms and from the results of different tests.

assistive devicesspecial equipment that helps a person who is ill or disabled

perform ADLs; also called adaptive devices.



The care team consists of many members who each play a different role. The resident is at the center of the care team.

Members of the care team include:• Resident and resident’s family• Nurse (RN, LPN or LVN)• Advanced practice nurse• Physician• Medical social worker


Members of the care team (cont’d.):• Physical therapist• Occupational therapist• Registered dietitian• Speech-language pathologist• Activities director• Nursing assistant



REMEMBER:The resident is the most important member of the care team.



10. Discuss the facility chain of command

Define the following terms:chain of command

the order of authority within a facility.charge nurse (nurse-in-charge)

a nurse responsible for a team of healthcare workers.liability

a legal term that means a person can be held legally responsible for harming someone else.


Transparency 1-3: Chain of Command


11. Explain “The Five Rights of Delegation”

Define the following term:delegationtransferring authority to a person for a specific task.



When planning care, nurses must decide which tasks to delegate to others.

“The Five Rights of Delegation” are the following:• Right Task• Right Circumstance• Right Person• Right Direction/Communication• Right Supervision/Evaluation


Consider these questions before accepting a delegated task:• Do I have all the information I need to do this job? Are there

questions I should ask?• Do I believe that I can do this task? Do I have the necessary

skills?• Do I have the needed supplies, equipment, and other

support?• Do I know who my supervisor is, and how to reach him/her?• Have I told my supervisor of my special needs for help and

support?• Do we both understand who is doing what?



REMEMBER:Asking questions and asking for help when you need it will allow you to provide the best possible care.



Think about this question:What could happen if you did not understand something you were asked to do, but did not ask for help?



12. Describe four methods of nursing care

Define the following term:holistic

care that involves the whole person; this includes his or her physical, social, emotional, and spiritual needs.



The nursing profession takes a holistic approach to caring for residents, meaning caring for the whole person. This includes his or her physical needs as well as other needs, such as social, emotional, intellectual, and spiritual. Meeting all of these needs will improve the residents’ quality of life.



Over the years, the nursing profession has seen many changes. Many types of nursing care have been used at facilities. Each facility chooses the type that provides the best care for their residents. Definitions for the different types of nursing care follow.



Define the following terms:resident-focused care

method of care in which the resident is the primary focus; residents and their families actively participate in care, and their choices are honored by caregivers whenever possible.

team nursingmethod of care in which a nurse acts as a leader of a group of people giving care.

team leadera nurse in charge of a group of residents for one shift of duty.



Define the following terms:primary nursing

method of care in which the registered nurse gives much of the daily care to residents.

continuity of care coordination of care for a resident over time, during which the care team is always exchanging information about the resident and working toward shared goals.

functional nursingmethod of care assigning specific tasks to each team member.


13. Explain policy and procedure manuals

Define the following terms:policya course of action to be followed. procedurea method, or way, of doing something.



All facilities have manuals outlining policies and procedures. These two manuals are usually kept together. The procedure manual serves as a guide if you want to review the steps in a procedure.



REMEMBER: You should always ask questions or consult the policy manual or procedure manual when you are unsure of something.


14. Describe the long-term care survey process

Define the following terms:citein a long-term care facility, to find a problem through a survey.Joint Commission

a not-for-profit organization that evaluates and accredits different types of healthcare facilities.



Inspections are done by the state agency that licenses facilities to make sure that facilities are following state and federal regulations. These inspections are called surveys.

Inspections are done more often if a facility has been cited for problems. If the facility has a good record and has not been cited, inspections are done less often.



The survey process includes the following:• Inspections are done periodically.• Surveyors observe and interview residents and staff to find

out how well residents’ needs are being met.• Nursing assistants should answer any questions asked by

surveyors to the best of their ability.• If a nursing assistant does not know the answer to a

question, he should say so and then find out.



As previously mentioned, the Joint Commission is an independent, not-for-profit organization whose standards focus on improving the quality and safety of care provided. The Joint Commission’s surveys are separate from state inspections.



REMEMBER:If a you are asked questions by surveyors during a survey and do not know the answer, be honest. Never guess. Tell the surveyor that you do not know the answer, but will find out as quickly as possible. Then check with your supervisor.


ExamMultiple Choice. Choose the correct answer.1. Long-term care is offered in:(A) Hospitals(B) Adult daycare facilities(C) Skilled nursing facilities(D) Ambulatory surgical centers

2. Residents in _____ are usually more independent and do not need skilled care.(A) Acute care facilities(B) Assisted living facilities(C) Subacute care facilities(D) Hospice settings


Exam (cont’d.)3. Which of the following types of health care is generally for people who will die in six months or less?(A) Long-term care(B) Outpatient care(C) Inter-generational care(D) Hospice care

4. _____ is a health insurance program for people who are 65 years of age or older or who are ill or disabled and cannot work.(A) Medicare(B) Medicaid(C) CMS(D) Health and Human Services


Exam (cont’d.)5. _____ is a medical assistance program for low-income people.(A) Medicare(B) Medicaid(C) CMS(D) HCFA

6. Medicare will pay for:(A) All care requested by the recipient(B) All care requested by the doctor(C) All care requested by the facility(D) Only care that it determines to be medically necessary


Exam (cont’d.)7. The amount that Medicare and Medicaid will pay long-term care facilities for services is based on:(A) The resident’s income(B) The resident’s need upon admission(C) The size of the facility(D) Who the resident knows at the facility

8. The residents with the longest average stay in healthcare facilities are:(A) Residents admitted for terminal care(B) Residents admitted for rehabilitation or temporary illness(C) Residents who are developmentally disabled(D) Residents with dementia


Exam (cont’d.)9. Dementia is:(A) Terminal illness(B) Loss of mental abilities (C) The number of days a person stays in a healthcare facility(D) Caring for the whole person

10. Most people in a facility are there due to:(A) Lack of ability to care for themselves and the lack of a support system(B) Depression and lack of medication(C) Terminal illness(D) Temporary illness


Exam (cont’d.)11. Which of the following is a task that nursing assistants commonly do?(A) Giving medication(B) Bathing residents(C) Changing sterile dressings(D) Giving tube feedings

12. Which of the following is a task that nursing assistants generally do not perform?(A) Shaving residents(B) Inserting tubes(C) Helping residents with toileting needs(D) Caring for equipment


Exam (cont’d.)13. Professionalism is related to:(A) How a person behaves at home(B) How a person behaves at work(C) How well a person performs on tests(D) How residents behave in a facility

14. A resident has purchased a special gift for her nursing assistant, Sarah. Which of the following would be the best response by Sarah?(A) Refuse but thank her for thinking of her(B) Accept because Sarah does not know her facility’s 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


Exam (cont’d.)15. One example of professional behavior by nursing assistants when working with residents is:(A) Keeping all resident information confidential(B) Sharing funny stories about coworkers with the residents (C) Giving gifts to favorite residents(D) Asking residents for advice about personal problems

16. Which of the following is an example of how a nursing assistant is demonstrating that she is dependable?(A) The nursing assistant is never more than 10 minutes late for work.(B) The nursing assistant performs tasks that she does not know how to do. (C) The nursing assistant avoids excessive absences from work.(D) The nursing assistant does not ask others for help.


Exam (cont’d.)17. To hold oneself accountable means to:(A) Admit mistakes and apologize for them(B) Always speak positively about the facility(C) Be able to work with people of many different backgrounds(D) Care about the problems of others

18. What does the term “empathetic” mean?(A) Empathetic means being alert around others.(B) Empathetic means being able to document honestly.(C) Empathetic means identifying with and understanding the feelings of others.(D) Empathetic means taking responsibility for one’s own actions.


Exam (cont’d.)19. Which of the following is a quality of the best nursing assistants?(A) Tolerance(B) Tardiness(C) Complaining(D) Ignoring constructive criticism

20. Which of the following will help a nursing assistant make a good first impression at work?(A) Bathing or taking a shower once a week(B) Using a pleasant perfume or after-shave(C) Keeping hair neatly tied back away from the face(D) Wearing artificial nails to work


Exam (cont’d.)21. The best type of jewelry to wear to work is:(A) A ring(B) A waterproof watch(C) A bracelet(D) A necklace

22. The most important member of the care team is:(A) The nurse(B) The nursing assistant(C) The physician(D) The resident


Exam (cont’d.)23. Which member of the care team assesses residents, monitors progress, and gives treatments?(A) The nurse(B) The nursing assistant(C) The medical social worker(D) The registered dietitian

24. Which member of the care team has the most direct contact with the residents?(A) The nursing assistant(B) The nurse(C) The physician(D) The activities director


Exam (cont’d.)25. The chain of command is:(A) A legal term meaning a person can be held responsible for harming someone else(B) The person in charge of the department for each shift(C) The line of authority in a facility(D) The department that a nursing assistant goes to if he wants to report a problem

26. In which style of nursing care are residents and their families active participants in care and have their choices honored by caregivers whenever possible?(A) Resident-focused care(B) Team nursing(C) Primary nursing(D) Functional nursing


Exam (cont’d.)27. In which type of nursing care does the registered nurse give much of the overall care to the residents?(A) Resident-focused care(B) Team nursing(C) Primary nursing(D) Functional nursing

28. What is one possible negative result of the functional nursing style of care?(A) There are too many tasks to be completed effectively.(B) Nursing assistants may not be adequately trained for their tasks.(C) Staff may overlook changes in a resident’s condition.(D) Residents may get tired of seeing the same care team members every day.


Exam (cont’d.)29. A policy is:(A) A course of action that should be taken every time a certain situation occurs(B) A specific method of doing something(C) The chain of command within the facility(D) A reminder on how to complete a procedure

30. Which of the following is the correct response by a nursing assistant if he forgets how to perform a procedure?(A) Review the steps of the procedure in the procedure manual(B) Act confident and perform the procedure anyway(C) Check with the resident’s family for help(D) Ask the resident for help in remembering how to perform the procedure


Exam (cont’d.)31. If a surveyor asks a nursing assistant a question, the nursing assistant should:(A) Answer honestly and to the best of her ability(B) Offer suggestions for making improvements in the facility(C) Refuse to answer any questions(D) Make up an answer if she does not know it

1 The Nursing Assistant in Long-Term Care 1. Define important words in this chapter accountable answerable for one’s actions. activities of daily living.

Documents

hospice care care

care team

resident care

home health care care

mouth care

hair care

live care

acute care