When a nursing home admits a resident, the facility and its staff become responsible for the person’s safety and well-being. The facility is required by law to protect a resident’s rights and provide quality care. A basic understanding of residents’ rights is essential to a nurse aide’s ability to provide quality care and to avoid mistakes that may compromise a resident’s safety or well-being. This module can be used to fulfill inservice hours for CNAs as well as other staff.

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The purpose of this program is to review the basic skills that a CNA needs to know to help prevent pressure ulcers. Pressure ulcers are among the most commonly cited survey deficiencies and are also one of the leading causes of nursing home litigation. In some states, jury awards against facilities that fail to prevent or treat pressure ulcers have exceeded tens of millions of dollars.  However, with a proper prevention program in place, most pressure ulcers are preventable.  According to federal regulations, nursing homes must ensure that an individual who is admitted without pressure ulcers does not develop pressure ulcers while being cared for at the facility. Federal regulations also say that if a resident develops a pressure ulcer while in the facility, then the resident must receive the necessary treatment to promote healing and to ensure that another one does not occur.  The skills of a CNA play a key role in helping to prevent pressure ulcers and in making sure that a facility’s pressure ulcer prevention program is successful.

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• Structure & function of the skin
• Factors contributing to skin breakdown
• Skills needed to help prevent skin breakdown include, skin inspection cleansing, moisturizing and protecting & turning and repositioning

For a frail, elderly nursing home resident, skin breakdown may lead to illness and depression. If a pressure ulcer develops, it places the resident at a higher risk for infections, and in some cases it may be life threatening. To protect residents who are at risk for skin breakdown, a facility should a have skin care program. In this program, a resident’s skin condition should be assessed and monitored on a continual basis. The resident’s care plan will indicate what actions you need to take to care for the resident’s skin and help in the prevention of skin breakdown.

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This program reviews two basic types of incontinence care: toileting assistance and perineal care. The program also discusses three types of problems often associated with incontinence: urinary retention, urinary tract infection and constipation. Incontinence among residents is often the result of illness and some of the disabilities that can occur as an individual ages. Residents’ ability to control bowel and bladder function ranges from simply needing toileting assistance to having no control and being completely dependent upon caregivers. Embarrassment and feelings of helplessness are emotions often experienced by residents who suffer from incontinence. Many of them live with the fear of losing bladder control in the presence of others, and of someone noticing the smell of urine. To avoid embarrassment, they may choose to isolate themselves and stay away from social activities. As a nurse aide, you can help ease a resident’s embarrassment and fear of accidents by providing assistance with toileting. Your emotional support combined with toileting assistance can help a resident live a more normal life. Incontinent residents who are bedridden or chairbound require perineal care to prevent skin breakdown. It is important to remember that prolonged exposure to incontinent waste places the resident at a higher risk for pressure ulcers and infections.

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A caregivers assistance and encouragement play an important role in helping residents receive appropriate food and fluid intake. In this video, caregivers will learn how to ensure that residents receive adequate intake and proper nutrition. Federal regulations require that nursing homes provide sound nutritional care and do everything possible to prevent unplanned weight loss among residents. Failure to fulfill these requirements can result in survey deficiencies, fines, or legal action. A resident who does not receive adequate food and fluid intake is often weak and more susceptible to diseases, falls,
bone fractures, confusion and agitation, bruises, skin tears, and pressure ulcers. Fortunately, malnutrition among elderly residents is most often avoidable. To help ensure proper nutrition, each resident at the facility must receive a nutritional assessment from a registered dietitian. This assessment is updated on a regular basis. The results of the assessment will determine what type of care plan the resident needs. This inservice will help nurse aides to better understand their duties in assisting residents with food and fluid intake.

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Falls are among the leading causes of nursing home survey deficiencies, fines, and lawsuits. For a frail, elderly resident, a fall may result in bone fractures such as a broken hip or head injury. Along with physical injuries, falls can have an emotional impact as well: often the resident becomes fearful of falling again. This fear may cause the resident to lose confidence in being able to perform daily activities that he or she was capable of doing before the fall. This program describes the actions a CNA should take to help prevent falls among residents.

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The purpose of this program is to demonstrate how to transfer a resident safely while preventing injury to the caregiver. We will discuss how caregivers can protect themselves from back strain or muscle pulls by using good body mechanics. To do this, we will provide examples of different types of transfers using a gait belt. Understanding how to transfer a resident safely can reduce the risk of falls and other accidents. In some cases, a mechanical lift should be used for the safe transfer of residents who are heavy or who are in a weakened state and have little or no mobility. It is important that residents have confidence in your ability to transfer them safely and without injury. You should always take into account a resident’s physical and mental condition. Some may have enough strength and mobility to assist in their own transfer, while others may not. Patience and gentleness can help ease a resident’s fears.

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Wandering is a behavior commonly found among nursing home residents with dementia. This program describes ways that caregivers can assist wandering residents and help prevent them from eloping. The video also presents some of the more common factors that may trigger a resident to wander or attempt to leave the facility. Wandering is often a sign that a resident needs help. If you take the time to talk with the resident, you may discover what is causing him or her to wander. Open communication is a first step to finding an answer. Understanding what is causing a resident to wander places you in a better position to assist the person.

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Being alert to mental changes and reporting them is an important part of a frontline caregiver’s responsibilities. Mental changes may signal an immediate threat to a resident’s health or well-being. Because CNAs spend the most time with residents, they are most likely to notice changes in a resident’s mental condition. This program will help CNAs recognize changes in a resident’s mental condition. The video reviews 4 basic types of mental changes, including depression, behavior problems, cognitive impairment and delirium. Changes or a decline in mental condition can make a resident more difficult to care for as well as place the resident at a higher risk for falls or other types of accidents. A mental change such as depression may result in a decline in appetite that can lead to the resident becoming underweight. A decline or change in mental functioning may have a wide range of causes. Some of these causes include advanced age, strokes, infections, reaction to medications and a loss of normal brain functioning such as dementia. Behaviors such as agitation or withdrawal from social activities can be brought on by a sense of isolation and the inability to adjust to life in a nursing home. The changes that a caregiver reports are an important first step in getting the help that a resident needs. Taking this first step may even turn out to be a lifesaving action.

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Recognizing and reporting changes in a resident’s physical condition such as loss of appetite or skin breakdown is the key to preventing a potential problem from becoming worse.  This video will help caregivers recognize changes in residents’ physical condition and understand their responsibility to report them. Because nurse aides are in close contact with residents every day, they are the ones most likely to notice when the residents’ physical condition changes or begins to decline.  Failure to report changes can lead to litigation, survey deficiencies or charges of neglect and abuse.  The changes that a caregiver reports can be used to make necessary adjustments to a resident’s care plan.

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This program reviews two basic but very important infection control practices: handwashing and glove usage. Frontline caregivers will learn how these practices can reduce the spread of disease and infection. Because of frail health and a declining immune system, many elderly residents are more susceptible to infections – for example, urinary tract infections or respiratory infections such as colds or pneumonia. Infection control practices as simple as handwashing can help prevent the spread of illnesses such as these. A disease or infection acquired by a resident may result in discomfort, pain or even death. If you are exposed to germs at the facility, you could also become ill, and in some cases, you could spread that illness to your family and friends.

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This program describes how frontline caregivers should treat residents when providing them with their daily personal care such as bathing, incontinence care, oral care or dressing. The topics include:

1. Protecting a resident’s right to privacy.
2. Encouraging residents to assist in their own care.
3. The importance of good communication.
4. Respecting a resident’s right to choose his or her own schedule of care.

Frontline caregivers play an essential role in providing comfort and care to frail, elderly residents. Being treated with dignity and respect is a basic right of all residents. It is a right that is enforced by the state and federal government. Mistreating a resident can result in litigation and charges of neglect and abuse. For many residents, the inability to fully care for themselves can cause them to become depressed and feel isolated. Showing compassion and understanding towards them can ease the difficulties they may be experiencing.

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This program provides caregivers with an understanding of what constitutes abusive and neglectful behavior. We will also discuss some of the signs indicating that a resident may have been the victim of mistreatment. Frail health and mental impairments can leave a nursing home resident powerless against abusive behavior and neglect. Situations in which residents are physically or emotionally mistreated usually take place when a caregiver becomes angry or impatient, or tries to control a resident by force. When a nursing home admits a resident, the facility and its staff become responsible for his or her safety and well-being.

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