Resident Rights, Ethics, and Communication
What the exam expects
Resident rights under federal nursing home law include dignity, privacy, confidentiality, choice, freedom from abuse and neglect, freedom from unnecessary restraints, the right to refuse treatment, the right to complain without retaliation, the right to see visitors, the right to participate in one's own care plan, and the right to contact the ombudsman. Informed consent is obtained by the provider or nurse - never by the assistant. Suspected abuse, neglect, or misappropriation of property must be reported immediately to your supervisor per facility policy; you do not investigate it yourself. Know that abuse can be physical, sexual, emotional, financial, or neglect, and that involuntary seclusion counts as abuse.
Communication that scores
With a hearing-impaired resident, face them, keep your mouth visible, lower your voice pitch rather than shouting, and reduce background noise. With a visually impaired resident, announce yourself and narrate what you are doing. With a resident who has aphasia, ask yes-or-no questions, allow processing time, and never finish their sentences. With dementia, validate feelings, redirect rather than argue, and use short, concrete statements. Protect confidentiality: no discussing residents in hallways, elevators, or on social media, and no reading records you do not need.
Traps
Watch for answer choices where the assistant accepts money or gifts, gossips, tells a resident "you can't refuse," discusses a resident where others can hear, or promises to keep a serious secret. A resident may refuse care; your job is to report the refusal, not to override it.
Rule of thumb
When a resident says no, that is a complete answer to respect - document it, offer again later, and report it. When someone asks you to keep a secret that affects safety, empathy plus reporting is the correct combination.