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Normal age-related cognitive change includes slower processing speed, occasional 'tip-of-the-tongue' word retrieval, and minor short-term forgetfulness — without loss of judgment, ADL independence, or recognition of loved ones. Failure to recognize family (c), getting lost on familiar routes (a), and decline in self-care (b) are red flags for dementia and must be reported. The CNA should never assume cognitive symptoms are 'just aging.' Per 42 CFR §483.40 the facility must assess and address behavioral and cognitive changes; Title 22 CCR §72315 requires ongoing nursing assessment of resident status.

Depression in older adults is common, often missed, and dangerous — it raises suicide risk and accelerates physical decline. Warning signs: anhedonia, sleep/appetite change, weight loss, hopeless statements. The CNA must report observations and verbatim resident statements to the nurse without delay so the resident can be assessed by the IDT and physician for depression and suicide risk. Waiting (d) risks deterioration or suicide. 'Cheer up' messages (b) shame the resident and worsen depression. Unilateral room changes (c) exceed CNA scope. 42 CFR §483.40 mandates behavioral health services.

Suicide warning signs in older adults include giving away possessions, saying goodbye, hopeless statements, sudden calmness after depression, hoarding medications, and refusing care or medications. Older adults — especially older white men — have the highest suicide completion rate in the U.S. Any warning sign MUST be reported immediately to the nurse who will arrange physician assessment and safety measures. Routine requests (b, d) and exercising the right to choose activities (a) per 42 CFR §483.10 are not warning signs. 42 CFR §483.40 requires behavioral health support.

Wandering is common in dementia and is best managed with redirection, supervised walking, scheduled activity, environmental cues (clear signage, safe walking paths), and care-plan review. Restraints (a, d) without medical necessity and informed consent constitute false imprisonment and abuse under 42 CFR §483.12 and 42 CFR §483.10(e) (right to be free from restraints). Locking residents in (b) is also unlawful restraint. The CNA reports patterns so the IDT can identify triggers (boredom, pain, toileting needs) and adjust the plan.

De-escalation: stop the trigger task, give the resident space, lower voice and posture, validate feelings, and remove yourself if unsafe to summon help. Pushing the resident's hand down (a) or holding her arms down to finish the bath (d) is physical restraint without a physician order and informed consent, violating 42 CFR §483.12 (right to be free from abuse and unnecessary restraint); unconsented physical force during care is also battery (PC §242) and abuse — grounds for immediate termination, criminal prosecution, and CDPH license revocation. Arguing (c) escalates. Title 22 CCR §72319 requires policies on resident behavior management without abuse.

42 CFR §483.10(e) and §483.12(a)(2) prohibit physical or chemical restraints imposed for discipline or staff convenience. Restraints are permitted only to treat a documented medical symptom, with a physician's written order specifying type, location, and duration, after less restrictive interventions have failed, and with informed consent. Staff convenience combined with wandering frequency (b), family preference (c), and a staff member's own judgment that the behavior is disruptive (d) are not legal justifications. Unauthorized restraint is false imprisonment and abuse, reportable to CDPH and law enforcement, and can result in license revocation.

Loneliness is a serious health risk in LTC, linked to depression, dementia progression, and increased mortality. 42 CFR §483.24(c) requires support of psychosocial well-being. The CNA provides presence and reports to social services who can arrange volunteer visitor programs, intergenerational visits, video calls with family, faith community visits, and pet therapy. Minimizing (c) and changing the subject (a) dismiss the resident's emotional reality. Documenting without action (b) is passive neglect. The CNA's compassionate listening is itself a meaningful intervention.

Difficult family dynamics are common and rarely about the CNA personally. The CNA should remain professional, use active listening, acknowledge feelings, and invite a private conversation that includes the nurse or social worker. Arguing (a) escalates and risks complaints. Ordering family out (c) exceeds CNA authority and may violate visitation rights under 42 CFR §483.10(f)(4). Withdrawing care (d) is abandonment. The charge nurse documents the interaction and coordinates with social services per Title 22 CCR §72527 (resident rights).

Substance use disorder in older adults is under-recognized and dangerous (falls, GI bleed, drug interactions). Ingesting alcohol-containing mouthwash is a red flag. The CNA must report observations to the nurse so the physician can assess and the IDT can revise the plan (alcohol-free mouthwash, screening, possibly addiction medicine consult). Ignoring (c) abandons clinical duty. Confronting (b) is shaming and outside CNA scope. Hiding without reporting (d) defeats care planning and may itself be a form of self-neglect facilitation. Under W&I §15610.07 self-neglect is a form of reportable elder abuse.

W&I §15610.07 defines elder/dependent adult abuse to include physical abuse (§15610.63), sexual abuse, neglect (§15610.57), financial abuse (§15610.30), abandonment, abduction, isolation, and the deprivation of goods or services necessary to avoid physical harm or mental suffering. Self-neglect is included. A resident's voluntary refusal of an offered dessert (b) is the exercise of the right to refuse — not abuse. CNAs are mandated reporters under W&I §15630 and must report suspected abuse, including by other staff, family, or visitors.

Under W&I §15630, a CNA in a long-term care facility is a mandated reporter of suspected elder/dependent adult abuse. The reporting flow: report immediately to the charge nurse and administrator AND personally ensure a report is made by phone to the local LTC Ombudsman or law enforcement (immediately for physical abuse) and a written report (SOC 341) within 2 working days. Confronting the suspected abuser (d) risks evidence destruction and retaliation. Waiting (b) or gossiping (c) violates mandated reporter duty and may expose the CNA to criminal penalty under §15630(h).

W&I §15630(b)(1)(A) requires immediate telephone (or via confidential internet report) notification, or as soon as practicably possible, to the local ombudsman, law enforcement, or APS depending on setting (in an LTC facility, ombudsman/law enforcement for physical abuse and serious bodily injury). A written report (form SOC 341) must follow within 2 working days. The resident's consent is NOT required. Delaying for family (c) or resident permission (a) violates the statute. Failure to report is a misdemeanor with fines up to $5,000 and possible jail time under W&I §15630(h).

42 CFR §483.10(f)(11) protects each resident's right to religious and spiritual practice. The CNA may read the passage or, if uncomfortable, arrange another staff member, volunteer, or chaplain. Refusing without alternatives (a, b) is denial of spiritual care. Proselytizing (d) violates the resident's rights and may be psychosocial abuse. Spiritual care reduces anxiety and improves coping in LTC. The CNA respects each resident's faith, dietary practices, and rituals without judgment, consistent with 42 CFR §483.40 (behavioral and psychosocial care).

Title VI (42 USC §2000d) prohibits discrimination based on national origin in any program receiving federal funds, including Medicare/Medicaid facilities. Facilities must provide meaningful language access (qualified interpreters, translated materials). 42 CFR §483.10(b)(3) requires care plan information in a language the resident understands. Speaking louder (c) is ineffective and demeaning. Relying solely on family (b) breaches privacy and may be unreliable. Skipping communication (a) is neglect and violates dignity. Culturally responsive care includes greetings in the resident's language, foods, and customs.

California's LGBTQ Long-Term Care Facility Resident's Bill of Rights (HSC §1439.50 et seq.) prohibits discrimination, mistreatment, or denial of services based on actual or perceived sexual orientation, gender identity, gender expression, or HIV status in LTC. The CNA affirms identity, uses chosen name and pronouns, protects privacy, and reports concerns. Silencing the resident (c) is itself harm. Casual disclosure (d) violates privacy. Refusing care (b) is discrimination and abandonment. Facilities must ensure equal access; violations may trigger CDPH enforcement and civil liability.

Under HSC §1439.50 (Lesbian, Gay, Bisexual, Transgender Long-Term Care Facility Resident's Bill of Rights), willful and repeated failure to use a resident's preferred name or pronouns can constitute prohibited mistreatment. Facilities must address residents by chosen name and pronoun and provide bathing, clothing, and rooming accommodations consistent with gender identity. The CNA documents preferences and reports any staff or roommate harassment. Using the legal name only (b, c) or polling others (a) violates dignity, identity, and CA law. Compliance is also a 42 CFR §483.10 dignity obligation.

Delirium is an acute, fluctuating disturbance in attention and cognition, often caused by infection (UTI, pneumonia), medication, dehydration, or pain. In elders, a UTI commonly presents with new confusion plus fever and incontinence. Delirium is a medical emergency — the CNA must report immediately. Dementia progresses slowly over months/years, not 24 hours (b). Sundowning (a) recurs late afternoon and does not include fever. It is never a 'choice' (c). 42 CFR §483.40 requires prompt response to behavioral and cognitive change.

W&I §15610.30 defines financial abuse as taking, secreting, appropriating, obtaining, or retaining real or personal property of an elder or dependent adult for a wrongful use, with intent to defraud, or by undue influence. Even a person with power of attorney commits abuse if the use is unauthorized or against the resident's interests. CNAs are mandated reporters (W&I §15630) and must report suspected financial abuse to APS or the LTC ombudsman. It is not a 'private matter' (d). POA does not authorize theft (c). The resident need not file written objection (a).

Under PC §11165.7, health practitioners (including CNAs) are mandated reporters of suspected child abuse or neglect, in addition to their elder abuse duties under W&I §15630. PC §11166 requires an immediate telephone report to a child protective agency (police, sheriff, or CPS) as soon as practicably possible, followed by a written report within 36 hours. Waiting for family (a) or only telling the principal (c) does not satisfy the statute. The duty applies whenever the mandated reporter, in their professional capacity OR within the scope of employment, learns of or observes suspected abuse.

Established under the federal Older Americans Act (42 USC §3058g) and codified in California's HSC §9700 et seq., the LTC Ombudsman investigates complaints from or on behalf of LTC residents, advocates for resident rights and quality of care, and is authorized to receive abuse reports under W&I §15630. Ombudsmen do not provide medical care (c), license CNAs (a — that is CDPH), or manage facility operations (d). The CNA must know how to contact the local Ombudsman and post their contact information conspicuously.