6.1 California Law: Abuse Reporting, Confidentiality, and Advance Directives
Key Takeaways
- Every CNA is a mandated reporter of suspected elder or dependent-adult abuse under California Welfare and Institutions Code 15630.
- In a long-term care facility with serious bodily injury, the phone report goes to local law enforcement within 2 hours; without serious bodily injury, the report goes to the ombudsman and law enforcement within 24 hours.
- A written report (form SOC 341) must follow the phone report within two working days.
- HIPAA and California law require keeping resident health information confidential and shared only with the care team on a need-to-know basis.
- An advance directive states the resident's wishes, while a POLST is a signed medical order (often on a pink form) that follows the resident across settings.
You Are a Mandated Reporter
Under California Welfare and Institutions Code section 15630, every employee of a long-term care facility and every health practitioner is a mandated reporter of suspected abuse or neglect of an elder (age 65 or older) or a dependent adult (age 18-64 with a physical or mental limitation). As a CNA, you do not need proof. You must report when you observe, are told about, or reasonably suspect abuse.
California recognizes several types of abuse. Know them, because the exam asks you to recognize the category:
| Type of Abuse | Example a CNA Might See |
|---|---|
| Physical abuse | Bruises in the shape of fingers, unexplained fractures, a slap |
| Sexual abuse | Bruising around breasts or genitals, fear of a specific person |
| Neglect | Pressure injuries, dehydration, soiled clothing left for hours |
| Financial abuse | Missing money, sudden changes to who controls funds |
| Abandonment, isolation, abduction | Resident left alone, visitors blocked, removed against will |
| Mental/emotional abuse | Threats, humiliation, intimidation, a resident who withdraws |
Self-Neglect and Reporting Triggers
Neglect includes a facility's failure to provide food, hydration, hygiene, medical care, or protection from health hazards. A new, deep pressure injury or rapid weight loss can be a neglect finding you must report. Your duty does not depend on who caused the harm, and it applies even if a coworker or supervisor is the suspected abuser. A resident's statement that they were hurt is enough to trigger your report.
The Reporting Timeline (High-Yield)
The timeline depends on whether there is serious bodily injury. Memorize the steps in order.
- First, tell the charge nurse/supervisor and follow facility policy. This does not replace your legal duty to report outside the facility.
- Make the required external report based on the situation:
| Situation in a Long-Term Care Facility | Phone Report | To Whom |
|---|---|---|
| Abuse with serious bodily injury | Within 2 hours | Local law enforcement (and ombudsman) |
| Abuse with no serious bodily injury | Within 24 hours | Local ombudsman and local law enforcement |
| Suspected criminal abuse generally | Immediately / as soon as practicable | Law enforcement and ombudsman |
- Submit a written report on form SOC 341 within two working days of the phone report. This applies to all cases.
The Long-Term Care Ombudsman
The ombudsman is an independent advocate for residents who investigates complaints and abuse reports inside facilities. A CNA can report directly to the ombudsman; you do not lose your right to report because a supervisor seems busy or tells you not to.
Protections and Penalties
Mandated reporters who report in good faith are protected from civil and criminal liability and from retaliation. Failure to report is a crime (a misdemeanor) and can carry fines and jail time, plus higher penalties when serious harm or death results. On the exam, the safe answer never ignores a sign of abuse and never tells the resident to keep it quiet.
Confidentiality, HIPAA, and Residents' Rights
The Health Insurance Portability and Accountability Act (HIPAA) and California law require you to protect protected health information (PHI). Share resident information only with the care team on a need-to-know basis. Do not discuss residents in hallways or elevators, do not post about residents on social media, and do not give medical updates to family or visitors without authorization.
Under Title 22 of the California Code of Regulations (CCR), section 72527, skilled nursing residents have specific rights, including the right to:
- Be treated with dignity and respect.
- Privacy in care, treatment, visits, and communications.
- Be free from abuse, neglect, and restraints used for staff convenience or discipline.
- Voice grievances without fear of retaliation.
- Refuse treatment and participate in their own care planning.
- Manage personal finances and keep personal possessions.
- Receive visitors of their choosing and send and receive unopened mail.
- Be informed of their condition and consent to or refuse care.
A resident who refuses a bath, a meal, or repositioning is exercising a right. The CNA does not force care; instead, the CNA respects the choice, tries again later, and reports the refusal to the nurse so it can be documented and addressed.
Restraints Are a Last Resort
Under Title 22, physical or chemical restraints may be used only to treat a medical symptom, with a physician's order and consent, never for staff convenience or discipline. Using a restraint to keep a resident quiet or out of the way is a rights violation and a reportable form of abuse.
Advance Directives, DNR, and POLST
Residents have the right to make decisions about end-of-life care in advance. Know these three documents and how they differ:
| Document | What It Is | Key Point for a CNA |
|---|---|---|
| Advance directive | A legal document stating wishes and naming a healthcare agent | States general wishes; not a physician order by itself |
| DNR (Do Not Resuscitate) | An order not to perform CPR if breathing/heartbeat stop | Means no CPR; comfort care still continues |
| POLST | Physician Orders for Life-Sustaining Treatment, a signed medical order on a (usually pink) form | A portable order that follows the resident across settings |
A DNR or POLST does not mean "do not care." You still provide hygiene, repositioning, food, fluids, comfort, and emotional support. The CNA's job is to know each resident's status, follow the order, and report any change to the nurse, never to make the resuscitation decision alone.
In a California long-term care facility, a CNA discovers a resident with a new, deep, infected pressure injury and signs of neglect that caused serious bodily injury. Within what timeframe must the phone report be made, and to whom?
A visitor asks a CNA for an update on their neighbor's medical condition. What is the correct action?
A resident has a valid POLST and DNR order. The resident is awake and asks for help to the bathroom and a snack. What should the CNA do?
Which statement best describes the difference between an advance directive and a POLST in California?