9.3 Mental Health & Emotional Needs

Emotional Needs in Long-Term Care

Moving into a facility often means losing a spouse, a home, independence, and routine. The Florida written test covers the CNA's role in recognizing and supporting emotional and mental-health needs — observing, providing presence, and reporting, never diagnosing or treating.

Depression: Recognize and Report

Depression is a serious, treatable medical condition. It is not a normal part of aging and is often missed in older adults because the signs differ from those in younger people. It can also mimic dementia (slowed thinking, poor concentration), which is why the care team must evaluate it.

Observable signs the CNA reports:

• Persistent sadness, tearfulness, or a flat, "empty" affect
• Loss of interest in activities, visitors, or grooming
• Appetite change (eating much less or much more)
• Sleep change (insomnia or sleeping all day)
• Fatigue, slowed movement, or new agitation
• Vague physical complaints with no clear cause
• Social withdrawal and isolating in the room
• Statements of worthlessness, hopelessness, or being a burden

The CNA notices, encourages gentle participation, provides a kind presence, and reports observations objectively so the care team can act. The CNA does not counsel, diagnose, or adjust medications.

Suicidal Statements and Anxiety

Suicidal Statements: Immediate Reporting (High-Yield)

This is one of the most important safety items on the exam. Any statement about wanting to die, not wanting to live, harming oneself, or having nothing to live for is reported to the nurse immediately. Examples include "I'd be better off dead," "You won't have to bother with me much longer," or suddenly giving away prized possessions.

Rules to memorize:

• Never promise to keep a suicidal statement secret. Confidentiality does not apply to safety threats.
• Take every statement seriously, even if it sounds offhand or like a joke.
• Stay with the resident, listen calmly without judging, and do not leave them alone if risk seems immediate.
• Report to the nurse right away and document the resident's exact words.
• Do not argue, lecture, or say "You don't mean that."

The correct exam answer is always "report to the nurse immediately" and stay with the resident — never "keep it confidential," "wait and see," or "document it later."

Anxiety

Anxiety may show as restlessness, pacing, rapid speech, repeated reassurance-seeking, or physical complaints. Help with a calm presence, a simple explanation of what happens next, a predictable routine, and a familiar caregiver. Avoid "There's nothing to worry about." New or severe anxiety with physical symptoms can mask pain, low oxygen, or low blood sugar — report it.

End-of-Life and Hospice Care

Hospice care is for a resident with a terminal illness and a prognosis of about six months or less; palliative care focuses on comfort and quality of life rather than cure. The CNA provides hands-on comfort care and supports the family and care team.

Stages of grief (Kubler-Ross / DABDA) — there is no fixed order or timeline; a person may skip stages, repeat them, or experience several at once:

The CNA supports grief by listening, allowing the person to talk, cry, or be silent, respecting cultural and religious practices, and offering presence — not clichés. Do not say "It was for the best" or "I know how you feel." Report prolonged decline, refusal to eat, or hopelessness.

The CNA's Role on the Hospice Team

Hospice is a team — nurses, aides, social workers, chaplains, and volunteers — and the CNA is the team member who spends the most hands-on time with the resident. Key duties and limits:

• Provide comfort-focused ADL care: bathing, mouth care, repositioning, and clean dry linens, at the resident's pace.
• Honor advance directives. A resident with a Do Not Resuscitate (DNR) order is not given CPR; comfort care still continues fully. The CNA never decides this — follow the care plan and posted orders.
• Support the family, who are also "the unit of care" in hospice — offer presence, a chair, water, and a quiet space, and call the nurse for their questions.
• Respect spiritual and cultural needs around dying and the body.

The goal of hospice is a dignified, comfortable, pain-managed death, not cure. The CNA reports new or worsening pain right away because comfort is the entire purpose of care.

Comfort Care, Signs of Approaching Death, and Postmortem Care

Signs of approaching (imminent) death the CNA may observe and report: cool, pale, mottled (bluish, blotchy) extremities; irregular breathing with long pauses (Cheyne-Stokes); decreased intake and output; a sinking, glassy stare; mouth-breathing with the jaw dropped; and decreasing responsiveness. Hearing is the last sense to fail, so always speak gently and explain care as if the resident hears you.

Comfort measures for the dying resident:

• Reposition regularly (about every 1–2 hours) for skin and comfort; keep skin clean, dry, and moisturized.
• Give mouth care often (about hourly) with a moist swab and apply lip balm — the mouth dries quickly.
• Keep the environment quiet and lighting soft; reduce strong odors.
• Report signs of pain (grimacing, restlessness, moaning) promptly so the nurse can medicate.
• Provide presence, gentle touch, and reassurance; support the family.

Postmortem care (after-death care, done per facility policy and after the death is pronounced): provide privacy and dignity, allow the family to say goodbye, follow cultural/religious wishes, bathe the body and position it in normal alignment, gently close the eyes and mouth and insert dentures before rigor mortis sets in, place pads for any drainage, remove or secure jewelry per policy, and gather the resident's belongings for the family. Treat the body with the same respect given in life.