Scenario Analysis: This scenario is professionally challenging because it requires balancing the resident’s expressed preferences with the documented clinical needs identified during a nutritional assessment. The CLTC professional must navigate potential conflicts between autonomy and beneficence, ensuring the resident’s dignity and quality of life are maintained while also addressing potential health risks. This requires careful communication, empathy, and a thorough understanding of nutritional science and ethical care principles. Correct Approach Analysis: The best professional practice involves a collaborative approach where the CLTC professional actively engages the resident in a discussion about their dietary preferences and the rationale behind the recommended nutritional plan. This approach respects the resident’s autonomy by seeking their input and understanding their perspective. It then involves clearly explaining how the recommended plan addresses the identified nutritional deficits and supports their overall health and well-being, linking it to the goals of the CLTC care plan. This method fosters trust, promotes adherence, and ensures the resident feels heard and valued, aligning with ethical principles of informed consent and person-centered care. Incorrect Approaches Analysis: One incorrect approach involves unilaterally imposing the dietary changes based solely on the assessment findings without resident input. This disregards the resident’s right to self-determination and can lead to resistance, decreased intake, and a negative impact on their emotional state, violating ethical principles of autonomy and dignity. Another incorrect approach is to simply accept the resident’s stated preferences without further exploration or explanation, even when they contradict the clinical assessment. This fails to uphold the professional’s responsibility to ensure the resident receives appropriate nutrition for their health needs, potentially leading to malnutrition or exacerbation of existing conditions, which is a failure of beneficence. A third incorrect approach is to present the dietary changes as non-negotiable directives without explaining the underlying nutritional reasons or how they relate to the resident’s health goals. This can create an adversarial relationship and undermine the resident’s understanding and willingness to participate in their care, failing to promote a therapeutic alliance. Professional Reasoning: Professionals should employ a shared decision-making model. This involves: 1) conducting a comprehensive nutritional assessment; 2) identifying and documenting nutritional needs and risks; 3) discussing the assessment findings with the resident in an understandable manner; 4) exploring the resident’s preferences, values, and concerns; 5) collaboratively developing a nutritional plan that integrates clinical recommendations with resident preferences to the greatest extent possible; and 6) regularly reassessing and adjusting the plan based on the resident’s response and evolving needs.

Scenario Analysis: This scenario is professionally challenging because it involves navigating the complex interplay between an individual’s expressed wishes, their evolving cognitive capacity, and the legal frameworks designed to protect vulnerable adults. The core difficulty lies in determining when an individual’s capacity to make decisions diminishes to a point where formal legal intervention is necessary, and how to ensure that any such intervention respects their dignity and prior intentions as much as possible. The financial implications and the potential for family conflict add further layers of complexity, requiring a sensitive and legally sound approach. Correct Approach Analysis: The best professional practice involves initiating a formal assessment of the individual’s capacity to manage their financial affairs. This assessment should be conducted by qualified professionals, such as a geriatric care manager or a medical doctor specializing in cognitive health, and should adhere to the legal standards for determining capacity within the relevant jurisdiction. If the assessment reveals a lack of capacity, the next step is to explore the existence of a Durable Power of Attorney for Finances. If one exists and is valid, it should be utilized according to its terms. If no such document exists, or if it is deemed invalid or insufficient, then pursuing guardianship or conservatorship through the appropriate court system becomes the necessary legal recourse. This approach prioritizes the individual’s well-being and legal rights by following established legal procedures designed to protect those who can no longer manage their own affairs, while also respecting any pre-existing legal directives. Incorrect Approaches Analysis: Pursuing immediate guardianship or conservatorship without first assessing capacity or exploring the existence of a Durable Power of Attorney is premature and legally inefficient. It bypasses less intrusive legal mechanisms that may already be in place and could impose unnecessary legal and financial burdens on the individual and their family. Relying solely on the family’s consensus without a formal capacity assessment or legal documentation is ethically and legally unsound. Family opinions, while important, do not substitute for a legal determination of capacity or the authority granted by a Power of Attorney or court order. This approach risks acting without proper legal standing and could lead to challenges and invalidation of decisions made. Ignoring the situation and allowing the individual to continue managing finances despite evident decline is also professionally negligent. This inaction can lead to significant financial harm to the individual and potential legal liability for those aware of the situation but failing to act. Professional Reasoning: Professionals facing such situations should employ a structured decision-making process. First, assess the immediate risk to the individual’s well-being and financial security. Second, investigate the existence and validity of any pre-existing legal documents, such as a Durable Power of Attorney for Finances. Third, if capacity is in question, initiate a formal capacity assessment by qualified professionals. Fourth, based on the assessment and the presence or absence of legal documents, determine the appropriate legal pathway, which may range from utilizing an existing Power of Attorney to petitioning for guardianship or conservatorship. Throughout this process, maintaining clear communication with the individual (to the extent of their capacity), their family, and relevant legal and medical professionals is paramount, always prioritizing the individual’s best interests and legal rights.

This scenario is professionally challenging because it requires balancing the client’s stated desires with the ethical obligation to ensure that goals are realistic, measurable, and aligned with the client’s actual needs and capacity for improvement. Misinterpreting or failing to adequately assess the client’s situation can lead to ineffective care plans, client dissatisfaction, and potential regulatory non-compliance. Careful judgment is required to translate subjective aspirations into actionable, outcome-oriented objectives. The best professional approach involves collaboratively developing specific, measurable, achievable, relevant, and time-bound (SMART) goals. This method ensures that both the client and the care provider have a clear understanding of what success looks like and how it will be measured. This aligns with the ethical principles of client-centered care and the CLTC’s focus on promoting independence and quality of life. By setting SMART goals, professionals can demonstrate progress, justify interventions, and ensure that care plans are dynamic and responsive to the client’s evolving needs, thereby meeting regulatory expectations for effective care planning and outcome tracking. An approach that focuses solely on the client’s immediate wishes without a structured framework for measurement or assessment is professionally inadequate. This can lead to vague objectives that are difficult to track and achieve, potentially resulting in a lack of demonstrable progress and unmet client needs. Ethically, it fails to ensure the provision of the most effective and appropriate care. Another professionally unacceptable approach is to impose a rigid set of predetermined goals without sufficient client input or consideration of their unique circumstances. This disregards the principle of client autonomy and can lead to goals that are not relevant or achievable for the individual, undermining the effectiveness of the care plan and potentially causing frustration or disengagement for the client. Finally, an approach that prioritizes documentation over actual client progress is ethically unsound and likely to fall short of regulatory requirements. While documentation is crucial, its purpose is to reflect and support the client’s journey towards achieving defined outcomes. Focusing on paperwork without a genuine commitment to measuring and facilitating client progress is a superficial engagement with goal setting and outcome measurement. Professionals should employ a decision-making framework that begins with a thorough assessment of the client’s current status, preferences, and potential for improvement. This should be followed by a collaborative discussion to establish shared understanding and agreement on desired outcomes. Goals should then be formulated using a structured methodology like SMART, ensuring they are specific, measurable, and actionable. Regular review and adjustment of these goals based on ongoing assessment and client feedback are essential to ensure the care plan remains effective and client-centered.

Scenario Analysis: This scenario is professionally challenging because it requires a CLTC professional to navigate the complex and often overlapping funding streams for long-term care, while ensuring the client receives accurate and unbiased information tailored to their specific needs and financial situation. Misinformation or a failure to consider all viable options can lead to significant financial hardship for the client and their family, and can also result in regulatory non-compliance. The CLTC professional must act as a trusted advisor, prioritizing the client’s well-being and understanding of their choices. Correct Approach Analysis: The best professional approach involves a comprehensive assessment of the client’s current financial resources, health status, and projected long-term care needs. This assessment should then be used to explain the distinct roles and limitations of Medicare, Medicaid, and private long-term care insurance in covering various aspects of long-term care services. The professional must clearly delineate which services each program typically covers, the eligibility criteria, and the potential out-of-pocket costs associated with each. For instance, Medicare’s role is primarily for skilled nursing care following a qualifying hospital stay, not custodial care. Medicaid has strict income and asset limitations but can cover a broader range of services for eligible individuals. Private insurance offers the most flexibility but requires premium payments and has varying policy structures. This approach ensures the client is empowered with knowledge to make informed decisions aligned with their circumstances and preferences, adhering to ethical obligations of transparency and client advocacy. Incorrect Approaches Analysis: One incorrect approach is to solely focus on Medicare as the primary funding source, assuming it covers all long-term care needs. This fails to acknowledge Medicare’s limitations, particularly its lack of coverage for long-term custodial care, which is often the most significant expense. This oversight can lead clients to believe their care is fully covered when it is not, resulting in unexpected financial burdens. Another incorrect approach is to present Medicaid as a universally accessible solution without thoroughly explaining its stringent eligibility requirements. This can create false expectations for clients who may not qualify due to their income or assets, leading to disappointment and a lack of preparedness for alternative funding strategies. It also neglects the potential for a client to deplete their assets to qualify, which may not be in their best financial interest. A third incorrect approach is to overemphasize private long-term care insurance without a detailed analysis of the client’s ability to afford ongoing premiums or the specific benefits offered by various policies. This can lead to recommending a product that is financially unsustainable for the client, or one that does not adequately meet their anticipated care needs, thereby failing to provide a truly suitable solution. Professional Reasoning: Professionals should adopt a client-centered decision-making process that begins with a thorough needs assessment. This assessment should inform a comparative analysis of all potential funding sources, highlighting their respective benefits, drawbacks, and eligibility criteria. The professional’s role is to educate, not to dictate, empowering the client to make the most appropriate choices for their unique situation, always in compliance with ethical guidelines and regulatory frameworks governing financial advice and long-term care planning.

The review process indicates a scenario where a CLTC professional must advise a client on long-term care insurance policies, specifically concerning the nuances of benefit triggers and elimination periods. This situation is professionally challenging because it requires not only a thorough understanding of policy mechanics but also the ability to translate complex insurance terms into clear, actionable advice for a client who may be unfamiliar with these concepts. Misinterpreting or miscommunicating these critical policy features can lead to significant financial and care-related consequences for the client down the line, potentially resulting in coverage gaps or unexpected out-of-pocket expenses. Careful judgment is required to ensure the client fully comprehends what activates their benefits and the waiting period they must satisfy before those benefits commence. The best professional approach involves clearly explaining to the client that benefit triggers are the specific conditions or events that must occur for the long-term care insurance policy to begin paying benefits. This explanation should include common triggers such as the inability to perform a certain number of Activities of Daily Living (ADLs) or requiring substantial supervision due to cognitive impairment. Furthermore, it is crucial to explain the elimination period as the waiting period after a benefit trigger is met, during which the insured must pay for care out-of-pocket before the policy starts reimbursing expenses. This approach is correct because it prioritizes client education and transparency, ensuring the client understands the fundamental conditions for coverage. This aligns with ethical obligations to act in the client’s best interest and regulatory requirements that mandate clear and accurate disclosure of policy terms and conditions. Providing this detailed, client-centric explanation empowers the client to make informed decisions about their long-term care planning. An incorrect approach would be to simply state that benefits are triggered by needing care and that there is a waiting period without elaborating on the specific definitions of “needing care” (e.g., ADL limitations, cognitive impairment) or the duration and nature of the elimination period. This failure to provide specific details constitutes a lack of transparency and can lead to the client having unrealistic expectations about when their coverage will activate. Ethically, this falls short of the duty to inform, and from a regulatory standpoint, it may violate disclosure requirements that mandate clarity on policy limitations and conditions. Another incorrect approach would be to focus solely on the policy’s maximum benefit amount and premium cost, neglecting to explain the mechanics of benefit triggers and elimination periods. While these are important policy features, omitting the conditions for benefit activation and the waiting period leaves a critical gap in the client’s understanding of how and when they will actually receive care support. This oversight can lead to the client believing they have immediate coverage upon experiencing a health event, only to discover a significant delay and out-of-pocket burden due to the unaddressed elimination period. This misrepresentation of coverage availability is both ethically problematic and potentially in violation of consumer protection regulations. A final incorrect approach would be to assume the client understands these terms based on prior insurance experience or to use overly technical jargon without simplification. Long-term care insurance can be complex, and assuming a client’s comprehension without verification is a disservice. This can lead to misunderstandings that have serious financial implications. Professionals have a duty to ensure comprehension, and failing to do so, even unintentionally, can lead to client dissatisfaction and potential regulatory scrutiny for inadequate client servicing. The professional decision-making process for similar situations should involve a structured approach: first, identify the client’s specific needs and concerns regarding long-term care; second, thoroughly understand the features and limitations of the proposed insurance policies, paying close attention to benefit triggers and elimination periods; third, develop a clear, concise, and client-friendly explanation of these complex terms, using analogies or examples where appropriate; fourth, actively solicit questions from the client and confirm their understanding; and finally, document the discussion and the client’s comprehension to ensure a record of informed decision-making.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the financial sustainability of a long-term care facility with the ethical imperative to provide high-quality, person-centered care. Decisions about cost analysis and budgeting directly impact the resources available for staffing, services, and facility maintenance, all of which are critical to resident well-being. Misjudgments can lead to understaffing, reduced services, or financial instability, potentially compromising care standards and regulatory compliance. Careful judgment is required to ensure that cost-saving measures do not inadvertently lead to a decline in the quality of care or violate residents’ rights. Correct Approach Analysis: The approach that represents best professional practice involves a comprehensive review of historical spending patterns, current operational costs, and projected future needs, while simultaneously evaluating the impact of proposed budget adjustments on the quality and scope of resident care. This method prioritizes a data-driven understanding of financial realities and their direct correlation to service delivery. It is correct because it aligns with the ethical duty of care providers to ensure that financial decisions are made with the best interests of residents at the forefront. Regulatory frameworks, such as those governing long-term care facilities, often mandate that budgets support the provision of adequate staffing, appropriate care plans, and a safe living environment. This approach ensures that any budgetary changes are assessed for their potential to meet or exceed these requirements, rather than simply cutting costs without considering the consequences for residents. It fosters transparency and accountability by linking financial planning directly to the observable outcomes of care. Incorrect Approaches Analysis: An approach that focuses solely on reducing direct care staff hours to meet budget targets without considering the impact on resident needs or staff workload is professionally unacceptable. This failure stems from a disregard for the direct link between staffing levels and the quality of care, potentially leading to violations of regulations that specify minimum staffing ratios or require individualized care plans to be met. Another unacceptable approach is to prioritize capital expenditures or administrative overhead reductions without a thorough analysis of how these cuts might indirectly affect resident care, such as by delaying necessary equipment upgrades or reducing essential support services. This approach is flawed because it fails to recognize that all aspects of a facility’s operations contribute to the overall resident experience and safety. Furthermore, an approach that relies on anecdotal evidence or the lowest bid for services without a rigorous assessment of the provider’s capacity to deliver quality care can lead to substandard outcomes and potential regulatory non-compliance. This demonstrates a lack of due diligence and a failure to uphold the professional standard of ensuring that all contracted services meet the needs of the residents. Professional Reasoning: Professionals should employ a systematic and holistic approach to cost analysis and budgeting. This involves establishing clear financial goals that are aligned with the facility’s mission and regulatory obligations. They should gather and analyze comprehensive data on all revenue and expenditure streams, and critically assess the potential impact of any proposed changes on resident care, staff morale, and operational efficiency. A key element of professional decision-making is the proactive identification of potential risks and the development of mitigation strategies. This includes engaging relevant stakeholders, such as care staff, residents, and their families, in discussions about budgetary considerations where appropriate, to ensure that decisions are informed by diverse perspectives and uphold the highest ethical standards of care.

This scenario presents a professional challenge because it requires balancing the client’s stated preferences with the professional’s ethical and regulatory obligations to ensure the client’s safety and well-being, especially when there’s a potential for cognitive decline or misunderstanding. Careful judgment is required to navigate the nuances of informed consent and the duty of care. The best approach involves a comprehensive assessment that goes beyond the client’s immediate verbal request. This includes gathering information from multiple sources, such as family members or previous care providers, and conducting a thorough evaluation of the client’s cognitive status and understanding of the proposed care plan changes. This multi-faceted assessment ensures that any decisions made are truly in the client’s best interest and align with regulatory requirements for person-centered care and informed consent. Specifically, CLTC professionals are guided by ethical principles that prioritize client autonomy while also mandating a duty to protect vulnerable individuals. Regulations often require that care plans be individualized and responsive to changes in a client’s condition, necessitating a robust assessment process before implementing significant changes, especially those that might increase risk. An approach that immediately implements the client’s request without further investigation fails to uphold the professional’s duty to assess the client’s capacity and the potential impact of the change on their safety. This bypasses the critical step of ensuring informed consent, as the client may not fully comprehend the implications of their request, particularly if cognitive impairment is present. Ethically, this could be seen as a dereliction of duty. Another incorrect approach involves solely relying on the family’s interpretation of the client’s wishes without directly engaging with the client to assess their understanding and preferences. While family input is valuable, the client’s voice and autonomy must be paramount, and direct assessment of the client’s capacity is a regulatory and ethical imperative. Finally, an approach that dismisses the client’s request outright due to a perceived minor inconvenience or a general assumption of incapacity, without a proper assessment, is also professionally unacceptable. This fails to respect the client’s autonomy and may lead to a care plan that does not meet their evolving needs or desires, potentially causing distress and undermining the therapeutic relationship. Professionals should employ a decision-making framework that begins with active listening and respectful engagement with the client. This is followed by a systematic assessment process that includes gathering collateral information, evaluating cognitive function relevant to the decision at hand, and clearly explaining the proposed care plan and its implications. The goal is to achieve a shared decision-making process where the client’s informed preferences are honored to the greatest extent possible, while ensuring their safety and well-being are protected in accordance with ethical standards and regulatory guidelines.

Scenario Analysis: This scenario presents a professional challenge due to the critical need for accurate and timely assessment data to inform care planning and reimbursement. Misinterpreting or misapplying assessment tools can lead to suboptimal care, financial penalties, and regulatory non-compliance. The professional must navigate the nuances of different assessment instruments and their specific applications within the regulatory framework. Correct Approach Analysis: The best professional practice involves utilizing the Minimum Data Set (MDS) for residents in Medicare and Medicaid certified skilled nursing facilities. This approach is correct because the MDS is a standardized, comprehensive assessment tool mandated by the Centers for Medicare & Medicaid Services (CMS) for all residents in these facilities. Its purpose is to provide a standardized way to collect specific resident assessment data, which is then used to determine care plans, quality of care, and reimbursement under the Prospective Payment System (PPS). Adherence to MDS guidelines ensures compliance with federal regulations and facilitates accurate care planning and financial reporting. Incorrect Approaches Analysis: One incorrect approach is to exclusively use the Outcome and Assessment Information Set (OASIS) for all long-term care residents. OASIS is specifically designed for home health agencies to assess patients receiving Medicare-certified home health services. Its application in a skilled nursing facility setting is inappropriate and would not meet the regulatory requirements for resident assessment in that environment, potentially leading to incorrect care planning and reimbursement issues. Another incorrect approach is to rely solely on informal clinical observations and staff anecdotal reports without systematically applying a standardized assessment tool. While clinical judgment is vital, it must be documented and supported by objective data gathered through mandated assessment instruments. This approach fails to meet the regulatory requirement for comprehensive, standardized resident assessments, which are essential for quality assurance, care planning, and reimbursement. A further incorrect approach is to use a proprietary, non-standardized assessment tool developed by the facility without validation or regulatory approval for use in Medicare/Medicaid certified facilities. While such tools might offer some insights, they do not fulfill the federal mandate for standardized data collection through instruments like the MDS, which are crucial for inter-facility comparisons, quality initiatives, and regulatory oversight. Professional Reasoning: Professionals should approach assessment by first identifying the specific regulatory environment and the type of facility or service being provided. This dictates which assessment tools are mandated. For skilled nursing facilities, the MDS is the primary tool. For home health, OASIS is required. In all cases, standardized, validated tools are preferred to ensure data integrity, facilitate communication, and meet regulatory obligations. When in doubt, consulting facility policy, regulatory guidance from CMS, and professional best practices is essential. The goal is to gather comprehensive, accurate, and standardized data that supports evidence-based care and meets all legal and ethical requirements.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate needs and preferences of a resident with the established standards of care and the potential for future decline. A CLTC professional must navigate the complexities of resident autonomy, family involvement, and the ethical imperative to ensure safety and well-being without infringing on personal dignity. Careful judgment is required to avoid paternalism while still upholding professional responsibilities. Correct Approach Analysis: The best approach involves a comprehensive, individualized assessment that considers the resident’s current cognitive and physical status, their expressed preferences, and the potential risks and benefits of the proposed change in care. This approach aligns with the ethical principles of person-centered care, respecting resident autonomy and dignity. Regulatory frameworks, such as those governing long-term care facilities, emphasize the development and implementation of individualized care plans that are responsive to resident needs and preferences, while also ensuring safety and quality of life. This method promotes collaboration among the resident, family, and care team to make informed decisions. Incorrect Approaches Analysis: One incorrect approach is to immediately implement the resident’s request without further evaluation. This fails to uphold the professional responsibility to ensure the resident’s safety and well-being. It may overlook potential risks that the resident, due to their condition, cannot fully assess, leading to a breach of the duty of care and potentially violating regulations that mandate risk assessment and management. Another incorrect approach is to defer entirely to the family’s wishes, disregarding the resident’s expressed preferences. This undermines the resident’s autonomy and dignity, which are central tenets of ethical long-term care. It can lead to a care plan that is not truly person-centered and may cause distress or dissatisfaction for the resident, potentially contravening regulations that prioritize resident rights. A third incorrect approach is to rigidly adhere to a pre-established facility policy that does not allow for individual exceptions, even when a resident’s needs or preferences suggest otherwise. While policies are important for consistency, an inflexible application can lead to suboptimal care and fail to meet the unique needs of individuals, potentially conflicting with the spirit and intent of regulations that promote individualized care. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes a thorough assessment of the resident’s current capabilities and preferences. This involves open communication with the resident and their family, consultation with the interdisciplinary care team, and a careful consideration of potential risks and benefits. The goal is to achieve a consensus that respects the resident’s autonomy while ensuring their safety and quality of life, in accordance with ethical guidelines and regulatory requirements.

The efficiency study reveals a critical juncture in long-term care financial planning where a client’s evolving needs clash with their initial financial strategy. This scenario is professionally challenging because it requires balancing the client’s current well-being and future security with the fiduciary duty to provide sound, ethical, and compliant financial advice. The CLTC professional must navigate potential conflicts between the client’s expressed desires and the realistic financial implications, ensuring transparency and informed consent throughout the process. The most appropriate approach involves a comprehensive reassessment of the client’s current financial situation, including updated income, assets, and expenses, alongside a re-evaluation of their long-term care needs and preferences. This includes exploring all available funding sources, such as private insurance, government benefits (like Medicaid or Medicare, where applicable and relevant to the client’s eligibility), and personal savings, and projecting their adequacy against revised cost estimates. The CLTC professional must then present a range of revised financial strategies, clearly outlining the pros and cons of each, and empowering the client to make an informed decision based on their updated circumstances and goals. This approach aligns with ethical obligations to act in the client’s best interest, maintain professional competence, and ensure that financial plans remain relevant and effective throughout the client’s life. It also adheres to the principles of client-centered care and informed consent, fundamental to responsible financial advisory practice in long-term care. An alternative approach that involves solely relying on the initial long-term care insurance policy without considering the significant increase in care costs and the client’s reduced ability to afford supplemental care is professionally unacceptable. This fails to acknowledge the dynamic nature of long-term care needs and financial realities, potentially leaving the client underinsured and facing significant out-of-pocket expenses. It neglects the fiduciary duty to proactively advise on necessary adjustments to financial plans. Another less suitable approach would be to immediately recommend liquidating all remaining assets to fund a new, potentially overly expensive, care plan without thoroughly exploring all other viable options or considering the client’s desire for legacy planning or other financial goals. This approach risks depleting the client’s resources unnecessarily and may not be the most efficient or appropriate use of their remaining wealth, potentially violating the principle of prudent financial management. A further inappropriate strategy would be to dismiss the client’s concerns about the adequacy of their current plan due to a perceived lack of available new funding options, without undertaking a thorough review of their current financial standing and exploring all potential avenues for adjustment. This demonstrates a lack of diligence and a failure to provide comprehensive advisory services, potentially leaving the client without necessary support or guidance. Professionals should employ a systematic decision-making process that begins with active listening to the client’s evolving concerns and needs. This should be followed by a thorough, up-to-date assessment of their financial resources and long-term care requirements. Subsequently, all available funding mechanisms and strategic adjustments should be explored and evaluated. Finally, transparent communication and collaborative decision-making with the client are paramount to developing and implementing a revised, effective, and ethical long-term care financial plan.