A home health nurse is making a home visit to an older adult client. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the client eliminate which of the following? (Select all that apply.)

Medicare supplemental insurance, commonly known as Medigap, does not have a Part 8. The options provided seem to be a combination of different parts of Medicare and supplementary insurance.

A. It covers the costs of outpatient services.

Explanation: This statement is generally true, but it is associated with Medicare Part B, which covers outpatient services. Medigap plans can help cover some of the out-of-pocket costs associated with Medicare Part B services.

B. It must be purchased and is a subsidized medical policy.

Explanation: This statement is partially true. Medigap policies must be purchased, but they are not subsidized. Individuals pay private insurance companies for Medigap coverage to help pay for certain costs not covered by Original Medicare (Parts A and B).

C. It covers the costs of speech therapy.

Explanation: This statement is generally true. Medigap plans may cover part or all of the costs associated with Medicare-approved services, including speech therapy.

D. It covers medication costs.

Explanation: This statement is not entirely accurate. Medigap plans do not cover prescription drugs. Coverage for prescription medications is typically provided through Medicare Part D, which is a separate prescription drug coverage plan.

A. Assist with obtaining informed consent from the client.
Explanation: Informed consent is a critical aspect of healthcare procedures, but it requires the patient to have the capacity to understand and make decisions. In this scenario, the client is intubated and on mechanical ventilation, which might compromise their ability to communicate effectively. If the client lacks capacity, obtaining consent from the durable power of attorney (POA) is more appropriate.

B. Refer to the client's advance directive for a name.
Explanation: Advance directives, including the durable POA, provide guidance on a person's wishes for healthcare decisions when they are unable to communicate. However, the advance directive may not always specify a particular person's name for decisions related to specific medical interventions. The key consideration in this situation is to determine the current decision-making capacity and involve the appropriate decision-maker if needed.

C. Determine the client's inability to make reasonable decisions.
Explanation: This is the correct answer. In this scenario, the nurse should assess the client's capacity to make decisions. If the client lacks capacity, the durable POA can be activated to make healthcare decisions on behalf of the client. Capacity involves the ability to understand relevant information, appreciate the consequences of decisions, and communicate a choice.

D. Use the oral trail-making test to measure cognitive function.
Explanation: The oral trail-making test is a cognitive screening tool, but it may not be suitable in this critical care scenario with an intubated and mechanically ventilated patient. Moreover, the primary concern in this situation is determining the capacity to make healthcare decisions, which requires a more comprehensive evaluation than a specific cognitive function test. The focus should be on decision-making capacity rather than a cognitive assessment.