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.)

A. TRICARE for Life.
Explanation: TRICARE for Life is a health insurance program for military retirees and their dependents. While it may be relevant for veterans, it is not typically available to widowed spouses, especially if they did not serve in the military themselves.

B. Medicaid.
Explanation: Medicaid is a state and federally funded program that provides health coverage to individuals with limited income and resources. In many states, Medicaid can assist in covering the costs not covered by Medicare, including premiums, deductibles, and other out-of-pocket expenses. Eligibility criteria for Medicaid vary by state, but it often considers income, assets, and medical needs.

C. Medicare Part D.
Explanation: Medicare Part D is the prescription drug coverage program for Medicare beneficiaries. It is not a substitute for supplemental insurance to cover other healthcare costs, and it focuses specifically on prescription medications.

D. Supplemental Security Income (SSI).
Explanation: SSI is a needs-based program that provides financial assistance to elderly or disabled individuals with limited income and resources. While it can assist with income support, it is not a health insurance program and may not directly cover healthcare costs. Medicaid is often coupled with SSI to provide comprehensive coverage.

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.