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Correct Answer: private duty nursing.
in addressing the question posed by the 70-year-old client regarding what services medicare typically covers and which it does not, it is crucial to understand the scope of medicare coverage. medicare is a federal health insurance program primarily for people aged 65 and older, as well as for some younger individuals with disabilities or specific diseases. its coverage includes several medically necessary services, but not all types of care are covered.
first, let’s clarify what medicare generally covers:
- **physical therapy**: this is covered under medicare part b when prescribed by a doctor and provided by a medicare-certified therapist. it falls under outpatient therapy services and is aimed at improving a patient's condition after an illness or injury.
- **occupational therapy**: similar to physical therapy, occupational therapy is covered when it is prescribed as necessary for the patient to recover or improve skills needed for daily living following health issues.
- **prosthetic services**: medicare part b covers prosthetic devices needed to replace a body part or function. this includes coverage for items like prosthetic limbs, when prescribed by a qualified healthcare provider.
however, there are services that medicare does not typically cover, which include:
- **private duty nursing**: this type of care involves one-on-one care by a nurse for extended periods, typically in a home setting or occasionally in a hospital. medicare generally does not cover private duty nursing, as it is considered custodial care rather than medical care. the care provided by private duty nurses is more focused on daily living assistance rather than medical treatment, which is outside the scope of medicare coverage.
aside from the specific services mentioned, it's important to note additional limitations regarding medicare coverage:
- medicare will cover a semi-private room in a hospital or skilled nursing facility, but it does not cover the cost of a private room unless it is medically necessary.
- while medicare covers meals provided in a hospital or skilled nursing facility, it does not cover personal convenience items such as phone calls or tv usage.
- medicare also excludes coverage for routine hygiene items like toothpaste or razors, as these are considered personal care supplies rather than medical necessities.
when advising the client, it is essential to ensure she understands that while medicare covers many aspects of recovery and rehabilitation through various therapies and services, it does not extend to all forms of care, particularly those deemed as non-medical or custodial, such as private duty nursing. understanding these distinctions will help manage her expectations and planning for her care needs.
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