Question

Mary is a 76-year-old woman, married to Henry for just over 50 years, and living in their own home in metropolitan Adelaide. Mary never learned to drive a car so Henry would take her to wherever she needed if it was too far for her to walk. While Henry's health has not been the best over the last couple of years (high blood pressure, diabetes type 2 - both managed well with medication), Mary's health was generally good until she had a massive stroke last week. As a result, she is paralysed down one side of her body, has difficulty swallowing (dysphagia), and Henry's concerned that she may not be able to return home. Mary and Henry have three children, all living interstate but phone them regularly. They have a granddaughter living close by who visits them every weekend. She is studying at university to be nurse Henry and Mary are financially comfortable - they own their home, have a well-maintained car, have private health insurance for hospital and extras but the cover is basic. They also have Ambulance cover. Your task . identify all medical, nursing and allied health services needed over a 3-month period (from just before the stroke to the end of rehabilitation), include a timeline and the various settings where services are accessed . specify where your future profession will have contact with Mary over the 3 months? Discuss briefly how the care pathway would change if Mary's socioeconomic status was different: low income receiving the Age Pension, had no private health insurance, did not have Ambulance cover), socially isolated (no supportive husband or grand-daughter).

Answer 1

1. Here in the present scenario, we can see, Mary is a 76-year-old and she has had a massive stroke in the last week till that her health is overall good. She has had private health insurance including the ambulance service. We can discuss the medical, nursing and allied health services for her under this private insurance she is having the option that she can choose

You can choose your own doctor, and decide whether she will go to a public or a private hospital that her doctor attends. She may also have more choice as to when you are admitted to the hospital.

Some or all of these costs may be covered on her private health insurance, depending on her policy.

The remaining costs include 25% of the MBS fee for doctors' services and any amount the doctors charge above the MBS fee, plus some or all the costs of:

• hospital accommodation;
• theatre fees;
• intensive care;
• drugs, dressings and other consumables;
• prostheses (surgically implanted);
• diagnostic tests;
• pharmaceuticals; and
• any additional doctor's fees.

Is applicable to her.

• most dental examinations and treatment;
• most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services;
• acupuncture (unless part of a doctor's consultation);
• glasses and contact lenses;
• hearing aids and other appliances; and
• home nursing.

Private health insurance covers many of these services.

Private health insurance covers many prescription medicines which aren't listed on the Pharmaceutical Benefits Scheme (PBS). Most funds will require you to make a co-payment towards the cost and will have limits on how much you can claim and as well as ambulance service is coverage for her.

2. Here the patient has had a massive stroke in the last week and she is a private insurance holder and after the stroke, she is paralyzed down one side of her body and presents with difficulty in swallowing and her husband is concerned that she may not be able to return home. According to her insurance policies, they will help pay for rehabilitation.

3. Medicaid is a state and federal program that provides health coverage if you have a very low income, Medicaid, on the other hand, can cover the cost of nursing homes, assisted living facilities, and other long-term care alternatives as long as they're deemed medically necessary. Medicaid has a state component