Long Term Care Certification Practice Test

Under what condition does Medicare provide coverage for nursing home care?

1. For long-term rehabilitation services

2. Only if part of treatment for a covered illness or injury

3. For routine custodial care

4. For pre-surgical assessments

The correct answer is: Only if part of treatment for a covered illness or injury

Medicare provides coverage for nursing home care primarily when it is part of a treatment plan for a covered illness or injury. This means that the patient must require skilled nursing care or rehabilitation services following a hospital stay (typically for at least three days) and must be receiving care that is medically necessary due to a specific medical condition. The nursing home care must be for rehabilitation purposes, aiming to improve the patient’s condition. This coverage is focused on situations where essential medical treatment is given rather than ongoing custodial care for general daily living activities. Therefore, Medicare does not cover routine custodial care, which often includes assistance with activities such as bathing and dressing that do not require skilled nursing intervention. Additionally, while pre-surgical assessments may be necessary, they do not qualify for nursing home coverage under Medicare unless they lead to a medically necessary inpatient stay and subsequent rehabilitation.