Custodial Care: What it is, How it Works

What Is Custodial Care?

Custodial care is non-medical care that helps individuals with their activities of daily living (ADL), such as eating and bathing. Custodial care for an individual is generally recommended by authorized medical personnel, but providers of custodial care are not required to be medical professionals.

Understanding Custodial Care

Some people with certain medical, physical, or mental conditions are unable to perform activities of daily living on their own and require assistance. These activities, such as eating, using the toilet, bathing, getting dressed or out of bed, moving around, etc. can reasonably and safely be provided by caregivers with no medical or nursing training. Beneficiaries who are in the care of non-medical aides are said to be in custodial care.

Custodial care differs from skilled care, which can only be provided by or under the supervision of licensed and trained medical professionals. A beneficiary in need of skilled care can be someone who is undergoing physical therapy, recovering from an accident, in need of intravenous injections, requires catheter care, etc.

Custodial care is a form of long-term care (LTC) that can be done within a nursing facility or at home. Most custodial care needs can be met by either in-home caregivers or assisted living aides. Payment for custodial care can be steep and is usually made with private funds and savings. Other forms of coverage for the cost of long-term care may include Medicare, Medicaid, or private insurance.

Generally, Medicare does not cover custodial care if that is the only type of care that is needed. Medicare will only offer coverage if two basic requirements are met: (1) The care is considered medically necessary and prescribed by a licensed physician or authorized medical personnel; and (2) the care is conducted by a healthcare provider who participates in Medicare. Medicare typically only pays for skilled care in a nursing facility that has a Medicare license and will only cover 100 days of nursing care.

Medicaid covers custodial care as long as it is provided within a nursing facility. The requirements and services for coverage vary widely from state to state. To be eligible for Medicaid, beneficiaries would have to first pay for custodial care out-of-pocket. Only when their assets have been used up will Medicaid kick in. Custodial care at home is typically covered only under long-term care (LTC) insurance, not by Medicaid, even though home care is cheaper than a nursing facility.

Some individuals opt for private LTC insurance to supplement their Medicare coverage. While these policies vary greatly, many provide coverage for nursing home and in-home care for a fixed period of time, such as three, four, or five years. Annual premiums on LTC insurance are fixed for the life of the coverage, and policyholders are reimbursed a specified amount for each day of custodial care received during the period of coverage.

Many communities run adult day care services for beneficiaries with certain types of ailments, e.g., Alzheimer’s. In some states, Medicaid also pays for adult day-care services. In addition, some states also offer programs such as homemaker services to qualifying seniors. In such cases, a caregiver is appointed to help the beneficiary to prepare meals, manage drug prescriptions, run errands, and assist with other chores.