Custodial Care: What It Is and 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.

Types of Services

Those with certain medical, physical, or mental conditions may be unable to perform activities of daily living on their own and require assistance. Activities such as eating, using the toilet, bathing, getting dressed or out of bed can reasonably and safely be provided by caregivers with no medical or nursing training. Beneficiaries 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 of skilled care may be someone undergoing physical therapy, recovering from an accident, in need of intravenous injections, or requiring catheter care.

Custodial care is a form of long-term care (LTC) performed within a nursing facility or at home. Most custodial care needs can be met by either in-home caregivers or assisted-living aides. Custodial care can be expensive and may be covered through a combination of Medicare, Medicaid, or private insurance.

Coverage for Custodial Care

Medicare does not commonly cover custodial care if that is the sole type of care required. Medicare will only offer coverage if the care is considered medically necessary and prescribed by a licensed physician or authorized medical personnel or if the care is conducted by a healthcare provider who participates in Medicare. Medicare typically pays for 100 days of skilled care in a nursing facility that has a Medicare license.

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 depleted 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 generally cheaper than a nursing facility.

Some individuals opt for private LTC insurance to supplement their Medicare coverage. While policies vary, many provide coverage for nursing homes and in-home care for a fixed period. Annual premiums on LTC insurance are usually 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.

The Bottom Line

Custodial care services commonly include living assistance, such as bathing, cooking, or other daily necessities. The care is considered non-medical care and may be performed by non-medical professionals. Medicare, Medicaid, or personal insurance help to cover custodial care services.