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Dear Ina,
I have been taking care of my spouse’s health needs every since she suffered a stroke and now she might need more care then I can provide her. I was told to ask you about the difference between custodial care and skilled care. Does Medicare cover these things?
Thank you for you help,
Carl Giver
Hi Mr. Giver,
Thank you for reaching out to us. GWAAR Legal Services Team has this to say about custodial care versus skilled care:
Medicare does not cover custodial care but will cover skilled care under specific circumstances. Knowing the differences between custodial care and skilled care will help you better understand your medical care choices and financial obligations. First, it is important to know what custodial care is.
Custodial care encompasses assistance with activities of daily living (ADLs), including bathing, dressing, eating, repositioning, and oral care. The ADLs are non-medical care that can be done reasonably and safely by a non-skilled or non-licensed caregiver. Custodial care can also be done at home, in a nursing home, or in an assisted living facility. This type of care consists of activities you need to do daily to care for yourself.
Skilled care must be provided by or under the supervision of a skilled or licensed medical professional. The care must be medically necessary and can only be safely performed by a skilled or licensed person. Examples of skilled care include physical therapy, occupational therapy, wound care, and intravenous injections. This type of care often happens in a skilled nursing facility. This care is usually more expensive than custodial care due to the complexity of the care and the need for a skilled or licensed provider to safely administer the care.
The most significant difference between custodial care and skilled care is the person providing the care. Skilled care must be performed by or under the supervision of a skilled or licensed person, while any caregiver can give custodial care. Custodial caregivers are not required to hold a formal license or complete medical training and are less costly to hire. If you are in a skilled nursing facility, skilled care should be covered, and custodial care will not be covered in that setting. In an assisted living facility, you will most likely receive custodial care that Medicare will not cover. In virtually all instances, custodial care will not be covered under Medicare.
Being informed about the medical care choices Medicare covers and your financial responsibility with those choices will help you be better prepared to meet your needs. Knowing the difference between custodial care and skilled care can help you prepare for decisions about long-term care choices. It will also help you advocate for yourself if you find yourself in a skilled nursing facility. It is essential to know what type of care Medicare will cover and what kind of care you will receive. Being informed will help you navigate your medical care and ensure you receive the care you need without financial surprises.
Sincerely,
Ina
Aging and Disability Resource Center (ADRC) of Waukesha County
By the GWAAR Legal Services Team (for reprint)
