Custodial Care

Also known as: Non-Skilled Care

Last Updated: August 28, 2020

Written by the Open Caregiving Team. Editorial review by Joyce O. Murphy RN, MSN.

What is custodial care?

Custodial care is caregiving provided alongside skilled services, such as those ordered by a doctor. This type of care can vary based on the setting, either at home or in a facility like a nursing home where nursing assistants provide care for your loved one.

What does custodial care include?

Custodial care includes help with personal care such as bathing, dressing, and using the toilet. When the care is provided at home it may include meal preparation and light housekeeping. This care is provided because your loved one is unable to do them safely on their own.

Custodial care helps some people stay at home as long as possible. This includes those who are frail, have a challenging physical ailment, or suffer from Alzheimer’s or another type of dementia.

What is the difference between skilled nursing services and custodial care?

It’s important for you and your loved one to know the differences between skilled nursing care, other skilled services, and custodial care. This is because Medicare and other health insurances may pay all or part of skilled care, based on where it is provided.

Skilled Services

  • Are medically necessary and need to be ordered by a doctor or other medical professional approved to do so.
  • Are to be provided by a Medicare approved professional, such as a nurse or therapist. They work for a Medicare certified organization, such as a nursing home.
  • Skilled nursing services include needs such as wound care, injections, tube feedings, and catheter changes.

Custodial Care

  • Is the daily care a person needs help with as they can’t provide it for themselves.
  • Offers help with many activities of daily living (ADLs). These include eating, personal care, medication reminders, and help with dressing, using the toilet, and getting around.
  • Is provided by non-medical staff such as certified nursing assistants or aides (CNAs).
  • Please note that Medicare and other insurances may not pay for custodial care even if they pay for skilled nursing care.

Who pays for custodial care?

There are limited payment options for custodial care. These include:

Medicare

Medicare only pays for custodial care if it meets certain requirements:

  • It is associated with a skilled service that is medically necessary. It must be provided by a Medicare-approved healthcare professional such as a physical therapist or registered nurse.
  • The skilled service is prescribed by a doctor or other medical person.
  • The custodial care is done to make sure your loved one has all the care they need while receiving skilled services.
  • Learn more on our Medicare page.

Medicaid

Medicaid may pay for custodial care in certain situations:

  • When your loved one is cared for in a nursing home.
    • This varies a lot from one state to the next.
    • Families may need to use all their loved one’s assets before being able to qualify for Medicaid.
    • Learn more on our Medicaid page.

Long-Term Care Insurance

Long-Term Care Insurance (LTC) may be used for custodial care.

  • LTC is purchased as a private insurance that supplements Medicare.
  • Policies vary with:
    • How much their premiums cost.
    • The length of time they’ll cover and how much and what services they’ll approve.
    • The amount they will pay or reimburse for the costs of custodial care.

What is non-custodial care?

Skilled nursing and therapy services are sometimes referred to as “non-custodial care.”

How much does Medicare pay for custodial care?

Medicare’s guidelines for paying for custodial care are clearly associated with skilled nursing care and/or other skilled services. These guidelines include:

  • That the services are prescribed by a physician.
  • Care that is needed to recover from surgery or an illness or health event such as a stroke.
    • Then Medicare may pay varying amounts for authorized skilled care for up to 100 days if your loved one:
      • Is receiving skilled nursing or therapy services in a nursing home.
      • Has skilled care services at home.
  • Medicare may pay for custodial care associated with the skilled services for 100 days or less if:
    • It is provided in a nursing home.
    • It is provided at home in conjunction with authorized skilled services.

Which Medigap policy plan provides coverage for long-term custodial care?

Medigap policies do not typically pay for custodial care.

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