Custodial care

What it means

Custodial care does not require a licensed clinician. It is the help a person needs to get through the day, provided at home or in a facility.

Medicare does not pay for it when it is the only care needed. This is the single most consequential fact in eldercare finance.

Skilled care is different: it needs a nurse or therapist, and Medicare may cover a limited period of it.

Why it matters

Families budget on the assumption that Medicare covers care and discover otherwise at the point of crisis, when there is no time to plan.

It is also why the distinction is worth checking on every bill: the same person in the same bed can be receiving skilled care one week and custodial care the next.

When you are likely to meet it

• When a parent needs help at home and nobody is paying for it.
• When Medicare coverage of a facility stay ends.
• When comparing what long-term care insurance actually covers.

Related terms

• Activities of daily livingThe everyday self-care tasks — bathing, dressing, eating, using the toilet, moving from a bed to a chair, continence — that care assessments and insurance policies measure.
• Adult day servicesA daytime program providing supervision, activity and often health care outside the home.
• Area Agency on AgingA local agency, part of a national network, that arranges and coordinates services for older adults in its own area.
• Assisted livingHousing with help for daily tasks and staff on site, but without the licensed clinical care a nursing facility provides.
• Benefit triggerThe condition a long-term care insurance policy requires before it starts paying — usually needing help with a stated number of daily activities, or having cognitive impairment.
• Continuing care retirement communityA campus offering independent living through to nursing care, usually entered by paying a large fee up front.
• Discharge plannerThe hospital staff member responsible for what happens after a stay ends.
• Elimination periodA waiting period after a long-term care claim is approved, during which the family pays and the policy does not.
• Geriatric care managerA professional, usually a nurse or social worker, hired to assess an older person's needs and coordinate their care.
• Home careNon-medical help at home — bathing, dressing, meals, housekeeping, company. Medicare does not pay for it.
• Home healthSkilled clinical care delivered at home, ordered by a doctor. Medicare may pay for it while the clinical need lasts.
• Instrumental activities of daily livingThe harder-to-see tasks — money, medication, cooking, transport, the telephone. Difficulty here usually appears long before difficulty with bathing or dressing.
• Long-term care insuranceA policy that pays toward help with daily living — at home, in assisted living, or in a nursing facility — which health insurance and Medicare do not cover.
• Long-term care ombudsmanAn independent advocate for residents of nursing homes and other care facilities, who investigates complaints and works to resolve them.
• MedicaidA joint federal and state program that pays for health care, including long-term care, for people with limited income and assets.
• MedicareThe federal health insurance program for people aged sixty-five and over, and for some younger people with disabilities. It does not pay for long-term care.
• Memory careResidential care designed for dementia — secured, higher-staffed, and more expensive than ordinary assisted living.
• Observation statusBeing in a hospital bed as an outpatient, which changes what Medicare pays for afterwards.
• Respite careShort-term care that gives an unpaid family caregiver a break — a few hours, a day, or a stay of some days.
• Skilled careCare so complex that only professional or technical staff can safely provide or supervise it — the test Medicare coverage turns on.
• Skilled nursing facilityA facility providing nursing and rehabilitation care that has to be delivered by licensed clinical staff — not the same thing as a nursing home in the everyday sense.
• Spend-downUsing up income or assets on care until they fall below the limit at which Medicaid will start paying.

Official sources

The authority this page describes, at the agency that publishes it. Sahvelo does not restate a rule from a secondary source.

• Medicare — what long-term care is, and what Medicare does not pay for (opens in a new tab)

Sahvelo guidance that uses this

• Housing transitions
• Long-term care insurance