Jeanette is 86 years old and has recently lost her husband, Bob, of sixty years. Although increasingly difficult with age, Jeanette would help Bob with his daily needs by feeding, dressing, and bathing him, and each day their adult children would stop by to help him get out of bed, move to the kitchen table, then to his recliner, and back to the bed in early evening. Over the last five years, as more help was needed than what the family could provide, Jeanette watched from her wheelchair as Bob received in home, custodial care to help him function through his Parkinson’s disease. Now that Bob is gone, Jeanette is alone and her own need for daily custodial care services is heightened by her deteriorating eyesight, her limited mobility from past hip surgery, her poor hearing, and the natural challenges of simply getting old. The scenario is familiar to many families. As seniors get older, the need for daily, routine care is inevitable, so preparation is important. Here’s what you need to know about custodial care, what differentiates it from skilled care, and how to pay for it.
Like Bob and Jeanette, as seniors age their health deteriorates, making it difficult to function without some form of assistance. Medical, physical, or mental conditions make it difficult for seniors to perform daily tasks, resulting in the need for custodial care, also known as long term care (LTC). As Jeanette transitions into her new life of being alone, she is faced with the reality of not being able to perform common, everyday tasks. As her family cannot provide her with daily care, they must implement custodial care. Custodial Care is long term care that is non-health related or non-medical care that provides support with activities of daily living (ADLs), both “basic” and “instrumental” (Hoyt, “Activities”). Examples of custodial care activities include help with brushing teeth, getting dressed, cooking, eating and bathing, doing laundry, managing medications and money, administering eye drops, cleaning the house, using the toilet, getting in and out of bed, moving around the house, ordering groceries, using the telephone or computer, etc. Provided by non-licensed caregivers—caregivers with no medical or nursing training—custodial care is an extremely important help for seniors to live safely and independently, whether the personal care is administered in the home, in an adult day care or assisted living center, or in a custodial care facility such as a nursing home. These custodial care facilities (CCFs) not only take care of patients’ ADLs, but they also provide social interaction, exercise and educational opportunities, and recreational activities.
Skilled nursing care is distinguishable from custodial care by its requirement to be physician-directed and delivered by clinically trained medical professionals to achieve safe and effective medical care. Registered nurses (RNs), certified nursing assistants (CNAs) and licensed vocational nurses (LVNs) fall into this category, as well as respiratory, physical, occupational, and speech therapists. Skilled nursing care is often given to patients recovering from surgeries or accidents and who have short term medical, or patients who may need end-of-life or palliative care. These services are considered to be skilled care because they must be performed by clinically trained medical providers, whereas custodial care tasks, by their nature, can be performed by trained, non-medical personnel. Skilled nursing care is often provided by medical professionals in Hospital-Based Skilled Nursing Facilities (HBSNFs), Skilled Nursing Facilities (SNFs), or Intermediate Care Facilities (ICFs).
It is expected that 10,000 baby boomers a day (through 2029) will turn 65 (Hoyt, “Baby Boomers”), and 70% of those will require long term, custodial care in their lifetime (longtermcare.acl.gov). The inevitability of this type of care is sobering, as is the cost. In 2019, the cost for 56 hours of home care per week (8 hrs./day and 7 days/wk.) averaged approximately $5500 per month, or $66,000 per year, and this cost is expected to rise to $89,000 per year by 2029 (genworth.com). Custodial care is expensive, and it is important to note that it is usually not covered by health insurance, and though one may have Medicare coverage, neither Medicare Part A nor B pays for any type of custodial care, only skilled nursing care under certain conditions. Also, most Medigap and Medicare Advantage (Medicare Part C) insurance plans do not cover custodial care. Medicaid may pay for custodial care only if the care is provided in a nursing home and only after out-of-pocket assets have been depleted, and some veterans may find limited custodial care coverage through the Veterans Administration. With this in mind, unless one has the private funds to pay for custodial care, long term care insurance (LTCI), not to be confused with health insurance, may be the best option for most people. For Bob and Jeanette, they began investing in monthly, long term care insurance when they were 65 and 60 years old. Premiums were fixed and predictable, and when the time came, they were both able to get the custodial care they needed and get reimbursed for all of their out-of-pocket expenses.
As Americans get older, the need for routine, daily care services are inevitable. Custodial care is a long-term necessity that helps seniors to live safely and independently during their final years, and understanding the essentials will help you to be prepared and to plan accordingly.
Genworth.com. “Cost of Care Survey 2019.” Accessed on May 11, 2020.
Hoyt, Jeff. “Activities of Daily Living (ADLs).” Seniorliving.com. August 16, 2018. Accessed on May 11th, 2020.
---. “The Baby Boomer Generation.” Seniorliving.com. March 13, 2020. Accessed on May 11, 2020.
---. “Nursing Home Costs.” Seniorliving.org. June 22, 2019. Accessed on May 11, 2020. https://www.seniorliving.org/nursing-homes/costs/
Longtermcare.acl.gov. “How Much Care Will You Need?” October 10, 2017. Accessed on May 11th, 2020.