Custodial care: How it works, the cost, and more
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Key takeaways
- Custodial care is non-medical care for people who need support with activities of daily living, such as bathing, dressing, cleaning, and cooking.
- Custodial care is different from skilled nursing care, which focuses on medically necessary care such as medication administration, physical therapy, and wound care.
- Medicare and most private insurance does not cover the cost of custodial care unless medical care is needed.
Aging is a beautiful part of life that can come with certain considerations, especially for adult children who have begun to support their older parents and loved ones. At a certain point, many older adults may need help with activities of daily living (ADL) like bathing, eating, and grooming. While they may not need medical care, they do need help with some tasks. That's where custodial care may make sense. In this guide, we explain what custodial care is, and the different factors to think about when considering this type of care for your senior loved ones.
What is custodial care?
Custodial care is non-medical care for individuals who need help with ADLs like bathing, eating, or grooming. Custodial care comes in many forms, such as home-based care, assisted living facilities, or adult daycare centers. This daily basic care can be given by a family member or by professional caregivers, depending on what works for your family.
What do custodial caregivers do?
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Family members often act as custodial caregivers. An adult child, for instance, may visit an older parent's home daily to cook, clean, and help address the parent's hygienic needs. You can also pay for in-home care such as homemakers to attend to these household tasks or opt for a personal care aide who provides hands-on support for more intensive ADLs like bathing.
There are benefits and drawbacks to both handling custodial care yourself and hiring a caretaker. While taking custodial care responsibilities upon yourself or setting up a plan with family members is a good way to make an older loved one feel comfortable and safe with someone they know, it's a very time-consuming responsibility, and issues may arise that you don't feel properly prepared to manage. When hiring a caretaker, the inverse may be true. They're more prepared to deal with the unexpected and can take a lot of responsibility off of your shoulders, but they're likely not a familiar face and it may take some time for a senior loved one to feel comfortable with them.
The difference between custodial care and skilled nursing care
While custodial care is a type of elder care, it is not the same as nursing or medical care. Here, we break down the differences between these two types of care.
Custodial care | Skilled nursing care |
|---|---|
Non-medical care that can be safely provided by family members and other non-licensed caregivers | Medically necessary care that can only be administered by a skilled or licensed medical professional like a nurse or doctor |
Includes help with ADLs such as bathing, grooming, and dressing as well as help with household tasks like cleaning, cooking, and shopping | Includes administering medication, physical therapy services, IV injections, and wound and injury care |
Can be provided at home or in a long-term residential facility such as an assisted living or nursing home | Can be provided by in-home medical care providers or at a long-term care facility such as a nursing home |
Not typically covered by private insurance or Medicare. May be covered by Medicaid if provided in a nursing home and not at home | May be covered under specific conditions by Medicare or covered by Medicaid depending on state requirements |
Custodial care is focused only on non-medical care, which is an important distinction from nursing care. Unlike skilled nursing, custodial care does not involve medical services like administering medication, wound care, or physical therapy. While you might remind a parent to take their medication, you shouldn't administer medications unless you’re licensed to do so.
Another difference between custodial care and skilled nursing care is that custodial care tends to be long-term. Skilled nursing care is typically for people with prescribed medical needs to manage a disease or recovery from surgery.
How much does custodial care cost?
Custodial care can be very expensive, so it's important to discuss these costs as a family before your senior loved one needs to pay them. Proactive planning can help ease the financial cost should your family need paid custodial care support. The national median cost of custodial care is:
Homemaker services: $5,892 per month
Home health aides: $6,481 per month
Adult daycare: $2,120 per month
Costs vary based on the type of care required and location. Generally, areas where the cost of living is higher will have higher custodial care costs. Non-medical care is still less expensive than medical care like skilled nursing. These costs can add up quickly, so it's important to discuss finances with your family and loved ones to create a plan before someone needs custodial care.
Does insurance cover custodial care?
Custodial care is not typically covered by standard health insurance plans or Medicare.
However, many insurance providers offer long-term care (LTC) policies to cover the cost of custodial care and other elder care or recovery costs. It's important to note, though, that LTC policies can be expensive since insurance companies know that you plan to use them eventually. Moreover, you must get an LTC policy before requiring custodial care. It's like a pre-existing condition — if your senior loved one is already in custodial care, they’re ineligible to receive an LTC policy.
A few other options to support the cost of custodial care include:
Medicaid: The state-sponsored health insurance program offers custodial care coverage for individuals who meet income requirements as long as the care is provided in a facility such as an assisted living or a nursing home.
VA: The Department of Veterans Affairs (VA) offers programs like the Veteran-Directed Care program and the Aid and Attendance benefit to cover some custodial care costs for eligible veterans.
The cost of custodial care can be significant, especially if it's needed for a long time. It's essential that your family aligns on both a care plan and a financial plan before a loved one needs long-term care. You may use a loved one's own pension or retirement funds or opt to pool family assets to contribute to the cost of a care plan.
Making the decision about custodial care
Embarking on custodial care is a major milestone for any family. It's a good idea to approach the topic with sensitivity and understanding so that you can develop a custodial care plan that puts your senior loved one's needs first.
While this guide is a good introduction to custodial care, consulting expert care managers and your loved one's doctors to create the best plan for your family is part of a smart, proactive plan. You can also check out Greenlight's family resources for additional guidance in planning for care needs.
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