Does Medicare Cover Custodial Care?

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Does Medicare Cover Custodial Care?

Does Medicare Cover Custodial Care?

Certainly it does. Medicare regularly pays for custodial care in every skilled care setting for which it provides payment. Medicare will not pay for custodial care in the nonexistence of a skilled care plan.

Medicare covered nursing home stay:

A patient getting skilled care in a nursing home from Medicare not only gets care from skilled providers such as nurses, therapists or doctors but also receives care from custodial providers such as aides or CNA's. This care generally comprises of help with bathing, dressing, ambulating, toileting, incontinence, feeding and medicating. Medicare does not keep out the custodial services but pays the entire bill since custodial care is an essential part of the skilled care plan in a nursing home.

Medicare covered home care:

Custodial care is always a part of a skilled care plan for home care. The patient receives skilled care from a nurse or therapist and custodial care from an aide for help with bathing, dressing, ambulating, toileting, incontinence, medicating and probably feeding. Medicare pays for both types of services.

Medicare hospice care:

The hospital team consists of a doctor, a nurse, a social worker, a therapist when required, a counselor and an aide to provide custodial care. Help with activities of every day living is provided at home or in a Medicare approved hospice facility. Custodial care is always a part of a hospice plan of care and Medicare routinely pays for these services.

There is no such thing as a custodial nursing home. All nursing homes are by meaning skilled care facilities because they have nurses who are skilled care providers. Also be aware that not all states license intermediate care facilities which may provide less than 24 hour registered nursing care. "Skilled care patients" in nursing homes are referred to as such because they are receiving payment from Medicare or sometimes payment from private health insurance plans. Almost all nursing home residents have medical requirements but Medicare and other insurance plans will only pay for patients that have certain acute medical wants where recovery is anticipated. Patients with chronic medical problems are typically not covered by Medicare but would be covered by Medicaid.

The confusion with understanding the term "skilled nursing care" possibly comes from Medicare itself. To be a certified Medicare nursing home and receive payments from Medicare a nursing home must meet the Medicare definition of a "skilled nursing facility". This means there must be registered nurses on duty 24 hours a day, there must be a doctor on call at all times and there must be ambulance service to a local hospital.

Medicare may also involve additional staffing and facility arrangements to get certification. It is unfortunate that the word "skilled" is used in this definition. All nursing homes whether they meet the definition of a "skilled nursing facility" or not provide services from a nurse, doctor or therapist and this meets the medical definition of skilled care. Many states have adopted the same federal criteria for licensing their nursing homes. In some states the "skilled" definition is the only alternative for a nursing home. But in some states facilities with lesser services can receive different licensing classes. These may be called intermediate care facilities or "small nursing homes".

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