Skilled Care vs. Custodial or Long-term Care

It isn’t unusual for families to feel confused about the different types of care that their loved ones may need when entering a care facility. The words used for different types of care are similar. Understanding the differences between different types of care and how that care is funded can be very helpful when making plans for a loved one’s care.

When a loved one receives therapy in a nursing home, that service is typically referred to as skilled care. Skilled care is care that requires a skilled person to provide it, such as therapies or nursing.  Examples of skilled care include physical therapy, occupational therapy, speech therapy, and wound care.  Once a patient has reached the end of his or her skilled care, he or she either goes home or stays in the nursing home under custodial care.

Custodial care is not skilled care.  Custodial care is for residents who have difficulty with activities of daily living (ADLs) or instrumental activities of daily living (IADLs).  ADLs include things a person does related to his or her own body such as getting up out of a chair, bathing, dressing, eating, etc. IADLs include activities a person does to take care of him or herself that are “outside” of his or her own body. These include managing finances, doing laundry, driving, shopping, and preparing meals. The IADLs require a higher level of problem-solving and planning than the ADLs and are often the first functional abilities to go when a person becomes sick.

There are also differences in the coverage of costs associated with skilled care and custodial care. For example, Medicare may pay up to 100 days of skilled care. On the other hand, Medicare does not cover any of the cost of custodial care.  Custodial care is paid out of pocket (sometimes referred to as “private pay”), through long-term care insurance, or through public benefits such as Medicaid or Veterans’ benefits.  It is important for families to understand the differences in types of care and how costs are covered so they can make informed decisions about where their loved one will reside after skilled care ends.

At first glance, up to 100 days of paid skilled care can seem like plenty of time to make decisions about where a loved one will receive custodial care.  Therefore, families sometimes delay making a decision. But it’s important to understand that the process for applying for public benefits takes time, and those 100 days can pass quickly, leaving families with difficult options.  Typically, the facility social worker will approach the resident or his or her health care agent to talk about long term placement decisions.  Before having this conversation, it is a good idea to investigate available options and develop a plan.  The sooner planning begins, the less likely the family will be blindsided by unexpected care expenses that rack up quickly and gobble up savings.

Remember that Elder Law of East Tennessee can help guide families through this decision-making process.  If you or a loved one are in need of assistance with determining the level of care needed or seeking benefits to cover the cost of care, please give us a call to start learning about your options.

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