Estimates by experts are that at least 60% of all individuals will need extended help of some type in one or more of the areas above during their lifetime.
Long-term care grew more expensive again this year, with the cost of the priciest option, a private nursing home room, edging closer to $100,000 annually, according to a survey from Genworth Financial.
Custodial Care versus Skilled Care
Custodial care and skilled care are terms used by the health care plans and the medical community just as health insurance plans, Medicaid, Medicare and the Veterans Administration. They are used primarily to differentiate care provided by medical specialists as opposed to care provided by family, friends, aides, volunteers. The use of these terms and their application is important in determining whether a health care plan will pay for services or not. Generally, skilled services are paid by a health care plan and custodial services, not in conjunction with skilled care (are not covered). However, custodial services are almost always a part of a skilled service plan of care and by being included, custodial services are paid by the health care plan as well. Many people have the misconception that only skilled services are covered. This is simply not true.
Please remember that the terms skilled and custodial do not refer to specific types of long-term care services but rather who delivers those services. This may include the delivery of skilled services must be done under a written plan of care which often includes custodial care services.
Does Medicare Cover Custodial Care?
Yes. Medicare routinely pays for custodial care in every skilled care setting for which it provides payment. Medicare will not pay for custodial care in the absence of a skilled care plan.
Medicare covered nursing home stay
A patient receiving skilled care in a nursing home from Medicare receives care from skilled providers such as nurses, therapists or doctors. The patient also receives care from custodial providers such as aides or CNA's. This care usually consists of help with dressing, bathing, ambulating, toileting, incontinence, feeding and medicating. Medicare should not exclude the custodial services but should normally pay the entire bill because custodial care is a necessary 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, toileting, ambulating, incontinence, medicating and sometimes feeding the patient as well. Medicare should pay for both types of services.
Medicare hospice care
Hospice staff normally consists of a doctor, a nurse, a social worker, a therapist when needed, a counselor and an aide to provide custodial care. There is help with activities of daily 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.
Please note that there is no such thing as a custodial nursing home. Nursing homes by definition are skilled care facilities. Due to the fact they have nurses who are skilled care providers. Not all states license intermediate care facilities which might provide less than 24 hour registered nursing care. In nursing homes are considered "Skilled care patients" because they are receiving payment from Medicare or sometimes payment from private health insurance plans. Practically all nursing home residents have medical requirement needs, but Medicare and other insurance plans will only pay for patients that have certain acute medical needs where recovery is anticipated. Patients with chronic medical problems are typically not covered by Medicare but should be covered by Medicaid.
At Knappmann Law our experienced Estate Planning & Elder Law Division team can provide immediate help by providing legal knowledge, guidance, and relief to seniors and their families when a senior needs long term care. We can walk you through your many affordable options and customize an appropriate plan for the senior members of your family. Give us a call today for a free consultation.
About Long Term Care
Seniors may need long term care in the such as medical, housekeeping, personal hygiene, social rehabilitative services, rehabilitative services. Long term care may be provided in a nursing home, assisted living facility or as in-home care for an elderly person. In some cases, benefits may be provided for long term care through Medicaid, Medicare or Social Security. In the state of Michigan, one may also purchase long term care insurance.
What type of care does long term care include?
When a person requires someone else to help him with his physical or emotional needs over an extended period of time, this is long-term care. This help may be required for many of the activities or needs that healthy, active people take for granted and may include such things as the following:
Providing comfort and assurance
Providing physical or occupational therapy
Attending to medical needs
Regular Balanced Meals & Feeding
Answering the phone
Meeting doctors' appointments
Using the bathroom
Helping with incontinence
Preventing unsafe behavior
Maintaining the household
Shopping and running errands
Attending to personal hygiene
Helping with personal grooming
Writing letters or notes
Making repairs to the home
Maintaining a property
The need for long term care help might be due to an illness, injury terminal condition, disability, or the infirmity of old age. Estimates by experts are that at least 60% of all individuals will need extended help of some type in one or more of the areas above during their lifetime. The need for long term care may only last for a few weeks or months or it may go on for years. Planning for the unexpected is comforting and economical.
Temporary long term care (need for care for only weeks or months)
Recovery from surgery
Recovery from injury
Rehabilitation from a hospital stay
Recovery from illness
Terminal medical condition
Ongoing long term care (need for care for many months or years)
Chronic medical conditions
Chronic severe pain
Ongoing need for help with activities of daily living
Need for supervision
Long-term care services may be provided in any of the following settings:
In the home of a family member or friend of the recipient
In an assisted living facility or board-and-care home
In a hospice facility
In a nursing home
In the home of the recipient
At an adult day services location