Skilled vs. Custodial Care: Not Knowing The Difference Could Cost You Thousands

Skilled vs. Custodial Care: Not Knowing The Difference Could Cost You Thousands

Every once in a while a client of ours visits our office with a hefty nursing home bill for their spouse or family member.  They want to know why Medicare didn’t cover their loved one’s stay.  After all, doesn’t Part A cover inpatient services?  The exchange usually ends with a huff of frustration:  “Medicare doesn’t seem to cover much of anything.”

I sympathize with this situation.  I really do.  But I find that their annoyance with Medicare usually subsides with a little understanding.  What they need to know is the difference between custodial and skilled nursing care, two important terms for retirees that are often used interchangeably or left unused.

So What’s the Difference?

Custodial care is non-skilled care for help with daily living. Think bathing, eating, getting up, sitting down, and going to the bathroom. This is not to say this type of assistance doesn’t take any skill. In fact, I would argue that it takes a great deal of patience, perseverance, communication and an awful lot of compassion. But this type of care can be administered safely without the help of a licensed nurse. That’s the difference.

Skilled nursing care is exactly the opposite. This type of care includes physical therapy or injections. It is delivered by registered nurses or licensed practical nurses. The driving idea is rehabilitation. They want to nurse the patients back to health, so they can take care of their daily living by themselves once again.


$ The Pocketbook Difference $

Here’s the dollars and cents difference: Medicare doesn’t cover custodial care, leaving you exposed to nursing home costs of 6000-8000 a month. However, it does cover the first 20 days of skilled nursing under part A (as long as you meet Medicare’s requirement for a skilled nursing stay).


This brings us back to our clients.

What they misunderstood was the nature of their loved one’s stay. Maybe it started out as skilled nursing care (and Medicare covered it), but transitioned into custodial care as the physical therapy or injections were no longer needed. Or maybe it was custodial care from the very beginning and their dad or brother or friend needs assistance over the long haul. Regardless, both of these scenarios resulted in overwhelming out-of-pocket costs.

The only way to combat these out-of-pocket costs is with careful planning. You can get a long-term care policy to cover custodial care. And you can get a Medicare Supplement to pick up the tab for days 21-100 for skilled nursing. It’s true that Medicare leaves a lot of gaps, so much so that it can feel like they don’t cover much of anything. But they are upfront about it, and they do deliver what they promise.

Need expert advice on Medicare? Call Seniormark at 937-492-8800 for a free consultation.



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