About Custodial Home Care

The National Clearinghouse for Long-Term Care Information, a website developed by the U.S. Department of Health and Human Services, estimates that more than 70 percent of people aged 65 and over will eventually need long-term care. While traditional health insurance and public programs cover medically necessary care, they don't pay for custodial care. People wanting such services must rely on benefits from a long-term care insurance policy or pay for it themselves.

Background

• Custodial home care refers to nonmedical, routine services performed by health aides or unskilled health care workers within a patient's home. Custodial in-home care providers generally need not undergo formal medical training unless employed by agencies that receive federal or state funding or if their employers require them to do so, according to the U.S. Bureau of Labor Statistics. These workers do receive on-the-job training to meet the specific health needs of their clients -- such as wound care and administering medicines. They also handle non-health related needs, such as meal preparation, bathing, medication reminders, errands, light housekeeping and companionship.

Benefits

• Home custodial care makes it possible for aging and/or semi-functional individuals to remain in their own homes comfortably, and can give the patient or the patient's family or guardian more influence in the patient's care. As in-home caregivers provide companionship, they also serve as an important psychological support to patients, the labor bureau points out.

Costs

• Although custodial home care costs less than custodial care provided in a skilled nursing home facility, public long-term care programs such as Medicare may only pay for custodial home care if coupled with medically necessary care, and even then the approved hourly allotment of that care is usually limited. Medicaid generally reserves its coverage of custodial home care services for the most financially and functionally needy individuals. Both Medicare and Medicaid pay for custodial care provided by skilled-nursing facilities on an inpatient basis.

Insurance

• Long-term care insurance policies supplement costs not covered or limited by public programs. Such insurance covers custodial home care services in an assisted-living facility, nursing home, acute hospital setting or private home. The National Clearinghouse for Long-Term Care Information explains that premiums vary based on the insured's age, the range of services covered and whether the insured selects add-on benefits such as inflation protection.

Hiring

• Custodial home care workers -- also known as unskilled health workers -- can be hired privately or through agencies that take care of payroll, tax and recruiting of staff as well as background checks and scheduling. The Family Caregiver Alliance cautions that patients or their families planning to hire health aides directly should be prepared to handle the legal, verification and tax-withholding tasks associated with hiring a household employee.