2024 Guide to Custodial Care

What Is Custodial Care?

How much does companion care cost?

Custodial care is a popular form of long-term support that helps older adults who need non-medical assistance on a daily or ongoing basis. Those who serve in this capacity don’t need a medical background, official training, or certifications. You can receive custodial care in a range of facilities, including at home through in-home senior care or at adult day care centers, assisted living centers, and residential care facilities.

What Do Custodial Caregivers Do?

Custodial caregivers for seniors perform basic duties. They are there to help your loved one mostly with activities of daily living (ADLs), such as showering, dressing, and going to the bathroom. These caregivers will often do light housekeeping and run errands for their charges, too.

According to long-term care policies, custodial care in a home setting means non-skilled (or non-medical) workers are in the home to provide help with ADLs as a long-term service. The goal is to help seniors with everyday tasks, like moving them into a bed or transferring them to a wheelchair, actions they can no longer do or have difficulty completing themselves.

Custodial caregivers work in all kinds of senior facilities but most often work in the homes of seniors who want to age in place. The in-home care option has become increasingly popular. You might hear professional caregivers referred to as homemakers (they manage the home) or personal care aides/assistants (they provide personal care and companionship, but not health care). These are two of the most common types of nonmedical home care services.

When contacting an agency, it’s important to know the difference between the types of custodial caregivers. Remember that homemakers focus on running the household: grocery shopping, doing laundry, housekeeping, and arranging transportation for appointments. Personal care aides (PCAs) are hands-on. They focus more on helping with ADLs and the personal care of the whole human being. PCAs do assist with housekeeping, meal prep, and errands too.

So, who uses these services? Senior beneficiaries of custodial care typically have a chronic condition. Or they might be recovering from a stroke or an illness. The in-home assistance from a professional caregiver can make daily life much more comfortable. Custodial caregivers are invaluable to seniors and their families, even if they work on a part-time or short-term basis. They often give much-needed respite for primary caregivers. In most households, the primary caregivers are also juggling other responsibilities besides care for their loved one.

Custodial Care vs. Skilled Nursing Care

As discussed above, custodial care is conducted by those who are not trained to address the health and medical needs of their senior clients. Custodial caregivers focus on taking care of the fundamental everyday activities and needs of seniors so they can live their life safely and comfortably.

Having a professional caregiver dress your loved one, prepare a nice lunch for them, and watch a movie with them also creates feelings of companionship and emotional well-being in the older adult. For isolated seniors who may be battling loneliness, these interactions can actually prevent further risks to their health and mitigate an earlier death.2

Caregivers with medical training, however, cannot be overlooked and can be essential for older adults. Let’s say your relative needs medication dispensed, wound care, physical therapy, intravenous injections, or help with their catheters. You will need someone with credentials and the expertise to assist with that on a regular basis.

Patients commonly choose skilled nursing care when they’re recovering from a short-term medical issue, dealing with complex medical issues, or living with chronic pain. Many also benefit from skilled nursing when it comes to end-of-life care or palliative care.

Skilled nursing professionals are medically trained and licensed, and work under the supervision of a team of medical providers. These professionals include:

• Certified nursing assistants (CNAs)
• Licensed practical nurses (LPNs)
• Registered nurses (RNs)

Registered nurses, who have the most education and responsibilities, have either an associate’s degree in nursing or a Bachelor of Science in nursing. RNs also work in areas of specialized care and with terminal patients.

Agencies often employ home health aides (HHAs) to work in the homes of seniors. Depending upon the state, some home health aides (HHAs) are allowed to administer medication and take vital signs working under the direction of a health care practitioner. Home health aides help seniors with daily living, provide companionship, and can accompany patients to doctor visits. HHAs usually get certified through a training program and do clinical work. An HHA works with seniors who need constant care, going beyond the services a PCA can provide. The level of care they provide differs from what a nurse provides. A CNA, LPN, or RN can assist seniors with medical tasks more than an HHA and can work with patients who have more severe and complex conditions.

The Cost of Custodial Care for Seniors

If you or your loved one has determined that a non-medical custodial caregiver will suffice at this time, answer the questions below. That way, you’ll have a better idea about how you want to go about the search and your requirements before contending with the costs.

• Will you be using an agency or hiring an individual yourself? Agencies cost more, but they do all the legwork to ensure that they employ quality caregivers.
• Will you be seeking in-home care, adult day care, or an assisted living/residential community?
• Will the assistance be part time, full time, or on an as-needed basis?
• If hiring an individual on your own, will you plan to offer bonuses and raises?
• Where do you live? Of course, the higher the cost of living in your area is, the more care is likely to cost.
• Does the beneficiary suffer from memory loss, have mobility issues, or another condition that calls for more in-depth caregiver experience?

While many considerations will factor into the final cost of custodial care, here are the national median costs for 2024 of custodial care providers for seniors:3

• Homemaker non-medical provider: $5,892 per month
• Home health aide: $6,481 per month
• Adult day care: $2,120 per month (depending upon hours)

While not commonly utilized for non-medical custodial care situations, some seniors opt to start with these options to maintain continuity of care. These are the median costs associated with facility-style living arrangements.

• Assisted living facility: $5,511 per month
• Semiprivate room nursing home care: $8,929 per month
• Private room nursing home care: $10,025 per month

How to Pay for Custodial Care

There are many ways to pay for or supplement the costs of custodial care.

Those with traditional health insurance plans may have benefits available for informal caregivers that provide custodial care. You will need to check your policy carefully to determine whether they offer this coverage, as many reimburse only costs associated with skilled nursing care.

Medicare: Medicare typically doesn't cover custodial care benefits, but it may for a short period (100 days or less) if it is combined with skilled medical care that is prescribed by a physician. When used in unison with private insurance, Medicare can be a useful supplement in certain situations.

Medicaid: You must meet strict financial requirements to qualify for state-administered Medicaid services to pay for custodial care. This program typically requires that beneficiaries be under care within an approved facility, such as a nursing home or assisted living. While benefits vary from state to state, some will cover adult day care and homemaker services for seniors who qualify.

Long-term care insurance: Long-term care insurance (LTC) is one of the best options for paying for senior custodial care, especially when combined with supplemental Medicare coverage. These fixed-priced policies vary in coverage but often provide reimbursement for care for several years.

Veterans may be able to use their government benefits to cover all or part of custodial care, especially within VA hospital settings or within the home.

SSI disability recipients may also qualify for certain benefits. However, most individuals inquire about Medicare, Medicaid, and long-term care insurance coverage for custodial care.

Where Can I Find Custodial Care Near Me?

You can find your local options for custodial care using our directory or by simply giving us a call on our helpline. We are happy to answer any questions you may have about custodial care and help you as best as we can.

It’s also a good idea to ask for recommendations from your doctor, friends, and family. If someone you know already has a custodial caregiver whom they love and trust, they might be a great fit for you as well!