What’s Custodial Care? Definition, Pros & Cons

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

In some ways, the term custodial care carries a connotation of assistance that isn’t as valuable as other forms of care. Nothing could be further from the truth. Custodial care is the foundation of care that encourages and allows older adults to remain as independent as possible for as long as they can.

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The nature of healthcare across the US can be disjointed and confusing. Moreover,  “unskilled” workers perform custodial care, many of whom are underpaid and undervalued. In fact, custodial care workers are found in all facets of healthcare. Without them, patients and clients would have to rely primarily on the family to care for them at home or more expensive skilled workers in healthcare settings.

Let’s explore what custodial care means, how to access it, and the ways it contributes to the well-being of clients and their families. 

Definition of Custodial Care

The word “custodial” comes from the word “custodian,” defined as “relating to, providing, or being protective care or services for basic needs.” Simply put, custodial care is non-medical care given to a person who cannot perform activities of daily living on their own due to illness, accident, dementia, or some other impairment. 

Skilled care, by contrast, must be provided under the supervision of licensed and trained medical professionals, often under a physician’s orders. Examples of skilled care are nursing and speech, occupational, and physical therapy. Custodial assistance can be short-term or long-term, depending on the needs of the patient. 

Is there a difference between caregiving and custodial care?

Caregiving is a broad term that can apply to anyone providing support and care to another person. A caregiver can give custodial care or medical care. Family members provide most caregiving in the US. Family caregivers do custodial care, but they are increasingly required to complete some medical tasks, as well, when no one else is available. 

Custodial care workers are often referred to as caregivers, but as non-family members, they are not permitted to perform any medical tasks.  

Are There Different Types of Custodial Care?

There aren’t necessarily different types of custodial care, but there are other settings where custodial care occurs. 

Nursing homes

Custodial care is a significant part of the services in a nursing home. Custodial care workers help patients with their activities of daily living, such as bathing, dressing, and mobility.

Assisted living

Assisted living communities offer custodial care for an additional cost to the resident. Some communities have a tier system of care, and others charge by the service the staff person provides. The availability of custodial care is one reason families choose assisted living for their loved ones.

Adult daycare

Adult daycare, which provides daily respite for seniors and their families, often offers custodial care. A participant might need help with ambulation, getting to the bathroom, or assistance with eating.

Residential or board and care homes

Board and care homes have fewer amenities and support services than assisted living, but they do typically offer custodial care. Most people who choose board and care homes have a few personal care needs but don’t require nursing care.

Examples of Custodial Care

Although custodial care is non-medical, there are a host of tasks that help adults live more independently. Many of these activities we take for granted each day if we can do them without assistance.

Bathing

Safety in the bathroom is a concern for people who aren’t able to bathe independently. Custodial care involves assisting adults by either standing by or helping with bathing in a shower chair. 

Dressing

For someone with a broken arm, shoulder, or lower extremity injury, getting dressed is challenging. Custodial care workers can assist with this activity. Your loved one may have dementia and be unable to select appropriate clothing, and custodial care can help.

Hygiene

Hygiene involves shaving, brushing teeth, washing hands, and wearing a mask when appropriate. 

Cooking and eating

Cooking and eating are fundamental skills. Some people are unable to cook due to cognitive impairment or physical constraints. If your loved one is on a special diet like pureed, custodial care involves ensuring that the person follows the proper diet. Others may need help with the physical part of eating, such as cutting up food. 

Shopping

If someone doesn’t drive, they need a person to shop for food and other essentials. Injury, sight impairment, or dementia are some of the reasons people stop driving. 

Cleaning

Housekeeping and keeping the home environment safe and clutter-free are custodial duties. 

Transportation

Custodial workers can provide transportation to doctor’s appointments or preferred activities. 

Companionship

Companionship is often an underappreciated component of custodial care. Loneliness and social isolation can plague a person who is confined to their home. Custodial caregivers can offer companionship and socialization and also help adults access activities that are valuable to them.

Who’s Custodial Care Typically For?

The situations where custodial care can help are almost endless. As people age, they are more prone to chronic diseases and general decline related to accidents or illnesses. Recovery from these conditions can take longer. Here are some of the typical needs and situations that call for custodial care.

Falls

Falls are the leading cause of death and injury in adults over the age of 65. The typical injuries caused by falls are broken bones or head injuries. If you know an older adult who has broken their hip, you understand how debilitating it is. Even with extensive rehab, some people struggle to perform their activities of daily living when they return home. Custodial care is a critical part of helping people continue to recover safely. 

Alzheimer’s and dementia

Cognitive impairment can have devastating effects on older adults and their families. Most forms of dementia are progressive, leading to increasing difficulty in functioning safely. People with cognitive problems struggle with judgment, organization, wandering, driving, and a host of other activities of daily living. Custodial care can be a critical component of care for these individuals. 

Chronic medical conditions

Chronic medical conditions like heart disease, kidney disease, arthritis, and cancer can lead to gradual decline and difficulty with daily activities.

Stroke and neurological disorders

Individuals who have had a stroke often have permanent disabilities, including weakness, speech, and comprehension problems. Neurological conditions like Parkinson’s, Multiple Sclerosis, and ALS contribute to progressive challenges managing activities of daily living. Custodial care can assist with safe mobility and transfers. 

How Much Does Custodial Care Cost?

Medicare does not cover most custodial care unless the care is included in skilled nursing, home health, or other insurance-covered services. Medicare does not cover in-home custodial care. Medicaid will cover custodial care in nursing homes and, in some cases, home care through a state-approved program.

The only other source of payment for custodial care in the home is long-term care insurance. Coverage depends on the specific policy, but it’s possible to have a plan that covers a maximum amount each day.

If none of these options are available, and for most families, they aren’t, private pay is the only way to pay for custodial care. The hourly cost of custodial care depends on several factors:

  • How many hours you need. The more hours, the higher the cost, although the actual hourly rate might be lower the greater the number of hours you contract for.
  • Hiring through an agency vs. private hire. If you hire someone privately, the price you pay is negotiable. If you hire through an agency, the price is not negotiable. The median hourly cost of care in 2021 is $23.50 an hour. 
  • Where you live. There’s no national standard for the cost of custodial care. You could live in a state where care costs are higher or lower than the average national rate. 

Pros and Cons of Custodial Care

As with any healthcare, custodial care has pros and cons, which is complicated by state regulations, cost of care, and lack of insurance coverage. Having as much familiarity with other options will help you make the best decisions for care for your loved one. 

Pros of custodial care

  • Custodial care helps individuals stay in their homes for as long as possible.
  • Custodial care does not require a doctor’s order.
  • Custodial care is flexible, and you can have as few or as many hours of care that you need.
  • Custodial care can take the stress off of family caregivers by providing relief.
  • Custodial care can help people recover safely from accidents or illness and prevent further decline.

Cons of custodial care

  • Insurance doesn’t cover custodial care except in specific circumstances.
  • Custodial care can get expensive if you need many hours of help a week
  • Custodial care as a service sector struggles to employ and retain workers. Turnover is a persistent problem due to low wages and the physical demands of the work. 
  • If you and your family rely on custodial care, you may experience a turnover of caregivers. 
  • Custodial care can not offer any medical services, which could leave your loved one with few options except time-limited home health. Complex medical needs are one of the areas that lead families to consider assisted living or, in other cases, nursing home care. 

Custodial Care

The demand for custodial care will continue to grow in all facets of healthcare. Finding good custodial care can mean the difference between aging in place and institutional care. Talk with your loved one about the benefits of custodial care sooner rather than later. Their independence may count on it. 


Sources:
  1. “Custodial.” Mirriam-Webster Dictionary. merriam-webster.coml
  2. “Keep on Your Feet-Preventing Older Adult Falls.” Centers for Disease Control and Prevention. cdc.gov
  3. “Cost of Care Survey.” Genworth. genworth.com
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