In-home caregiving help enables many seniors to safely live at home longer. In-home care agencies, referral agencies, placement agencies, and home health agencies can help you find the assistance you need.

Care in the home is divided into two types, skilled and custodial. It’s important to understand this distinction, as it will determine where you find assistance as well as the reimbursement and payment options.

Skilled Care

Skilled care is usually provided by licensed professionals such as nurses, physical therapists, and occupational therapists. The category may also include social workers, some laboratory services, medical services, and equipment. These services, deemed “medically necessary,” are often needed when a patient returns home from the hospital or experiences a significant change in health status.

Medicare pays only for skilled care, not custodial care. The care must be intermittent, the individual homebound, and the care ordered by a doctor. The services must be provided by a Medicare-certified home health agency.

If all these criteria are met, Medicare will pay for home health care services and 80 percent of pre-approved durable medical equipment. In addition to care from licensed professionals, limited personal care by a home health aide may be covered by Medicare.

Custodial Care

Custodial care includes help with activities of daily living such as eating, dressing, bathing, toileting, and transferring to or from a chair or bed. It may also involve companionship and supervision for a person with a cognitive impairment, as well as tasks like shopping, light housekeeping, and laundry.

Custodial care doesn’t require the skills of a nurse or other licensed professional—instead, it’s typically provided by paraprofessionals such as companions or home health aides. Although it is not considered “skilled or medically necessary” care, it may be required for a person to safely remain in their home or live independently.

Custodial care is not covered by Medicare or most private health insurance. It is paid for by the individual or family, some long-term care insurance and, for those who qualify, Medi-Cal.

Custodial Care: Key Questions to Ask

To figure out whether a particular agency will meet your custodial care needs, consider the following questions:

  • Is the agency licensed, and if so, by whom?
  • Do they provide a detailed care plan to the worker, with a copy to the family?
  • Do they require a minimum number of hours of care per day?
  • Are their caregivers trained to work with chronically ill or memory-impaired individuals?
  • What specialized training do their workers receive?
  • Is their agency bonded? Are their workers bonded?
  • How long has the agency been in business in this area?
  • What are the fees? Do they offer a sliding fee scale for lower-income individuals?
  • Are there any additional costs for items such as travel or a home assessment?
  • How often do they bill?
  • Who is responsible for the worker’s Social Security, Medicare, and federal tax deductions?
  • Who supervises the caregiver and how often?
  • How do they handle complaints?
  • Can they provide a substitute caregiver if the usual caregiver is unable to work?
  • How do they handle emergencies in the home?
  • How do they safeguard client confidentiality and possessions?
  • What screening process do they use when hiring workers?
  • Do they perform a criminal background check or require references?
  • Do they provide references from current clients?
More Guidance

Get more guidance about working with a paid caregiver. For additional information about finding caregiving help, call John Muir Health Senior Services at (925) 947-3300.

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