Skilled Care vs. Personal Care

Long-term care consists of skilled and non-skilled services and supports. Non-skilled services are often referred to as personal, or custodial, care. There is a big difference between skilled care and personal or custodial care in terms of who provides care, how care is initiated, the goal of care and how care is paid for.

VariableSkilled CarePersonal or Custodial Care
ProviderPhysicians, nurses, physical, occupational, speech and respiratory therapists, medical social workers and other professionalsCertified nursing assistants, home health aides, homemakers, caregivers, family
Care InititationMust be ordered by a physicianPhysician’s order is not necessary to initiate care unless it is included in an order for skilled care on a short-term basis
Goal of CareSpecific goals are established for improvement or maintenance of function; once these goals have been met, skilled care endsOngoing assistance with ADLs and IADLs to help the individual maintain the highest quality of life possible
PayerMedical insurance, Medicare, Medicaid, Veteran’s AdministrationPrivate pay, Medicaid, long term care insurance, Medicare*, veteran’s benefits and/or pension, some employer medical insurance plans

Medicare and Personal or Custodial Care

Medicare is medical insurance for those over 65, the blind and the disabled. Personal, or custodial care, is non-medical care. Medicare does not cover ongoing custodial care but will cover some personal care on a short-term basis when ordered by a physician in conjunction with skilled care or under hospice care.