When Texas families research the differences of care available to their aging loved ones, two come to mind that are used by the medical community, health care plans, health insurance plans, and Medicare, Medicaid, and the Veterans Administration. The two are custodial care and skilled care.
Custodial and Skilled Care are different in the sense that one is used when care is provided by medical specialists as opposed to care provided by aides, volunteers, family or friends. The use of these terms is important when families are determining whether a health care plan will pay for services or not.
Just so you know, skilled services are paid for by a health care plan and custodial services are not covered, if custodial care is not associated with skilled services. But the custodial services are “almost always” a part of a skilled service plan of care when included, custodial services are paid by the health care plan as well. Many people have the misconception that only skilled services are covered. In a lot of cases, this is simply not true.
American College of Medical Quality says, ” Skilled care is the provision of services and supplies that can be given only by or under the supervision of skilled or licensed medical personnel. Skilled care is medically necessary when provided to improve the quality of health care of patients or to maintain or slow the decompensation of a patient’s condition, including palliative treatment. Skilled care is prescribed for settings that have the capability to deliver such services safely and effectively.
Custodial care is the provision of services and supplies that can be given safely and reasonably by individuals who are neither skilled nor licensed medical personnel. The medical necessity and desired results of skilled care must be clearly documented by a written treatment plan approved by a physician. A patient may have skilled and custodial needs at the same time. In these circumstances, only those services and supplies provided in connection with the skilled care are to be considered as such. The treatment plan must include:
• The applied therapies;
• The frequency of the treatment which is consistent with the therapeutic goals;
• The potential for a patient’s restoration within a predictable period of time, if applicable;
• The time frame in which the prescribing physician will review the case for the purpose of evaluating a patient’s status and before reassessing the medical necessity of ongoing treatment; or
• The maintenance, palliative relief, or the slowing of decompensation in a patient’s status, if applicable.
For help on understanding and seeking advice from professionals who deal with these issues, contact WorkingCaregiver.com or email Carol@WorkingCaregiver.com. Visit Long Term Care Link for more information on these matters.
