Long-term care is the variety of services given to people who need personal care for an extended period of time. It’s different from basic health care, and it’s normally not covered by most health insurance policies. There are two kinds of long-term care: custodial care and skilled nursing care. Most patients, including those with dementia and Alzheimer’s, will only need custodial care.
What is Custodial Care?
Custodial care (also called personal care) involves help with basic everyday activities, also known as Activities of Daily Living (ADL’s). Custodial care is non-medical in nature, so it does not require a skilled nursing staff. It can be given by paid caregivers, volunteers, and family members. Helping patients fulfill their basic needs is an important first step in giving them a sense of independence and self worth. Examples of ADL’s are:
- Walking and wheelchair assistance
- Using the toilet
- Preparing and eating meals
- Paying bills
- Remembering to take medication
Where is Custodial Care Given?
Homes: Care is given by caregivers or family members. Most patients prefer to receive care at home because they are able to live more independently. The home can be the patient’s residence or a family member’s residence.
Communities: Examples include adult day cares, retirement communities, and senior housing centers. Like home-based care, communities offer patients an independent living style.
Facilities: Examples include assisted living facilities (also called retirement homes) and residential care facilities (also called personal care homes or family homes). Facilities offer higher levels of care by skilled caregivers, including 24-hour service.
What is Skilled Nursing Care?
This type of care is medical in nature, and is given by a skilled nursing staff made up of registered nurses, certified nurse assistants, and licensed vocational nurses. They are trained to provide medical care, such as:
- Diabetic care
- Vitals monitoring
- Feeding tubes
- Care before and after an operation
- Rehabilitation and therapy
- Wound care
- Administering medication
Where is Skilled Nursing Given?
Institutions: Examples include nursing homes and convalescent homes, where nurses can closely monitor patients around the clock.
Most Patients Will Only Need Custodial Care
For example, people with dementia and Alzheimer’s usually will only need custodial care for help with ADL’s like walking, bathing, and using the bathroom. It’s important to know when skilled nursing is actually required. Many patients and doctors mistakenly choose skilled nursing because they have the misconception that it provides better care.
But unless there’s a serious medical need, custodial care actually provides better care because it gives the patient more choices. Patients can choose to live at home where they are in a familiar setting and are closer to loved ones. Or they can choose a community where they can make new friends, and which compared to a nursing home has a much higher staff-to-patient ratio.
You can find out more about long-term care, including the rising cost of care, how likely you are to need it, whether or not Medicare and Medicaid will cover your care, and common misunderstandings that can lead you to make the wrong decisions.