CARD T271
Skilled Care
Care requiring professional clinical skills. Skilled nursing treatment is an example; help with dressing alone is generally a different care level.
How it works
Skilled care requires clinical expertise, such as skilled nursing or rehabilitation delivered under applicable professional and coverage standards. The need for professional skill distinguishes it from help with daily personal tasks alone. Medicare skilled nursing facility coverage is conditional and time-limited; it is not a promise to pay for every nursing-home stay. [21] [22] [24]
A nurse managing a complex wound provides skilled care; an aide helping with dressing alone provides personal assistance.
A facility’s name does not make every service provided there skilled care.
CARD T272
Custodial Care
Assistance with everyday personal needs rather than skilled medical treatment. Help with bathing or dressing is a familiar example.
How it works
Custodial care provides help with ordinary personal needs such as bathing, dressing, toileting, and eating when professional clinical skill is not required for that assistance. It may occur at home or in a facility. Medicare generally does not cover long-term custodial care when that is the only care needed; LTC insurance and Medicaid may help when their eligibility and coverage rules are met. [21] [22] [24]
A person needs daily bathing and dressing assistance but no skilled therapy. The assistance is custodial care.
Medically important personal assistance is not automatically a covered Medicare skilled service.
CARD T273
Home Health Care
Health-related services delivered in a person’s home. Coverage depends on the services, provider, and policy or program requirements.
How it works
Home health describes a setting and a collection of services, not a guarantee of payment. Skilled nursing, therapy, and qualifying aide services may be included under specified conditions. Medicare home health generally requires homebound status, a need for part-time or intermittent skilled services, a care plan, and a Medicare-certified agency. Homebound does not mean a person can never leave home. Stand-alone housekeeping or personal care without a qualifying skilled need is generally not covered by Medicare home health. [21] [22] [24]
A homebound patient receives prescribed skilled nursing visits through an eligible agency; the plan must still meet Medicare’s coverage requirements.
Being treated at home does not by itself make a service covered.
CARD T274
Adult Day Care
Supervised daytime services for adults who need support. Participants typically return home afterward.
How it works
Adult day care provides supervision, activities, and support during daytime hours, sometimes including health services. Participants usually return home afterward. It can support a person who needs help while a family caregiver works. LTC reimbursement depends on whether the policy covers the service, the provider meets its standards, and the insured satisfies benefit conditions. [21] [22]
An adult attends a supervised center during the workday and returns to a family home each evening.
Daytime support is different from full-time residential care.
CARD T275
Respite Care
Temporary care giving a regular caregiver a break. It may be delivered at home or in another setting.
How it works
Respite care temporarily substitutes for a regular caregiver so that caregiver can rest or attend to other needs. It can be provided at home, in a day program, or in a facility depending on the benefit. Policies and programs may limit days, settings, or amounts. Medicare hospice has a specific inpatient respite benefit generally limited to up to five consecutive days per stay; that rule is not the definition of all respite care. [21] [22] [25] [26]
A family caregiver takes a short break while an approved service temporarily provides the insured’s care.
Respite describes relief for the caregiver, not necessarily recovery from the insured’s condition.
CARD T276
Hospice Care
Care focused on comfort and support for a person with terminal illness and their family. Program eligibility and covered services vary.
How it works
Hospice focuses on comfort, symptom management, and support for a terminally ill person and family. Medicare eligibility generally requires certification of a prognosis of six months or less if the illness follows its normal course and election of hospice care instead of treatment intended to cure the terminal illness and related conditions. Care for unrelated conditions can still be covered. Eligibility can continue beyond six months with required recertification; six months is not an automatic lifetime cutoff. [21] [22] [25] [26]
A patient receives pain management and family support at home under hospice while appropriate unrelated medical needs remain addressed separately.
Hospice does not mean stopping all medical care.
APPLY THE TERMS
Practice questions
Select an answer, then check it to see why each option is right or wrong.
T271 · Skilled Care
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T272 · Custodial Care
0 of 3 answered
T273 · Home Health Care
0 of 3 answered
T274 · Adult Day Care
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T275 · Respite Care
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T276 · Hospice Care
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Sources & further reading
Original explanations and practice scenarios informed by the following regulatory, legal, and product resources. State examples are not presented as nationwide deadlines or requirements.