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Custodial Care at Home

Custodial care is often an important part of living with a serious illness.

Custodial care is non-skilled care delivered by a Home Health Aide/Attendant (HHA). Custodial care involves assistance with Activities of Daily Living (ADL), such as walking, cooking, cleaning, bathing, dressing, and using the bathroom. Help with these tasks is usually provided by a family member or HHA, not a Registered Nurse (RN).

Aides are not allowed to assist with medication preparation, wound care, catheter care, or suctioning devices. Aides who provide custodial care can be obtained through a Certified Home Health Agency (CHHA), Licensed Home Care Services Agency (LHCSA), or by privately hiring someone using recommendations from friends, family members, or an aging-in-place organization.

Aides have different levels of training and skills, and different titles. In New York State, a Home Health Aide/Attendant (HHA) usually has more training and skills than a Personal Care Aide/Assistant (PCA). Aides who have been trained abroad or outside New York State may be labeled differently and have different skills and levels of training.

Custodial care is not covered by Medicare or private health insurance unless the person is also receiving skilled care services. The cost of custodial care can be high over a person’s lifetime.  Additional details on the How to Pay for Care at Home page in The GUIDE.

Regardless of payment or coverage, every individual approaches the situation of hiring a home health aide differently. Understanding your needs and abilities is a good starting point. Whether you are speaking with an agency or hiring someone privately, you may consider the following:

  • How many hours of help do I need, per day or per week?
  • What activities of daily living support are needed?
  • What additional care do I require?
  • Can the aide or agency provide references?
  • Who will coordinate the schedule of the home health aide?

To work well with an aide it is important to identify and clearly communicate your needs, how you like things done, and any other important issues that need to be understood. The amount of time you spend with a home health aide can be long and includes social time together. It is important to discuss shared activities, such as watching TV, reading, and mealtimes, and to explain what you want from the beginning.

In the final analysis, your choice of aide will be based on a balance of your needs, your financial situation, and the aide’s training, experience, and personality.

List of Resources for Aides