This document defines custodial care, a type of care that generally provides assistance in performing activities of daily living (ADL); for example, assistance walking, transferring in and out of bed, bathing, dressing, using the toilet, preparation of food, feeding and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel.

Note: Please see the following related documents for additional information:

• CG-MED-23 Home Health
• CG-MED-71 Chronic Wound Care in the Home or Outpatient Setting
• CG-REHAB-07 Skilled Nursing and Skilled Rehabilitation Services (Outpatient)
• CG-REHAB-08 Private Duty Nursing in the Home Setting

Clinical Indications

Care that does not meet the criteria for skilled nursing or skilled rehabilitation services is considered custodial.
Note: Not all benefit contracts/certificates include benefits for custodial services as defined by this document. Benefit language supersedes this document.

Definition of Custodial Care:

1. Custodial care is that care which is primarily for the purpose of assisting the individual in the activities of daily living or in meeting personal rather than medical needs, which is not specific therapy for an illness or injury and is not skilled care.
2. Custodial care serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered.
3. Custodial care essentially is personal care that does not require the continuing attention or supervision of trained, medical or paramedical personnel.
4. Custodial care is maintenance care provided by family members, health aides or other unlicensed individuals after an acute medical event, including behavioral health events, when an individual has reached the maximum level of physical or mental function.
5. In determining whether an individual is receiving custodial care, the factors considered are the level of care and medical supervision required and furnished. The decision is not based on diagnosis, type of condition, degree of functional limitation or rehabilitation potential.

Note: Custodial care may occur in settings other than the home.

Examples of Custodial Care, include, but are not limited to, the following:

1. Assistance in dressing, eating, and toileting;
2. Periodic turning and positioning in bed;
3. Prophylactic and palliative skin care, including bathing and application of creams, or treatment of minor skin problems;
4. Stable bolus feeding by nasogastric, gastrostomy or jejunostomy tube (Note: skilled care, supervision or observation may be required if feedings are not stable);
5. Routine care of the incontinent individual, including use of diapers and protective sheets;
6. Routine services to maintain satisfactory functioning of indwelling bladder catheters (this would include emptying containers and cleaning them, and clamping tubing);
7. General maintenance care of colostomy and ileostomy;
8. General supervision of exercises, which have been taught to the individual and do not require skilled rehabilitation personnel for their performance. This includes, but is not limited to:
   1. repetitive exercises to maintain function, improve gait, or maintain strength or endurance; or
   2. passive exercises to maintain range of motion in paralyzed extremities, or
   3. assisted walking.
9. Daily supervision and assistance with dressing, eating and hygiene for an individual with serious mental illness with findings such as cognitive impairment, delusions and hallucinations that interfere with an individual’s ability to live in the community.
10. Changes of dressings for non-infected postoperative or chronic conditions;
11. General maintenance care in connection with a plaster cast (skilled supervision or observation may be required where the individual has pre-existing skin or circulatory conditions or needs to have traction adjusted);
12. Routine care in connection with braces and similar devices;
13. Use of heat as a palliative and comfort measure, such as whirlpool or steam pack;
14. Routine administration of medical gases after a regimen of therapy has been established (i.e., administration of medical gases after the individual has been taught how to institute therapy);
15. Administration of routine oral medications, eye drops, and ointments (the fact that an individual cannot be relied upon to take such medications himself/herself or that state law requires all medications be dispensed by a nurse to those individuals in an institution would not change this service to a skilled service);
16. Chronic uncomplicated oral or tracheal suctioning (Note: skilled care, supervision or observation may be required if suctioning is complicated).

Coding