The three levels of long-term care are skilled care, intermediate care, and custodial care — each defined by the intensity of medical attention involved and who’s qualified to provide it. Understanding these levels matters because many long-term care insurance policies only cover certain types of care.
What Is Long-Term Care?
Long-term care refers to a broad range of medical and personal services designed to help people who have lost the ability to function independently. The need for this ongoing care typically arises from a chronic disability, or when physical or mental impairments prevent someone from performing basic daily activities, such as:
- Feeding
- Bathing
- Dressing
- Transferring (moving in and out of a bed or chair)
- Toileting
The Three Levels of Long-Term Care Explained
Because long-term care insurance policies often subsidize only specific types of care, it’s important to understand how each level is defined.
Skilled Care
Skilled care is continuous, around-the-clock care designed to treat a medical condition. It’s ordered by a physician, performed by skilled medical personnel such as registered nurses or professional therapists, and follows an established treatment plan.
Intermediate Care
Intermediate care is intermittent nursing and rehabilitative care, provided by registered nurses, licensed practical nurses, and nurse’s aides, under a physician’s supervision. Unlike skilled care, it isn’t continuous around-the-clock treatment.
Custodial Care
Custodial care helps someone perform activities of daily living, such as bathing, eating, and dressing. It doesn’t require professional medical skills to provide, though it’s typically supervised by a physician.
Tip: These terms may be defined differently by Medicare, so it’s worth confirming how your specific policy or program defines each level before assuming coverage applies.
Where Is Long-Term Care Provided?
Long-term care can be provided in a number of places, though some long-term care insurance policies limit which facilities or settings qualify for benefits. Most long-term care falls into one of the following settings.
Nursing Homes
Many nursing homes provide all three levels of care — skilled, intermediate, and custodial — often within the same facility. If a patient no longer needs skilled care, for example, they can often be transferred to an intermediate or custodial section without changing locations. Nursing homes typically offer 24-hour care and a wide range of services, including intravenous therapy and physical therapy. Florida residents researching nursing home care should compare costs and services locally, since availability and pricing can vary by region.
Home Health Care
Home health care makes sense for someone recovering from an injury or illness who doesn’t need 24-hour supervision, or whose needs fall into the custodial care category. It’s typically provided by a visiting nurse, therapist, or home health aide, often through several visits per week. Services can include:
- Respiratory therapy
- Wound cleaning and bandaging
- Health monitoring
- Assistance with bathing and dressing
Adult Day Care
Adult day-care centers provide care in a group setting for older adults or people with disabilities who live at home — often with a relative who works and can’t provide care during the day. These centers typically offer social interaction, therapeutic activities, preventive health services, and nutritious meals.
Hospice Care
Hospice provides comfort and care for terminally ill patients, either in a dedicated facility or at home.
Respite Care
Respite care gives a regular caregiver — often a family member — temporary time off. It can be provided through a short-term stay in a nursing home or through in-home support from a home health aide.
Frequently Asked Questions
What are the three levels of long-term care?
The three levels are skilled care (continuous, physician-ordered medical treatment), intermediate care (intermittent nursing and rehabilitative care), and custodial care (help with daily living activities).
What’s the difference between skilled care and custodial care?
Skilled care requires licensed medical professionals and a physician-ordered treatment plan, while custodial care helps with daily activities like bathing and dressing and doesn’t require medical training to provide.
Does long-term care insurance cover all three levels of care?
It depends on the policy. Some long-term care insurance policies cover all three levels, while others limit coverage to specific types of care or specific settings, so it’s important to review your policy’s definitions.
Where is long-term care typically provided?
Long-term care services are commonly provided in nursing homes, through home health care, at adult day-care centers, in hospice settings, and through respite care.
Understanding Your Long-Term Care Options
Knowing the difference between skilled, intermediate, and custodial care — and where each is provided — helps you make more informed decisions about your long-term care insurance coverage and future care planning. Reviewing your policy’s specific definitions with a licensed professional can help ensure your coverage matches the type of care you’re most likely to need.
