Opinion ID: 2039455
Heading Depth: 1
Heading Rank: 4

Heading: Medicare definition of custodial care.

Text: Although the Medicare definitions are not controlling in the present case, each party attempts to use cases decided under the Medicare custodial care exclusion to support its position. A review of the factual settings of those cases convinces us that the care supplied to plaintiff was not merely custodial care under the liberal interpretations given to the Medicare Act. [6] In several cases similar to the present case, courts have reversed the administrative denial of benefits under the Medicare custodial care exclusion. In Whitman v. Weinberger, 382 F.Supp. 256 (E.D.Va.1974), the patient was a 74-year-old man who had suffered a stroke. He suffered various other attacks and was ultimately admitted to a nursing home. His care included intensive physical therapy, daily medications, and observation for a generally deteriorating physical condition. The court stated that a pragmatic, case by case, analysis of custodial care was necessary, and that the secretary of health, education and welfare must consider not only services given, but the patient's overall need for medical care. In Coe v. Secretary of Health, Education and Welfare, 502 F.2d 1337 (4 Cir. 1974), the court reversed a lower court's decision excluding certain services from Medicare under the custodial care exception. The services held to be more than custodial care were almost exactly the same as those provided Ms. Olson in the present case, including feeding, position changing, physical therapy, and the use of a urinary catheter. The court relied upon the following definition of the term custodial care: [M]arked by or given to watching and protecting rather than seeking to cure [for example] custodial care rather than a therapeutic program. 502 F.2d 1340. In Klofta v. Mathews, 418 F.Supp. 1139 (E.D.Wis.1976), the court found that the plaintiff's decedent had received skilled nursing care and was entitled to Medicare benefits. The patient received physical therapy, medication, assistance in going to the toilet, and other personal care services. The court held that where the patient required the care of skilled personnel, she was receiving skilled nursing care,  even if she was not receiving skilled nursing services within the meaning of 20 CFR § 405.127. It also held that the court was not bound by the regulations. The court quoted with approval the following: [Custodial care] is care that could be administered by a layman, without any possible harm to the one in custody.   This view of `custodial care' is also in agreement with the definition of `custodial' as found in Webster's Third New International Dictionary (1967 ed.), i. e., `relating to or marked by guardianship or maintaining safely.' Thus, mere `custodial care' refers quite simply to guardianship for convenience that has no significant relation to medical care of any type. Samuels v. Weinberger, 379 F.Supp. 120, 123 (S.D.Ohio 1973). 418 F.Supp. 1143. The Medicare cases consider not only the actual services rendered but also the need for extended medical care, Rockingham National Bank v. Weinberger, 381 F.Supp. 373 (W.D.Va.1974), and the possible medical consequences of the patient's not receiving care. Bremer v. Richardson, 347 F.Supp. 465 (D.Neb.1972). In light of Dr. Lerdahl's testimony and the actual provision of care by skilled nursing personnel, even under Medicare the care given Ms. Olson would have qualified for reimbursement. [7]