As we age, it can become harder to perform basic activities. Whether we’re limited by mobility or a change in capability, the things we once did without thinking – like getting up or going to the bathroom – aren’t easy anymore.
Once we require regular assistance with these types of tasks, it may be time to seek additional care. Unfortunately, that care can be expensive as it’s often not covered by traditional insurance policies.
Long-term care insurance can help cover the cost and reduce the financial burden of care, allowing you control over how and when you will receive services once you qualify for care. Below, we’ll discuss more about the six daily living activities and the role they play in securing long-term care.
Why Activities of Daily Living Matter in Long-Term Care Planning
Activities of daily living (ADL) help insurance companies determine if you qualify for care. Once you’re no longer able to complete at least two of them, you should qualify to claim your long-term care insurance benefits.
An assessment of your functional abilities helps insurers process claims promptly. You can get a formal assessment from a doctor, nurse, occupational therapist, or other qualified medical professional to help determine your ability to complete ADLs. If someone is submitting a claim on your behalf, they may also provide a written statement.
It’s critical to understand what ADLs you are able to complete and which you need assistance with to understand what type of care is needed for your long-term care planning. You may only need part-time assistance to help you age at home or require full-time supervision in a facility as your cognitive function declines. Your long-term care is completely designed around your capabilities.
What Are Activities of Daily Living (ADLs)?
Activities of daily living are the activities you need to do on a regular basis to care for yourself. There are six commonly recognized ADLs:
- Bathing
- Dressing
- Eating
- Transferring
- Toileting
- Continence
Once you are no longer able to complete at least two of these ADLs, your long-term care insurance policy benefits will trigger.
ADLs are not an official medical diagnosis. They are simply self-care activities that you should be able to complete in order to take care of yourself without assistance. Some of the decline in these activities may coincide with medical diagnoses, but they are not a medical diagnosis in themselves.
ADLs are used as objective benefit triggers in long-term care insurance policies. Because they are required for a person to independently take care of themselves, they can easily be measured on a standard scale to determine an individual’s capabilities.
The Six Activities of Daily Living Explained
The six ADLs may seem straightforward; however, there are specific activities and behaviors within them that professionals look at when assessing capabilities.
Bathing
Bathing is more than just washing yourself. It’s also about your ability to maintain your personal hygiene in general. You must wash thoroughly, whether you stand, sit, or move in other ways to clean all areas of your body.
You should also be able to brush your teeth, brush your hair, and wash your face using the necessary supplies. Maintaining your personal grooming is essential to caring for yourself.
Dressing
Dressing means putting on the right clothes in the right order, starting with undergarments. Additionally, you should be able to secure the clothing, using buttons, zippers, velcro, and snaps as needed to be fully dressed.
You may also be required to retrieve your clothes from dressers, closets, and other locations to ensure you can dress yourself.
Eating
Eating and drinking are essential ADLs that help ensure you’re getting adequate nutrients. You should be able to use utensils, chew, and swallow food and drink without assistance.
Note that the eating ADL only covers the act of eating. It is not assessing your ability to prepare food to feed yourself.
Transferring
Transferring is the act of moving from one location to another without assistance. For example, you must be able to transfer yourself in and out of bed, from the couch to standing, and between rooms.
During the transfer process, you can use mobility aids, such as canes or walkers, to make the process easier. These do not count against you when being assessed for the transferring ADL.
Toileting
Toileting is more than simply using the bathroom independently. You also need to be able to transfer yourself to and from the toilet, clean yourself, and manage your clothing.
You have to master access, hygiene, and dressing as part of this ADL, so if you have challenges with any of those tasks, you may also have challenges with toileting independently.
Continence
Continence is your ability to manage your bladder and bowel functions. If you can no longer control them, you should be able to manage the personal hygiene products that accompany them.
For example, changing pads and diapers, or managing medical devices such as catheters, without assistance.
While it may seem similar to toileting, it’s actually different. You are controlling your bodily functions during continence assessment, while toileting covers the ability to physically move.
How ADLs Are Used to Qualify for Long-Term Care Benefits
In order to qualify for long-term benefits, most LTC insurance policies require that you need assistance with two or more ADLs. Because many are interconnected, it is often not difficult to qualify once your daily functioning has declined.
Long-term insurance carriers follow an assessment process to determine if you qualify for long-term care benefits. It can include:
- Clinical assessments from qualified medical professionals like doctors, nurses, and occupational therapists.
- Functional demonstrations that prove you are able to complete basic tasks without assistance in all six core areas.
- Documentation review of previous medical history, like doctor’s notes, hospital records, etc.
Cognitive impairment, like Alzheimer’s and dementia, often impacts your ability to complete ADLs. They can even trigger your benefits before you are no longer able to complete your ADLs, depending on the policy. You complete a mini-mental state exam to assess cognitive impairment.
If you have already been diagnosed with cognitive impairment, you may not qualify to secure new LTC insurance policies. However, future diagnoses will be covered and trigger benefits once you meet the minimum policy requirements.
Real-Life Scenarios Where ADLs Trigger Coverage
There are various scenarios that can trigger long-term care coverage.
For example, an individual may experience a gradual physical decline related to aging or a chronic illness. Over time, they are unable to complete ADLs without assistance. It may start occasionally before becoming daily.
Another scenario is if an individual suddenly loses function after an injury or hospitalization. Originally, they had no issues, but an event has now prevented them from toileting and transferring without assistance. Some may be able to overcome this with physical therapy and time, while others may require long-term care to support these activities.
Lastly, cognitive conditions like Alzheimer’s and dementia can affect daily independence. An individual may forget what they are doing or believe they are living in the past. This can be unsafe for an individual, requiring constant supervision to prevent them from posing a danger to themselves or others.
Why Understanding ADLs Is Essential for Policyholders
ADLs are important for policyholders to understand because they help you recognize when benefits may become available. Once you or your loved ones notice that you are no longer able to complete these ADLs, you should be able to trigger your benefits.
You can also secure the right documentation to help you avoid delays during the claims process. You know what you need in order to get your claims approved and secure financial assistance from your policy.
Our guide to long-term care can help planning feel less intimidating. Once you understand what triggers benefits, you will be able to secure the care you want without becoming a financial burden on your loved ones.
Common Misconceptions About ADLs and Long-Term Care Insurance
Like most traditional insurance, LTC insurance can be complex, leading to misconceptions about eligibility, coverage triggers, and more.
- ADLs are not medical diagnoses. ADLs are just activities, and you’re assessed whether or not you are able to complete them without assistance. Medical diagnoses may impact your ability to complete ADLs, but they do not indicate a medical diagnosis in themselves.
- You automatically qualify for coverage. You have to submit documentation in order to trigger your coverage. Just because you can no longer complete ADLs doesn’t mean you will automatically qualify for coverage.
- ADLs and IADLs are not the same thing. For example, your ability to feed yourself – physically bring food to your mouth – is an ADL. Your ability to cook is an IADL. While they are related, they are not the same.
During the course of your treatment, it’s critical that you secure proper documentation, including the necessary functional and mental assessments. It will help speed up coverage once you are ready to trigger your benefits.
Planning Ahead: How ADLs Fit Into a Strong LTC Strategy
As we live longer, a robust long-term care strategy is essential to ensure our needs are met. It’s critical that you understand ADLs before care is required so you can understand when you may need to seek assistance.
ADLs can influence policy design and benefit selection, so it’s critical that you meet with a professional to discuss your coverage. Our team at Lavine LTC Insurance can help you navigate your options and design a policy that fits your long-term care needs and budget.
Contact us today for a free consultation.