Activities of Daily Living and Long-Term Care

Most long-term care plans list six categories of activities of daily living (ADL). These are the basic tasks of everyday life, and are used to determine when benefits kick in. However, not all insurance companies use the same guidelines.
 
    Examples of ADLs may include:
·    Dressing – taking off and putting on all items of clothing, braces, fasteners, and artificial limbs.
·    Bathing – getting into or out of the tub or shower with or without equipment or adaptive devices. Washing yourself in a tub, a shower, or by a sponge bath
·    Ambulating – moving back and forth from a bed to a chair
·    Transferring – moving in and out of a bed, chair, or wheelchair with or without equipment such as canes, quad canes, walkers, crutches, grab bars or other support devices including mechanical or motorized devices
·    Feeding – getting food into the body from a plate, cup, a feeding tube, or intravenously
·    Toileting – getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene
·    Continence – the ability to maintain control of bowel or bladder function

The inability to perform any two of the above ADLs will trigger the benefits in most policies. However, some companies include continence within the toileting ADL, which means you would need assistance with another ADL to receive the policy benefits. Certain plans may require that you must be unable to perform three of seven ADLs without help. These “three of seven” ADL insurance plans are often hardest to qualify for benefits. Next hardest would be a “two of six” plan. A “Two of seven” ADL plan is generally the easiest for obtaining benefits. In addition, some plans will let you qualify for benefits if you have Alzheimer’s, other forms of severe cognitive impairment, or other conditions such as congestive heart failure, as long as you meet certain clinical criteria. More restrictive plans may call for hands-on assistance rather than just supervisory help with the ADLs to receive the benefits. So, it’s important to understand ADLs and how the insurance company uses them.         
   
ADLs are complicated and an important consideration when you’re comparing LTC insurance options. As policy coverage varies among companies, you should compare coverage prior to making a final decision. Please also remember that policy benefits are subject to the insurer’s claims-paying ability. For this reason, it is also wise to check the insurer’s financial rating and claims-paying history prior to purchasing a policy.