The Core Activities of Daily Living (ADLs)
The six core Activities of Daily Living (ADLs) are standardized, fundamental personal care tasks used by long-term care insurance policies to determine eligibility for benefits. To trigger coverage, a licensed healthcare practitioner must certify that the policyholder is unable to perform a certain number of these ADLs without “substantial assistance,” either hands-on or standby, for a period of at least 90 days.
The Six Standard ADLs
- Bathing: The ability to wash oneself in a tub or shower, including getting in and out and performing related hygiene and grooming activities.
- Dressing: The capacity to put on and take off clothing, including any necessary braces or artificial limbs, without help.
- Eating: The ability to feed oneself, getting food from a plate or cup into the body.
- Transferring: The process of moving from a bed to a chair, wheelchair, or another location, and vice versa.
- Toileting: The ability to get to and from the toilet, get on and off, and perform related personal hygiene.
- Continence: The ability to maintain control over bowel and bladder functions or manage related hygiene needs, such as a catheter or colostomy bag.
Hands-On vs. Standby Assistance
Policies differentiate between two types of assistance that qualify as an inability to perform an ADL:
- Hands-on assistance: The physical help of another person is required to perform the task. For example, a caregiver physically helps with bathing.
- Standby assistance: The presence of a caregiver is necessary to supervise or provide verbal cues to ensure the task is performed safely. An example is someone with a balance issue needing someone within arm's reach to prevent a fall.
The Role of Cognitive Impairment
In addition to the inability to perform ADLs, severe cognitive impairment is another primary trigger for long-term care benefits. Conditions like Alzheimer’s disease or other forms of dementia, which require continual supervision to protect the policyholder or others, will qualify for coverage even if the individual can perform all six ADLs. The impairment must be severe enough to require protection or constant supervision to prevent harm.
Instrumental Activities of Daily Living (IADLs)
While not typically used to trigger benefits in most tax-qualified long-term care policies, Instrumental Activities of Daily Living (IADLs) are more complex tasks related to independent living. They can play a role in care planning and may be covered under certain circumstances, especially with a plan of care.
Common IADLs include:
- Managing finances: Paying bills, budgeting, and managing banking.
- Medication management: Taking prescription medications as directed.
- Meal preparation: Planning, preparing, and cleaning up after meals.
- Housekeeping: Performing light cleaning and laundry.
- Transportation: Using a vehicle or arranging public transit.
- Shopping: Purchasing groceries and other necessities.
ADLs vs. IADLs: Long-Term Care Policy Comparison
| Feature | ADLs (Activities of Daily Living) | IADLs (Instrumental Activities of Daily Living) |
|---|---|---|
| Definition | Basic self-care tasks essential for independent living. | More complex, organizational tasks necessary for independent living. |
| Policy Trigger | Standardized trigger for benefits in most tax-qualified LTC policies (inability to perform 2+ ADLs). | Not typically a benefit trigger for tax-qualified policies, but may be used in care planning. |
| Examples | Bathing, dressing, eating, transferring, toileting, continence. | Managing finances, managing medications, meal preparation, housekeeping. |
| Type of Assistance | Requires hands-on or standby assistance due to physical or functional impairment. | May require supervision or assistance due to physical, functional, or cognitive impairment. |
| Required Impairment | Loss of physical or functional capacity. | Often related to cognitive ability, memory, or organizational skills. |
| Relevance | Determines eligibility for policy benefits and level of care needed. | Used for broader care planning and determining the extent of support required to maintain independence. |
How to Trigger Your Long-Term Care Policy Benefits
Triggering long-term care benefits is a process that involves a few key steps after a need for care arises.
- Doctor's Certification: First, a licensed healthcare practitioner must certify that you are either unable to perform two or more ADLs or that you have a severe cognitive impairment. The inability to perform ADLs must be expected to last for a period of at least 90 days.
- Plan of Care: A plan of care must be established, often in coordination with the insurance company, outlining the necessary long-term care services.
- Elimination Period: The policyholder must satisfy the elimination period, or waiting period, before benefits begin. This period, which can range from 0 to 90 days or more, functions like a deductible and can be based on calendar days or service days, depending on the policy. During this time, the policyholder covers the cost of care themselves.
The Significance of ADLs in Long-Term Care
ADLs are far more than just a list of tasks; they are a standardized metric that allows the long-term care industry to assess an individual's need for assistance objectively. The framework of ADLs and IADLs provides a clear language for medical professionals, caregivers, and insurers to communicate an individual's functional abilities. This system helps in determining the appropriate setting for care—whether at home, in assisted living, or a nursing home—and the level of support required.
Conclusion
What are the activities of daily living in a long term care policy is a central question for anyone planning for future care needs. The standard six ADLs—bathing, dressing, eating, transferring, toileting, and continence—are the foundational criteria used to trigger long-term care insurance benefits, alongside severe cognitive impairment. Understanding how these triggers work and the difference between basic ADLs and more complex IADLs is essential for navigating your policy and ensuring you receive the necessary care when the time comes. By staying informed about these metrics, you can make more strategic financial and healthcare decisions for your future.
For more information on long-term care options and planning, consider consulting with a qualified financial advisor or visiting resources like the National Council on Aging: https://www.ncoa.org/.
