A person’s ability or inability to perform ADLs is one factor insurance companies look at when deciding whether they’re eligible for long-term care insurance benefits. It also plays a role in determining whether applicants are approved for certain types of insurance.
Bathing: The ability to get into and out of the shower or bath and wash oneself sufficientlyContinence: The ability to control one’s bladder and bowel movements, or manage a colostomy bag or catheterDressing: The ability to put on and take off one’s clothing, and any necessary braces, artificial limbs, etc.Eating: The ability to feed oneselfTransferring: The ability to move around as needed, including into and out of bed, into and out of a car, etc.Toileting: The ability to get to and from the bathroom, on and off the toilet, and maintain hygiene
When a person can no longer perform some or all of these tasks independently and has long-term care insurance, they should contact their provider to see if they qualify for benefits.
How Activities of Daily Living Are Used in Insurance
When a person can no longer take care of their needs on a daily basis, long-term care insurance can help cover the costs of getting assistance. Insurance companies that provide long-term care, however, need a way of determining when policyholders qualify for benefits. Enter the activities of daily living. Policyholders typically qualify for long-term care insurance benefits when they can no longer perform at least two of the six ADLs. However, other qualification requirements can apply. For example, some insurers require policyholders to need hands-on assistance, and won’t approve the need for standby assistance alone. Further, some require a health care practitioner to verify that ADLs can’t be performed and may require that they can’t be performed for a certain amount of time (such as 90 days). You’ll need to read the fine print of your insurance policy or talk to your agent to learn all the details.
Example of How an Insurance Company Uses ADLs
If your spouse has a life insurance policy with a long-term care rider, the rider enables your spouse to use part of their death benefit to pay for long-term care services. However, before they can, they’ll need to meet the insurer’s requirements. For example, let’s say the insurer requires certification from a health care practitioner that your spouse is unable to perform at least two ADLs for at least 90 days. If your spouse is diagnosed with rheumatoid arthritis and hasn’t been able to independently bathe or use the bathroom for the past six months, they should qualify for your long-term care benefits. However, their doctor would need to verify the situation.
ADL vs. IADL
Along with ADL, you may also come across the abbreviation “IADL.” IADL stands for “instrumental activities of daily living.” While ADL refers to the basic personal tasks of daily life, IADL refers to more complex tasks that are still essential; for example, housekeeping, managing money, preparing meals, taking medication, caring for pets, and making necessary trips (going to the grocery store, doctor, etc.). While ADLs are often used to determine eligibility for long-term care insurance benefits, the benefits themselves often include assistance with IADLs.
