What are Activities of Daily Living
Jason Stolz CLTC, CRPC
Activities of Daily Living (ADLs) are the essential, hands-on self-care tasks most people perform every day without assistance. Insurers, care coordinators, and government programs use ADLs to evaluate functional ability, determine care needs, and—in long-term care (LTC) insurance—decide when policy benefits can start. Knowing how ADLs work can help you plan care, choose the right coverage, and avoid surprises at claim time.
What Are the Core ADLs?
While wording can vary slightly by insurer, the six most common ADLs used in long-term care insurance contracts are:
- Bathing: Getting into/out of a tub or shower and washing safely.
- Dressing: Putting on/taking off clothing and applying fasteners or braces.
- Eating: Getting nourishment into the body (not meal preparation).
- Toileting: Using the toilet safely and performing related hygiene.
- Continence: Ability to control bowel and bladder function.
- Transferring: Moving to/from a bed, chair, or wheelchair safely.
Important: Policies typically require that the inability be due to a loss of functional capacity (illness, injury, or frailty), or due to a severe cognitive impairment such as advanced dementia, as certified by a licensed health professional.
ADLs vs. IADLs (Instrumental Activities of Daily Living)
IADLs are the “life management” tasks that support independent living but are not hands-on self-care. Examples include managing medications, grocery shopping, preparing meals, doing housework, handling finances, and using transportation. Many LTC policies focus on ADLs for benefit eligibility; IADL limitations alone usually are not enough to trigger benefits unless the contract explicitly allows it or cognitive impairment criteria are met.
How ADLs Trigger Long-Term Care Insurance Benefits
Most LTC policies start paying benefits when a licensed practitioner certifies that you need substantial assistance with at least two ADLs for a period expected to last at least 90 days, or when you have a qualifying cognitive impairment requiring supervision for safety. Key points:
- Substantial assistance: Hands-on physical help and/or standby assistance to prevent falls or injuries.
- Elimination period: A waiting period (e.g., 0–90 days) before benefits pay; some policies have “calendar day” vs. “service day” rules.
- Covered settings: Home care, assisted living, memory care, adult day care, and nursing homes—subject to your policy’s provisions.
- Care plans and documentation: Most insurers require a plan of care and periodic recertification to continue benefits.
Examples: When ADL Help Is Needed
- Post-stroke weakness: A person needs steadying and partial lifting to transfer and bathe safely.
- Advanced arthritis: Hand dexterity limits the ability to manage buttons, zippers, or braces for dressing.
- Dementia: The individual can physically eat but requires cueing and supervision to ensure nutrition and safety.
- Parkinson’s disease: Freezing and imbalance make transfers hazardous without standby help.
How Insurers Evaluate ADLs
Insurers rely on professional assessments (nurses, occupational/physical therapists) to evaluate which ADLs require assistance, the type of help needed (standby vs. hands-on), frequency, and safety risks. Tips for smoother claims:
- Be specific: Describe exactly what happens during tasks (e.g., “needs two-person assist to transfer” rather than “needs help”).
- Provide records: Share therapy notes, hospital discharge summaries, home-health documentation, and medication lists.
- Align care plan: Ensure the written plan of care matches the actual services and hours being provided.
Common Policy Terms Tied to ADLs
- Daily/Monthly Benefit: Maximum dollar amount the policy pays for covered care.
- Benefit Period/Pool: Total duration or pool of money available once ADL/cognitive triggers are met.
- Elimination Period: Waiting period before payments start (some policies waive it for home care).
- Care Coordination: Some contracts include a care coordinator to help source providers and update care plans.
- Inflation Protection: Increases benefits over time to keep pace with rising care costs.
ADLs and Care Settings
Needing help with two or more ADLs doesn’t automatically mean facility care. Many people begin at home with a few hours of help per day and progress to assisted living or memory care if needs increase. Your policy may pay differently by setting (e.g., separate limits or requirements), so it’s wise to match benefits to likely care paths.
Planning Considerations
- Benefit size: Estimate local costs for home care vs. assisted living vs. memory care to set appropriate daily/monthly benefits.
- Elimination period strategy: Choose a waiting period you can self-fund (cash, family help) without financial stress.
- Shared Benefits for Couples: Couples may consider shared-care riders to access a combined pool of benefits.
- Cognitive coverage: Confirm how the policy defines and evaluates cognitive impairment (testing, supervision requirements).
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FAQs: Activities of Daily Living (ADLs)
What are the six ADLs?
Bathing, dressing, eating, toileting, continence, and transferring. These hands-on self-care tasks are the industry standard for evaluating functional ability.
How many ADLs must I need help with to trigger LTC insurance benefits?
Most policies require substantial assistance with at least two ADLs, or a qualifying cognitive impairment requiring supervision, as certified by a licensed professional.
Do IADLs count toward eligibility?
Typically no. Instrumental ADLs (like shopping or housekeeping) support independent living but generally don’t trigger benefits unless cognitive impairment criteria are met or your policy explicitly allows it.
What’s the difference between standby and hands-on assistance?
Hands-on means physical help to complete the task. Standby means a helper is present to prevent falls or cue the person; many policies recognize both as “substantial assistance.”
Who decides whether I qualify for benefits?
An insurer-approved licensed health professional assesses your abilities, documents ADL limitations, and creates or reviews a plan of care.
How does cognitive impairment factor in?
Severe cognitive impairment (e.g., dementia) that requires continual supervision for safety can qualify you for benefits even if you can still perform ADLs physically.
Do I have to be in a facility to receive benefits?
Not necessarily. Many policies cover home care, assisted living, and adult day care, in addition to nursing facilities—subject to your contract terms.
What documents help with a smoother claim?
Professional assessments, physician notes, therapy reports, discharge summaries, home-health visit logs, and a written plan of care aligned with actual services.
