One of the more common questions our specialists often get asked is, once someone purchases a long-term care (LTC) policy, when do they get to use the benefits – when can they go on claim? The answer to that is usually either as soon as they are unable to perform two of six Activities of Daily Living (ADLs) or if they are diagnosed with a cognitive impairment. Then of course they get the follow-up question of, what are ADLs?
ADLs are everyday functions and activities individuals usually do without help. ADLs include bathing, continence, dressing, eating, toileting, and transferring. A cognitive impairment is more commonly known as dementia or Alzheimer’s. A doctor must note the diagnosis in official medical records for the insurance carrier to acknowledge the impairment.
- Bathing – Washing oneself in either a tub or shower. This activity includes getting in or out of the tub or shower.
- Continence – Being able to control bowel and bladder function or being able to manage personal hygiene (such as a catheter or colostomy bag).
- Dressing – Putting on and taking off all items of clothing including braces, fasteners, or artificial limbs.
- Eating – Feeding yourself by getting food into the body from a receptacle (such as a plate, cup, or table).
- Toileting – Getting to and from the toilet, getting on and off the toilet, and doing related personal hygiene.
- Transferring – Moving onto and out of a bed, chair, or wheelchair.
- Cognitive Impairment – A loss of short- or long-term memory; difficulty knowing people, places, or the time or season; loss of the ability to make good decisions; or loss of safety awareness.
While this is generally what is required to trigger benefits in an LTC policy, it is always very important to fully read your policy and understand any slight differences. Some polices are more specific than others. For example, some policies may say that you need someone to physically help with an ADL, while others may say you simply need someone nearby to assist if needed. Ask your specialist or insurance carrier if you are unsure about your own policy. Though less common, a few policies require policy holders need assistance with three out of six ADLs.
Looking at the list of ADLs, most would think those activities are so easy, so normal, so mundane. It’s easy to think you may never need assistance in any of those areas. However, the statistics say otherwise. 15 million Americans are expected to need LTC by 2050 and 52% of people 65 and older will need LTC in their lifetime. The odds are daunting. Make sure you know your family’s history and do some research as to what your options are. At LTC Consumer we provide everything you could ever need when it comes to LTC planning. We have the cost of LTC in your state, the cost of an LTC insurance policy, and many other easy to use features – including this blog which explores the ins-and-outs of all things LTC related.
If you are interested in speaking to an expert, someone to guide you on your retirement planning journey, request an LTC insurance quote. Our consumer specialists focus only on LTC solutions for you and your family. They will listen to your needs and health concerns and choose from the industry’s top carriers the best option for your future. To see what other people have to say about our specialists, visit our Testimonials page. Needing help with ADLs is not something anyone wants to think about, but preparing now makes the time when help is needed much easier for everyone involved.