As people age, they may depend more on others for care and help with daily living. Often, these needs translate to costs that are covered by a health care or insurance provider. To figure out the type and amount of care a loved one need when aging, health care and insurance providers apply a set of standards to assess how well they can perform daily tasks and function on their own. These standards are called "activities of daily living," or ADLs. They cover the full range of basic daily tasks such as eating, dressing, grooming, and more.
If you have a loved one who is starting to have trouble getting by on their own, and in need of some extra help, you may be involved at many levels. Whether you hire extra help out of pocket, or work with an insurer or care provider to cover the costs, it will help to learn how this work is billed. Here you'll learn how ADLs are used so you can be aware of costs, as well as when when you or your loved ones need to prepare for a higher level of care.
- The activities of daily living (ADLs) are the basic tasks that you need to be able to perform to function in a healthy way each day.
- Health care providers and insurer use your ADLs as a guide for how much daily care you need.
- If you are concerned that you or a loved one may have trouble living alone, or paying for the help needed, you should look into long-term care insurance options early on, before care is needed.
What Are the Activities of Daily Living?
Activities of daily living (ADLs) are routine tasks that people must carry out each day to take care of themselves. The ADLs used by most systems fall into six main types:
- Eating: Are they able to feed themselves without help? (Eating may also include cooking and meal shopping in some cases.)
- Bathing: Can they bathe and take showers on their own? Can they complete all other grooming tasks, such as oral care, hair care, shaving, etc.?
- Dressing: Can they choose clothing and get dressed? Buttons and zippers often used as benchmarks
- Mobility (or "transfer"): How well can they get into and out of bed or a chair, and move from place to place without help?
- Continence: Can they can control their bladder and bowel functions?
- Toileting: Do they need help to get on and off the toilet?
Older adults with plenty of physical and mental strength to perform all the above ADLs on their own can often thrive without extra help. By contrast, people who cannot carry out these tasks on their own may need home care, home health care services, nurses, or assisted living. There is a wide spectrum of the level of help a person might need, and ADLs help to define this. One one end, a person may need help with simple meal prep a few times a week, such as if they are a little slow getting around, or can no longer drive to the store. On the other end of the spectrum is a person who may be ailing from a severe illness that limits their mobility, and needs help bathing, dressing, using the bathroom, feeding themselves, taking pills at the right time, etc. In either case, and for all in between, a chart with their ADLs can be used by any caregiver to gather all the details needed to provide the right help. ADLs will also be useful for an insurer who needs to be sure that any claim they cover is legit.
Without this simple system to measure the amount of help a person needs, many would suffer from a reduced quality of life and an increased risk of injury or illness by living solo.
Other ADL Systems
It should be noted that not all systems define ADLs in the same way. There is no single authority on the subject, and instead, each care provider or insurer comes up with their own rubric and set of standards that suit their uses. For instance, a lead nurse might use a person's ADLs to assess the levels of care needed, and to assign duties to other nurses. Hiring and payroll may even come into play. An insurer, on the other hand, may use ADLs to adjust a claim, or to suggest a proper policy.
For instance, "eating" may seem like a very clear standard, but in some systems it means simply whether or not a person can put fork to mouth, while in others it includes the desire to eat as well. There are many types of illness where people cannot detect hunger, but perhaps have no problem feeding themselves; this means that if not prompted, they would forget to eat. A home health aid who has this extra ADL detail would know that their patient needs to be prompted at meal times.
How Insurance Coverage for ADLs Works
As with other health care costs, the price tag on long-term care for older adults can be very high, so people who need these services may choose to buy long-term care insurance to help pay.
To get the best deal, you should try to buy long-term care insurance before you need care. As with other forms of insurance, long term care insurance must first go through the process of medical underwriting. The price will depend on many factors, such as your current state of health, your medical history, and in some cases whether you may be at risk for illness, though the law is tricky here. Long story short, you'll get the best price while you're young and healthy. Also, if you buy early you'll have more time to pay into the policy, which could help to lower your monthly cost as well.
You can purchase long-term care insurance through an insurance agent or broker. Many companies will send an agent to your home to conduct an evaluation and to create a plan of care. This way they can assess what ADLs you need help with, and they can work within the benefits you have. If your care needs exceed the amount of coverage you have, these agents may also be able to help you look at other options.
Many long-term care insurance policy benefits kick in when a person needs help with at least two of the six ADLs. But each long-term care insurer defines ADLs in their own way, so refer to your contract to get the details on what standards must be met to trigger the benefits.
Understanding Policy Limits
Though it depends on the exact long-term care policy you have, there may be an "elimination period," or a waiting period, from 30 to 90 days from the time you start to receive help with ADLs and the time you can collect benefits. Also, most policies place a cap on the time period in which you can collect benefits, and on the total amount you can receive over your lifetime. Others will offer a more flexible daily "cash disability" amount that you can count on whether you use services each day or not.
When shopping for long-term care insurance, it's important to assess your current health concerns, and any that you suspect may come up in the future, alongside these limits.
A policy with a longer elimination period can put you on the hook for out-of-pocket costs if you need care before it tolls. Make sure you have the funds to cover that gap, or choose a policy that doesn't take as much time to start working.
Other Ways to Pay for Care for Daily Living Activities
If you or a loved one think you may need help with daily tasks in the future, the safest plan of action is to shop for long-term health insurance now to avoid being turned down later.
If you are an existing policyholder who is struggling with daily ADLs, check your long-term health care contract to see if you can ramp up care. If not, you may need to speak with an agent. Without these costs covered, you'll have to pay out of pocket.
If you don't have or and can't afford insurance, and don't have the money to pay as you go, look for other ways to pay for assisted living costs. Some long-term care facilities offer financial aid programs. You can also seek out help from people who provide care outside the standard systems. Ask your friends and neighbors if they know of people who are looking for work in this field. You may be able to find a trusted nurse or home aid through your network. You can also look to online job boards to hire help; just be sure you run background checks on any strangers.
Lastly, there are ample sources of help through aid agencies and local, state, and national nonprofit organizations. Area Agency on Aging is a good place to start to find sources of help in your area.