Activities of Daily Living & Triggering Long-Term Care Insurance

Long-term care insurance (LTCI) is designed to cover the costs associated with long-term care services, which are often needed by individuals who can no longer perform basic activities of daily living (ADLs) independently. Right at Home North and Central Queens can assist you with activating your LTCI policy to cover home care services. Among the key things you want to consider before activation is the number activities of daily living (ADLs) that you need assistance with.

What are Activities of Daily Living (ADLs)?

Activities of Daily Living (ADLs) are fundamental tasks required for self-care and independent living. These tasks include:

1. Bathing: The ability to wash yourself in the bathtub, shower, or by sponge bath.
2. Dressing: The ability to put on and take off clothing.
3. Eating: The ability to feed yourself.
4. Transferring: The ability to move in and out of bed, chair, or wheelchair.
5. Toileting: The ability to get to and from the toilet, use it appropriately, and clean oneself.
6. Continence: The ability to control bladder and bowel functions or manage incontinence effectively.

These ADLs are the basic criteria used by long-term care insurance policies to determine eligibility for benefits.

How ADLs Trigger Long-Term Care Insurance

Most long-term care insurance policies require that the policyholder be unable to perform a certain number of ADLs before benefits are triggered. Typically, this number is two or three ADLs. Here’s how it works:

1. Assessment: When you file a claim, an assessment is conducted by the Right at Home nurse to evaluate your ability to perform ADLs. Our nurse will coordinate this assessment with your insurance company.
2. Eligibility Criteria: The assessment will determine if you are unable to perform the required number of ADLs as specified in your policy. For example, if your policy requires the inability to perform two out of six ADLs, the assessment nurse will check if you meet this criterion.
3. Benefit Activation: Once the inability to perform the specified number of ADLs is confirmed, your benefits are activated. This means that your insurance company will start covering the costs of long-term care services as outlined in the policy.

Conclusion

Understanding the role of ADLs in triggering long-term care insurance policies is essential for making informed decisions about long-term care planning. If you or a loved one may need long-term care in the future, reviewing your insurance policy and familiarizing yourself with the ADLs and eligibility criteria can help ensure you receive the necessary support when the time comes.

Long-term care is about preserving dignity and quality of life, and knowing how your insurance policy works is a critical step in achieving that goal. Right at Home North and Central Queens is here to help. If you have any questions or need further information, contact us today at 516-513-1070.