Activities of Daily Living Defined

Most policies use your inability to perform certain "activities of daily living" (ADLs) as one trigger to determine if you are eligible for policy benefits. The ADLs include (1) bathing; (2) continence; (3) dressing; (4) eating; (5) toileting and (6) transferring. Before paying benefits, insurers usually require certification by a physician or licensed health care practitioner that you cannot perform certain ADLs because of physical or cognitive impairments. Most long term care insurance policies will pay benefits when you cannot do 2 out of 6 of the activities of daily living, but this number will be determined by your policy.

Another hurdle that insurance companies can put up is to require hands-on assistance to perform an ADL. In other words, some policies will not count an ADL toward the benefit trigger unless you need actual hands-on assistance. Other policies will count an ADL as long as you need stand-by assistance. Obviously, it is harder to qualify for benefits if you have a policy that requires hands-on assistance.

In addition, it is easier to claim benefits if you have a policy that recognizes more than five ADLs. It is also easier to claim benefits if your policy recognizes bathing as one of the ADLs since this is usually the first ADL that a person cannot do. Your policy will define ADLs as the relate to your coverage. The following definitions are not intended to take the place of what your policy says. They are merely to help explain what may be covered under each activity.

Activities of Daily Living (ADLs)

• Bathing Washing yourself by sponge bath; or in either a tub or shower, including the process of getting into and/or out of the tub or shower.


• Continence
  Ability to maintain control of bowel and bladder functions; or when unable to maintain control of bowel or bladder functions, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).


• Dressing
  Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs. This includes buttoning buttons and tying shoes.


• Eating
  Ability to, without the aid of another person, maintain an adequate food and fluid intake consistent with dietary needs.


• Toileting
  Getting to and from the toilet, getting on and off the toilet and performing associated personal hygiene.


• Transferring
  Moving into or out of a bed, chair or wheelchair. Transferring does not include the task of getting into or out of the tub or shower.