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ADLs and Long-Term Care Insurance: What Caregivers and Families Need to Know

When planning for long-term care, understanding the concept of Activities of Daily Living (ADLs) and their role in long-term care insurance is essential. ADLs serve as a benchmark for determining care needs and are often the criteria insurance companies use to assess eligibility for benefits. In this article, we’ll explore what ADLs are, their importance, and how they intersect with long-term care insurance to help you make informed decisions.

What Are Activities of Daily Living (ADLs)?

ADLs refer to basic tasks that an individual needs to perform to live independently. They are divided into two categories:

  1. Basic ADLs (BADLs):

    • Bathing: The ability to wash oneself, including getting in and out of the shower or tub.
    • Dressing: Choosing appropriate clothing and dressing oneself.
    • Eating: Feeding oneself, including using utensils and managing food.
    • Toileting: Managing hygiene and continence.
    • Mobility: Moving from place to place, including getting in and out of bed or a chair.
  2. Instrumental ADLs (IADLs): These involve more complex skills necessary for independent living, such as:

    • Managing medications.
    • Handling finances.
    • Preparing meals.
    • Performing housework.
    • Using transportation.


Long-term care (LTC) insurance typically starts paying out after the policyholder meets the following conditions:

  1. Inability to Perform ADLs: The policyholder is unable to perform two or more Activities of Daily Living (ADLs) (e.g., bathing, dressing, eating) or has a cognitive impairment requiring supervision.

  2. Elimination Period: Most policies have a waiting period (commonly 30-90 days) after care begins, during which the policyholder must cover expenses out-of-pocket before benefits kick in.

  3. Certification of Need: A healthcare provider must certify that the policyholder requires long-term care services.

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ADLs and Long-Term Care Insurance

How ADLs Determine Care Needs

When an individual can no longer perform two or more ADLs without assistance, they may require long-term care. This can include in-home care, assisted living, or nursing home care. ADL assessments are typically performed by medical professionals or care coordinators.

Long-Term Care Insurance and ADL Triggers

Long-term care (LTC) insurance policies are designed to provide financial support for care services when individuals can no longer perform specific ADLs on their own. Key points to know:

  • Eligibility: Most LTC insurance policies require the inability to perform two or more ADLs to activate benefits.
  • Care Settings: Coverage may include care in various settings, such as at home, in an assisted living facility, or a nursing home.
  • Elimination Period: There’s often a waiting period (e.g., 30-90 days) before benefits begin, during which the policyholder is responsible for covering costs.

While the Certification of Need can often be provided by the nurse employed by the long-term care insurance (LTC) company, having a doctor's certification or documentation from a trusted care agency in advance can strengthen your claim and streamline the process.

Why Understanding ADLs Is Crucial

  1. For Care Planning: Knowing which ADLs your loved one struggles with helps identify the level of care they need.
  2. Insurance Claims: Proper documentation of ADL limitations is essential for filing claims with LTC insurance providers.
  3. Preventing Caregiver Burnout: Recognizing ADL-related needs early allows caregivers to seek appropriate support and resources.

Navigating Long-Term Care Insurance Policies

What to Look For in a Policy

  • Comprehensive Coverage: Does the policy cover in-home care, assisted living, and nursing home care?
  • Flexibility: Look for policies that allow care in a variety of settings.
  • Benefit Caps: Be aware of daily or lifetime benefit limits.
  • Inflation Protection: Ensure the policy keeps up with rising care costs.

Common Exclusions

Some policies may exclude coverage for certain conditions (e.g., pre-existing conditions) or specific types of care. Always read the fine print.

The Role of ADL Assessments in Claims

When filing a claim, insurance companies will often require an assessment of the policyholder’s ADLs. This may involve:

  • A physical evaluation by a licensed healthcare professional.
  • Documentation from caregivers or medical providers.

Tips for Families and Caregivers

  1. Start Early: Long-term care insurance is often more affordable when purchased at a younger age.
  2. Understand Policy Terms: Work with an insurance professional to fully understand the ADL criteria and coverage limits.
  3. Document Everything: Keep detailed records of your loved one’s ADL limitations and care needs to simplify the claims process.
  4. Seek Professional Help: Consult a financial advisor or elder care specialist for personalized advice.


Age Well Care: Supporting Your ADL Needs

At Age Well Care, we specialize in providing in-home care that supports independence while addressing ADL needs. Whether your loved one requires assistance with bathing, mobility, or meal preparation, our compassionate caregivers are here to help.

Planning for long-term care can be overwhelming, but you don’t have to navigate it alone. 


Contact us today at 805-900-0829 or email us at contact@agewell.care  to learn how we can support your family in creating a personalized care plan.

Empower your loved one to age with dignity, comfort, and confidence.