Learn the Lingo: What Are "Activities of Daily Living?"

When it comes to insurance claims, activities of daily living are actually really important. But what are they? And why are they so important?

What Are the Activities of Daily Living?

According to the Centers for Medicare & Medicaid Services (CMS), the 6 activities of daily living include the following:

1. Bathing or showering
2. Dressing
3. Getting in and out of bed or a chair
4. Walking
5. Using the toilet
6. Eating

If a person can’t do one of these activities without help, they are deemed to have a limitation in that activity.

So, in sum, the activities of daily living are 6 tasks we all need to do to keep ourselves alive and in good hygiene.

According to a recent survey from the CDC, about 20% of seniors ages 85+ need help with person care from other persons.

They also learned from the survey that females are more likely to need care than men.

For example, 22.9% of females over age 85 need assistance, while 14.4% of males need assistance.

You also see this is other age groups, with 3.5% of females ages 65-74 needing help, while 2.9% of males need help.

But why is this concept so important?

Why Are the Activities of Daily Living Important?

If you can’t perform the activities of daily living, it has major implications on insurance:

1. You may not be approved for new insurance
2. If you’ve already purchased insurance, you may now qualify for the benefits

It’s critical that you talk with an insurance agent about insurance before it’s too late, because as soon as you need help with the activities of daily living, it can be difficult to find insurance that you still qualify for.

In essence, when you need help with the activities of daily living, you’d ideally be using the benefits from a policy you purchased in the past.

Being declined for insurance

If you can’t perform some of the activities of daily living, you’ll often be an automatic decline.

For example, some Medicare Supplement applications directly ask you about this:

“Do you currently need assistance bathing, transferring, toileting, eating, dressing, or are you bedridden?”

Without saying it, the application is asking if you have any trouble with the activities of daily living. If you answer “yes,” you’ll be automatically declined.

Other applications won’t ask this question, but the other questions will likely answer it for you. For example, if you need assistance with one of the activities of daily living, you likely are living in a nursing home, an assisted living facility, or are receiving home health care services.

In these cases, you’ll be declined when you answer “yes” to these types of questions:

“Are you currently confined, scheduled for admission, or in the last two years have you been confined to a nursing facility or assisted living facility?”

“Do you currently receive home health care services or, in the last two years, have you received home health care services for more than three separate periods of care?”

Another examples comes from a life insurance application, which asks the following question:

“Does the Proposed Insured currently use a wheelchair due to a chronic illness or disease, or require assistance with activities of daily living such as bathing, dressing, eating or toileting?”

Questions like these that are answered “yes” will cause the application to be declined.

Insurance you may still be approved for

While it’ll be difficult to be approved for many types of insurance, including life insurance and Medicare Supplements, all is not lost if you do need help with the activities of daily living.

For example, Guaranteed Issue (GI) policies do not require you to pass any underwriting questions, meaning your health is not taken into account at all.

There are certain types of life insurances that are Guaranteed Issue, and there are certain situations when a Medicare Supplement could be Guaranteed Issue as well.

It’s important to talk with an agent if you’re interested in getting insurance – even when it seems like there are no options, there may still be a way to get insured.

Our resident expert on annuities and life insurance, Kirk Sarff, explains, “Depending on the the face amount and need, there is always a life insurance policy available for anyone.”

Qualifying for insurance benefits

The reason we buy insurance is often to protect our finances if we do need help with the activities of daily living.

Read about how much skilled care really costs → https://www.samshockaday.com/resources/is-long-term-care-insurance-worth-it

These 3 insurance plans will help pay for a skilled nurse to take care of you if you need assistance:

1. Long-term care insurance
2. Short-term care insurance
3. Life insurance with a long-term care rider

All three of these plans have a benefit that can be used as soon as you can verify that you need help with 2 out of the 6 activities of daily living.

As a reminder, here is an activities of daily living list:

1. Bathing or showering
2. Dressing
3. Getting in and out of bed or a chair
4. Walking
5. Using the toilet
6. Eating

So, as an example, a short-term care policy comes with a daily nursing facility benefit, which includes assisted living. In order to receive that benefit, you must prove one of the following:

• You can’t perform, with the hands-on assistance of another person, 2 or more of the Activities of Daily Living, or
• You have a Cognitive Impairment.

This is a very standard qualification for all insurance plans that come with some type of nursing home or skilled care benefit.

Activities of Daily Living Checklist

If you’re not sure how to determine whether an individual needs assistance, PBS.org has put out a checklist that can help.

After filling it out, you might notice that your loved one needs more care than you thought, and vice versa.

You can download that checklist here: https://www-tc.pbs.org/wgbh/caringforyourparents/handbook/pdf/cfyp_adl_checklist.pdf

Check out the other posts in this series:

1. Learn the Lingo: What does “Guaranteed Issue” mean?
   
2. Learn the Lingo: What does “Attained Age” mean?