When the general population considers the concept of long-term care, I would venture to say that this concept is closely associated with medical care. This association can lead to misconceptions about where and how long-term care is provided, when it is needed, and who pays for it. Essential to an understanding of long-term care and its components are criteria which in the industry are called ADLs, or Activities of Daily Living. Identification of an individual’s level of functioning in relation to these criteria can help families and professionals determine appropriate types of services and methods of payment for these services.
There are six primary ADLs which are necessary for personal functioning.
- Bathing
- Dressing
- Eating
- Transferring
- Toileting
- Continence
The first three are easily understood. Transferring means the ability to move oneself from a bed to a chair, from one chair to another, etc. This skill is used instead of walking (or ambulation) to assess mobility. Toileting and continence may initially be seen as the one and the same, however toileting refers to the ability to physically use a commode for elimination, while continence is the ability to recognize the need for elimination (bladder and/or bowel) and maintenance of control of the actual process.
There are many other tasks that people perform each day which contribute to health, safety, and the management of personal/social responsibility. These tasks are often referred to as IADLs, or Instrumental Activities of Daily Living. Examples of IADLs include housekeeping, meal preparation, shopping, transportation, taking medications, financial tasks such as paying bills or balancing the checkbook, caring for pets, and using a telephone. For older adults, care needs often begin with IADLs.
The provision of assistance with ADLs and IADLs is not considered medical care; instead, it is often called custodial care. For this reason, the cost of long-term care is not covered by Medicare, which is a form of medical insurance. For those who qualify financially, the cost of long-term care may be covered by Medicaid (also known as Medical Assistance), but one must reside in a nursing home to receive fully paid 24-hour care, and a physician and the Office of Aging must verify that the individual requires a certain level of assistance with ADLs.
For those who require minimal to moderate assistance with their ADLs and IADLs, long-term care can be provided by home care agencies, personal care homes, assisted living facilities, and adult day care services. These types of care are usually private pay, but may be covered by some long-term care insurance (LTCI) policies. LTCI policies often contain language that an individual must require assistance with at least two ADLs in order for the policy to pay for care services. Read the policy carefully, because if the individual only needs assistance with IADLs, the services may not be covered. Also, the type of provider may impact coverage eligibility. For older adults without the financial means to pay for care, waiver programs exist which are able to provide some assistance. The county Office of Aging will evaluate the individual’s ability to perform ADLs and IADLs as part of the application process. ADLs are also taken into consideration for a benefit available for wartime veterans and their spouses. The Aid & Attendance benefit is designed specifically to help cover the cost of long-term care.
The distinction between ADLs and IADLs is one aspect to consider in order to successfully advocate for a loved one who requires care. There are many other details which can influence a long-term care situation. The staff of Keystone Elder Law is happy to share our expertise. Please call our office (697-3223) for a free telephone consultation.
Karen Kaslow, RN