According to medical and insurance companies, long term care is deemed necessary if someone cannot perform 2 of the 6 ADLs or has a severe cognitive impairment.

ADL is an acronym commonly used when talking about long term care. It stands for Activities of Daily Living. And in our insurance glossary, we define it as:

Daily self-care activities: bathing, dressing, eating, continence, toileting, transferring. A person's ability or inability to perform these ADLs is used to measure his/her functional status. To receive benefits from a long term care insurance (LTCi) policy (or Hybrid Life/LTCi or Hybrid Annuity/LTCi), most companies require that insureds be unable to perform at least two of the six ADLs.

Severe cognitive impairments include Alzheimer’s disease and other forms of dementia.

Whether it’s the ADLs or a cognitive issue, the diagnosis can mean a loss of independence for the individual. Most people prefer to stay in their own home for as long as possible.

A long term care insurance policy will allow your clients to maintain some independence. How?

Medicare: requires you to enter a skilled nursing facility within 30 days after a hospitalization of at least 3 days to receive benefits . Benefits for nursing home and home health services are limited.

Medicaid: requires a level of care equivalent to that received in a nursing facility.

Long term care insurance policy: typically covers skilled, intermediate, and custodial care in state-licensed nursing homes; home care services like skilled or non-skilled nursing care, physical therapy, homemakers, and home health aides provided by state-licensed and/or Medicare-certified home health agencies; assisted living, adult daycare, and other care in the community; alternate care (non-conventional care and services developed by a licensed health care practitioner that serve as an alternative to more costly nursing home care for special medical care and treatments, different sites of care, or medically necessary modifications to the insured’s home like ramps for wheelchairs or kitchen/bath modifications); respite care for the caregiver.