Understanding the purpose and role of Activities of Daily Living in regards to long-term care will make it easier to get the help you or a loved-one needs. This includes benefits that can pay for care, like Aid & Attendance.
Activities of daily living (ADLs) refers to daily tasks that a person normally executes without assistance. The term originated during the 1950s as a way of evaluating an individual’s ability to function in life. When someone cannot perform these activities, they are no longer able to care for themselves.
The Five Activities of Daily Living
There are five types of daily living activities: dressing, bathing, eating, toileting and transferring.
Dressing is the individual’s ability to dress themselves, but can also include reminders to dress and picking out clothes.
Bathing is any assistance needed with washing the body, such as getting in and out of a tub or shower, adjusting shower heads or changing water temperature. It can also include stand-by assistance when the person is considered a fall risk.
Eating refers to feeding someone, pureeing their food so it can be eaten or reminders to eat. It does not include cooking or meal preparation. Ensuring a person is eating nutritiously may also apply depending on the situation.
Toileting is any type of toilet hygiene. It includes getting to the toilet, cleaning oneself or getting up from the toilet. Any assistance needed with incontinence (lack of voluntary control over urination or defecation) is also considered help with toileting.
Transferring is movement from one place to another. It typically refers to assistance getting in and out of a bed or chair, but can also include help up and down stairs or in and out of a vehicle.
The Katz Activities of Daily Living Assessment
The concept of ADL measurement and the first activities of daily living assessment tool (Katz Index of INdependence in Activities of Daily Living) was developed by physician and scientist Sidney Katz more than 50 years ago. It is still used today as a way of determining a person’s independence versus dependence.
One (1) point is given for each daily living task that an individual can complete, and 0 points are given if the activity cannot be completed. A person who scores 6 is considered independent, while a score of 0 means the person is very dependent.
IADLs – Instrumental Activities of Daily Living
ADLs measure many key activities needed for independent living. An additional list of daily living activities called Instrumental Activities of Daily Living (IADLs) includes more complex independent living tasks.
- Meal preparation
- Using a telephone
- Managing personal finances
- Taking medication
ADLs and Long-Term Care
ADLs are a type of disability classification that determines the basic care needs of an individual. When a person cannot perform one or more types of daily living activities, they will usually need long-term care such as in-home care, assisted living or skilled nursing facility care.
ADL Home Care
Millions of individuals currently receive some type of home care due to illness, disability or cognitive impairment. Many are seniors who need assistance with ADLS, IADLs or both. With ADL home care, a person with care needs can live independently for a longer period of time.
The average pay for a home caregiver is $14 to $24 per hour. Daily rates range from $113 to $192 per day. A home care aid hired through an agency will often have a 2 to 4 hour per visit minimum charge.
Paying for care out-of-pocket can be expensive, especially as care needs increase. Some health insurance and long-term care insurance polices may help cover some or all o f the cost of home caregiver.
Medicare also offers home care assistance depending on the circumstance, but only for a short period of time.
A person with a very low income and limited financial resources may be able to qualify for Medicaid’s waiver program, which provides home and community-based services. Unfortunately, even if you meet Medicaid waiver requirements, you may end up on a waiting list to get the benefit.
If you are a veteran or the spouse of a deceased veteran, the Veterans Administration’s Aid & Attendance benefit is another way to cover caregiving expenses. The benefit is a reimbursement for care that can pay up to $2,846 per month to qualified individuals who need help with daily living activities. Other Aid & Attendance requirements include the veteran having served during an eligible period of war.
ADL Assisted Living and Skilled Nursing Care
Because care needs often increase over time, a person receiving home care will eventually transfer to an assisted living or skilled nursing facility.
Assisted living facilities provide long-term care for seniors who need ADL and other types of support. Facility services typically include medication management, meals, transportation and help with bathing and dressing, as well as social and recreational activities.
According to a study conducted by the National Center for Assisted Living, the average resident of an assisted living facility will need help with at least 2 ADLs, with 72% requiring assistance with bathing and 57% requiring assistance with dressing.
Individuals who can no longer perform any ADLs will usually require skilled nursing facility care.
Care facility costs generally range from $2500 to $4000 a month for assisted living, $4,000 to $6,000 a month for memory care and $7000 or more a month for skilled nursing.
Long-term care insurance can help pay for an assisted living or skilled nursing facility, either as a reimbursement or on a per diem basis. Most policies can be activated when the person can no longer perform two out of the five types of ADLs.
The VA Aid & Attendance benefit also provides financial assistance to qualified veterans and spouses who are transitioning into a care facility.
Medicaid will pay for long-term (custodial) care in a facility as well, but the program has strict financial requirements.
Activities of Daily Living and the VA Aid & Attendance Benefit
Aid & Attendance is a lifetime, tax-free benefit for qualified veterans and surviving spouses who need help with some of the activities of daily living. The benefit can be used to help pay for home care, board and care, assisted living and a skilled nursing facility.
When filing a claim, you will need to provide evidence that the claimant (veteran or spouse) needs ADL assistance. Properly documenting the need for care is extremely important. If it isn’t done correctly, the claim will be denied.
We often get calls from people asking if the benefit will cover the cost of IADL help, especially tasks like medication management, meal preparation, housework and transportation. Aid & Attendance is almost exclusively a reimbursement for assistance with personal care. On rare occasions a person living in a care facility who needs IADL support may qualify for the benefit, but only under very specific circumstances.
An American Veterans Aid benefit consultant can explain more about ADLs and the VA Aid & Attendance benefit. Contact us today for a free consultation.