Riverside, OC & San Bernardino Social Security Disability Attorneys
ACTIVITIES OF DAILY LIVING
What Are Activities of Daily Living?
Activities of Daily Living (ADLs) are basic tasks that a person must accomplish every day. There are twelve generally recognized Activities of Daily Living. They include: (1) personal hygiene (bathing, grooming, oral, nail and hair care), (2) continence management (a person's mental and physical ability to properly use the bathroom), (3) dressing (a person's ability to select and wear the proper clothes for different occasions), (4) feeding (a person's ability to maintain nutrition), (5) ambulating (a person's ability to change from one position to the other and to walk independently), (6) companionship and mental support (to keep a person in a positive frame of mind), (7) transportation and shopping (to procure grocery and pharmacy needs without help), (8) preparing meals (planning and preparing the various aspects of meals, including shopping and storing groceries), (9) managing a person's household (cleaning, tidying up, removing trash and clutter, and doing laundry and folding clothes), (10) managing medications (getting prescriptions filled, keeping medications up to date and taking meds on time and in the right dosages), (11) communicating with others (phones and mail and generally making the home hospitable and welcoming for visitors), and (12) managing finances (managing bank balances and checkbooks and paying bills on time).
Many disability policies provide benefits for caregiver home health services if “you need human assistance or continued supervision in order to perform two or more Activities of Daily Living, or, you require continued supervision due to a Cognitive Impairment.”
The ability to care for ourselves and live independently at home depends on how well we can manage our ADLs. That's something most of us take for granted, until we can no longer do them and require assistance.
Funding Sources for Long-Term Care
Unfortunately, the Medicare program does cover long term care whether at home or in facilities. Therefore, Medicare will not reimburse for expenses related to in-home caregivers that help with ADLs.
Medicaid (“Medi-Cal”) covers long-term care services but requires a “needs test” that is usually referred to as the “Comprehensive Assessment and Review for Long Term Care Services” (CARES). If a person requires help with at least three ADLs, then Medi-Cal may approve the highest level of care.
Private long-term health insurance policies typically have two “benefit triggers” that include cognitive impairment or when a person requires assistance with at least two activities of daily living.
Denial of Benefits
If a long-term medical care insurer denies coverage, you may appeal the denial to the insurer, and if needed to the California Department of Insurance, 300 South Spring Street, South Tower, Los Angeles, CA 90033. Telephone 1.800.927.4357.