Why Dressing Matters: Understanding ADLs in Long-Term Care Insurance Claims

Understanding Dressing as an Activity of Daily Living (ADL): Its Role in Long-Term Care Insurance Eligibility

Dressing is classified as an activity of daily living (ADL); it’s vital for maintaining independence, dignity, and quality of life. The inability to dress signals the a need for additional supportive care.

Long-term care insurance policies are designed to provide financial assistance for care when an individual is unable to perform ADLs due to illness, physical limitations often due to aging or disability. Insurance providers use ADLs as a standardized method to assess eligibility for coverage. When policyholders are evaluated, their ability to complete these activities independently is tested, often through medical examinations or assessments by healthcare professionals.

Most long-term care policies require that an individual be unable to perform at least two of the six ADLs to qualify for benefits.

The Six Core ADLs

Here are the six universally recognized primary ADLs:

1. Bathing – The ability to wash oneself all over for maintaining personal hygiene. This also includes getting in and out of a tub or shower.
2. Dressing – The capability to select appropriate clothing and put it on properly and take it off with ease.
3. Eating – The act of feeding oneself, not necessarily including food preparation. This is often described as using a spoon or fork and moving it from the food on a plate to one’s mouth and to repeat the process.
4. Toileting – The ability to get to and from the toilet, use it appropriately, and manage personal hygiene. Cleaning-up well after going is key.
5. Transferring – Moving from one position to another, such as getting in and out of bed or a chair.
6. Continence – The ability to control bladder and bowel functions or manage personal hygiene if control is lost.

Dressing specifically refers to the ability to put on and take off clothing and footwear in an appropriate and coordinated manner. This task requires a combination of fine motor skills, visual-motor coordination, bilateral hand use, pinch and grip strength, and cognitive abilities such as sequencing and problem-solving. Dressing involves managing fasteners like buttons and zippers, choosing weather-appropriate clothing, and ensuring garments are worn correctly and safely.

Being able to dress oneself is a marker of personal independence. It allows individuals to maintain control over their appearance, express their identity, and participate fully in daily life. When someone loses the ability to dress independently—due to illness, injury, or age-related decline—it often signals a need for additional support or care.

Why Dressing is an ADL:

• Essential for Independence: The ability to dress oneself is a key marker of independence. When individuals can choose and put on their own clothing, they retain control over their appearance and personal routines, which is crucial for self-esteem and autonomy. Losing this ability often signals a need for increased care or support.
• Complex Skill Set: Dressing is not a simple task; it requires the integration of multiple physical and cognitive skills, including:
  • Fine motor skills (manipulating buttons, zippers, or laces)
  • Gross motor skills (balancing on one foot to put on pants or socks)
  • Coordination and planning (sequencing the steps, choosing appropriate clothing)
  • Visual and perceptual abilities (identifying clothing, matching items)
  • Tactile sensation and body awareness (feeling for sleeves, knowing limb positions)
• Indicator of Functional Status: Health professionals often assess a person’s ability to dress independently as a measure of their overall functional status and level of care required. Difficulty with dressing can reflect underlying issues such as physical disability, cognitive impairment, or mental health challenges.
• Promotes Dignity and Well-being: Dressing oneself is closely tied to personal dignity and self-worth. Being able to select and wear preferred clothing allows for self-expression and contributes to psychological well-being. Dependence on others for dressing can lead to feelings of vulnerability or loss of privacy.
• Safety and Health: Proper dressing is also important for health and safety. Wearing appropriate clothing protects the body from environmental hazards (cold, heat, sun), maintains hygiene, and can prevent injuries (such as falls from tripping on loose garments).
• Developmental Milestone: For children, learning to dress is a significant developmental milestone, reflecting growth in motor skills, independence, and readiness for broader social participation.

What is the Correct ADL Assessment for Dressing?

The correct ADL assessment for dressing consists of evaluating an individual’s ability to independently select, retrieve, and put on appropriate clothing, as well as remove it, considering both physical and cognitive aspects.

There are several standardized tools and structured approaches are commonly used in clinical and care settings which rate ability as: completely able, able with aids/difficulty, able with helper, or unable. Considers fine motor skills, strength, and ability to use aids.

Other Assessment Tools Include:

Katz Index of Independence in Activities of Daily Living (ADL) Assesses six functions including dressing. Rates independence (yes/no) for each activity.

Barthel Index Evaluates ten basic ADLs including dressing. Measures degree of assistance required.

Functional Descriptions (as used by case managers)

Assessment Steps Are:

• Observe or ask the individual to demonstrate dressing tasks.
• Document if the person:
  • Completes the task independently and efficiently.
  • Needs adaptive equipment or takes extra time.
  • Requires physical or verbal assistance.
  • Is unable to perform the task or is fully dependent.

Additional Considerations:

• Assess cognitive ability for sequencing and decision-making.
• Note any safety concerns (e.g., risk of falls, improper clothing for weather).
• Include the use of prosthetics or orthotics if relevant.

Purpose of Assessment:

• Determines the level of support required.
• Informs care planning and eligibility for services.
• Tracks changes in functional status over time.

Understanding Activities of Daily Living is fundamental for anyone considering long-term care insurance. These routine tasks are more than just daily habits; they are vital indicators of health and independence. For insurance providers, ADLs serve as a clear, standardized measure to determine the necessity and scope of care. For individuals and families, awareness of ADLs can help in planning for future healthcare needs, ensuring that proper support is available when it is needed most.

A long-term care insurance attorney can help you with your claim and can improve your chances of getting paid the benefits you paid for by premium dollars.

Hiring an experienced long-term care attorney for your denied long-term care claim can greatly improve your chances of winning. Attorneys understand the complexities of both medical evidence and insurance policy language, enabling them to build a strong case, manage communications with insurers, and handle appeals if necessary. By ensuring that every aspect of your claim is addressed correctly, an attorney can help you secure the benefits you deserve.

If your long-term care claim has been denied call Jonathan Feigenbaum 617-357-9700 today for a complimentary review of your claim. He is there to help you.