Qualifying for Long-Term Care
LTCI contracts have two distinct benefit triggers—a loss of physical function or the existence of cognitive impairment.
Loss of the Ability to Perform Two Activities of Daily Living (ADLs) The inability to perform two or more of six physical functions is collectively defined as the basic activities of daily living (ADLs). The six recognized ADLS include the following (1) Bathing (2) Dressing (3) Toileting (4) Transferring (5) Continence (6) Eating.
Policies will pay benefits if the insured is unable to perform two or more of these tasks without substantial assistance. The NAIC defines substantial assistance as including either hands-on or physical assistance or even stand-by assistance. Stand-by assistance means that a caregiver is physically within arm’s reach of the insured and can provide hands-on assistance if needed.
Cognitive Impairment The NAIC Model Regulation regarding long-term care insurance defines a “cognitive impairment” as a deficiency in a person’s:
- Short or long-term memory
- Orientation as to person, place, and time
- Deductive or abstract reasoning, or
- Judgment as it relates to safety awareness
LTCI specifically covers conditions related to organic neurological disorders related to diseases of aging. Some well-known conditions that result in cognitive impairment are Alzheimer’s disease (ALZ), Parkinson’s disease, and non-ALZ senile dementia. Individuals also experience damage to their cognitive ability from other causes that are not necessarily related to aging, such as strokes and accidental brain injuries.
