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Long-Term Care Awareness - ADLs and IADLs

Perspective Matters

November is Long-Term Care Awareness Month (or Long-Term Care Insurance Awareness Month, take your pick.) Either way it's a good time to talk about a subject that makes many of us uncomfortable - the increasing need for help we all face as we age.

Planning for aging-in-place or long-term care is emotionally fraught; none of us wants to contemplate losing independence as we age. The reality though is that since more of will live into our 80s and 90s than ever before in human history, the best way to preserve as many choices as possible for as long as possible is to assume we will all need some help and educate ourselves before we are faced with urgent and unpleasant choices and decisions.

Previously I wrote about improving general awareness about options for aging-in-place. Future posts will discuss different levels of care and explore ways to maintain your financial independence as you age. Today I am going to talk about some of the specific areas of help with activities we mean when we talk about long-term care and aging-in-place.

You may have heard the term “Activities of Daily Living,” or ADLs for short. These are a widely accepted list of the types of activities we all need to be able to do for ourselves in order to live independently. They are:

  • Bathing - maintaining personal hygiene, such as bathing or showering, and including oral care, nail care and other aspects of personal grooming.

  • Dressing – both choosing appropriate clothing and physically dressing/undressing oneself.

  • Eating – preparing meals is not included in this, only feeding oneself.

  • Maintaining continence – this refers to both the mental and physical requirements of properly and hygienically using a restroom (being incontinent is categorized as meeting the need for substantial assistance with an ADL).

  • Transferring – this is about mobility; being able to get yourself in and out of bed, being able to stand up from a sitting position, and being able to walk independently from one location to another (including from one room in your home to another).

Whether you are reviewing eligibility for benefits under a long-term care insurance policy or simply speaking with a potential home care service provider, you should be familiar with this list. Typically, the standard of needing “substantial assistance” with at least two of the six (including incontinence) with trigger eligibility for insurance benefits, so many geriatric case managers think in terms of assessing our needs based on these ADLs.

Assistance with these ADLs is intimate and personal out of necessity. As uncomfortable as it may be to imagine ourselves needing this kind of help, 2 out of 3 of us will. From whom we receive this help can have a significant impact on our quality of life, so putting a plan in place before you need help can reduce the risks of having a less desirable solution forced on you.

In addition to ADLs, there are IADLs (or Instrumental Activities of Daily Living) to consider. They are:

  • Basic communication skills – using the phone, email or internet.

  • Transportation – including driving yourself, arranging rides and/or using public systems.

  • Meal preparation – not only planning the meal, cooking and cleaning up but also storing food properly and safely using kitchen utensils.

  • Shopping – making appropriate food and clothing purchases.

  • Housework – everything from doing laundry to dusting and vacuuming (can you keep your home clean on your own?)

  • Managing medications – if you are taking more medications as we age, remembering what to take, when to take them and how to take them can become overwhelming.

  • Managing personal finances – not only paying your bills and staying within your budget, but also avoiding scams.

Like ADLs, we don’t know if we will need a little help with some of these IADLs or perhaps a lot of help with a few. Needing assistance with IADLs won’t necessarily make us eligible for benefits under a long-term care insurance policy, but help is available from people who specialize in helping seniors with these activities.

When we reach a point of needing substantial assistance with any of these, it is time to think about getting some help. You may have a family member who can help with your care, but keep in mind that it’s important to have a back-up plan as well. What if that person gets sick? Geriatric Case Managers, Estate Planning Attorneys, and Certified Financial Planners® who specialize in serving retirees will often be a good source of suggestions for people who can help with both ADLs and IADLs.

Although none of us knows what the future holds, the Administration on Aging has published some important statistics here. There is also an important glossary of key terms here. Since it is likely that 2/3 of us will need some sort of assistance as we get older, I encourage you to think about your own situation, and start planning sooner rather than later.

I believe that financial planning is about making sure the right person in your life has the right cash to do the right thing at the right time, and done well, can give you the flexibility to react to the curve balls life will throw you. Since the future is unknown, why not try to preserve as many choices as possible for as long as possible?

One benefit of working with a Certified Financial Planner® is the ongoing continuing education we are required to complete. As our needs change, and the choices of how to address those needs evolve, having a relationship with someone who can help you plan for the future you want can give you peace of mind. We may not be able to control some of the ravages of age, but we may be able to have some control over how we navigate that journey.

Certified Financial Planner Board of Standards, Inc. (CFP Board) owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™, and CFP® (with plaque design) in the United States, which it authorizes use of by individuals who successfully complete CFP Board’s initial and ongoing certification requirements.


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