Serving Orange County & the Coachella Valley · CA Licensed HCO #304700544
Activities of daily living and how benefit triggers work
Most long-term care policies pay benefits when the insured needs substantial assistance with a defined number of activities of daily living — usually two of six — or has a severe cognitive impairment as the policy defines it. The six are bathing, dressing, toileting, transferring, continence, and eating. The exact definition and threshold are set by the policy.
The six activities
- Bathing — washing safely in a tub or shower, including getting in and out.
- Dressing — putting on and removing clothing and any braces or limbs.
- Toileting — getting to and from the toilet and managing hygiene.
- Transferring — moving between bed, chair, and standing.
- Continence — maintaining control, or managing a catheter or colostomy.
- Eating — getting nourishment into the body, by any means.
Cognitive impairment as a separate trigger
A person with dementia may still be physically capable of dressing and bathing and yet be unsafe alone. Most policies address this with a separate severe cognitive impairment trigger, evaluated through standardized testing and reports of behavior — wandering, leaving appliances on, missed medications, disorientation at night.
How to describe need accurately
- Describe the ordinary day, not the best day.
- Use specifics: "cannot step over the tub wall without a hand" rather than "trouble bathing".
- Note how often standby help is needed, not just hands-on help.
- Include the near-misses — falls, burns, missed doses, night wandering.
- Do not exaggerate. An inaccurate picture undermines the whole file.
I have a policy and need home care
Request a no-cost policy review conversation, or call and speak with someone who has handled long-term care documentation before.
Common questions
Keep reading
Official resources
Contact the company directly for current claim forms and instructions.
Information last reviewed: August 2026