Sometimes the Path to Independence is Admitting You Need Help

In my years working with elderly clients navigating long-term care insurance claims, I've witnessed a recurring scenario that keeps many seniors from accessing the benefits they're entitled to receive. It's a situation born from understandable human pride, but one that ultimately works against their health and safety.

The Independence Paradox

I recently spoke with a woman whose long-term care insurance claim had been denied. When we discussed why, an illuminating pattern emerged. She couldn't bend over to tie her shoes, she could not put on a brassiere and she could not wear her favorite shirts with buttons—tasks that fall under what insurance companies classify as the dressing "Activities of Daily Living" or ADLs. Rather than acknowledge these limitations and accept help, she had adapted by wearing only slippers, not wearing a brassiere, and wearing outfits that she generally did not like. This in turn resulted in increased social isolation because she did not feel comfortable being seen in public.

While her adaptability shows remarkable resilience, it undermined her emotional health, her physical safety (as a fall risk) and ultimately her insurance claim. By avoiding the activity she clearly needs help with and accepting care, she appeared more independent on paper than she truly was in daily life.

Understanding Activities of Daily Living (ADLs)

Most long-term care insurance policies trigger benefits when the policyholder can no longer perform a certain number of ADLs independently. These typically include:

• Bathing

• Dressing (including activities like tying shoes)

• Toileting

• Transferring (moving from bed to chair, etc.)

• Continence

• Eating

Insurance companies often assess these activities not based on ability, but on what is actually happening. This can be problematic when care is needed but avoided. For instance if you cannot put on brassiere, or button your pants, and you receive assistance with those activities, an insurer will likely concede you need assistance with dressing. But if you start wearing slippers and a bath robe only, and do not get help putting these items on, they'll say you do not need assistance with dressing. 

The Adaptation Trap

Many seniors develop creative workarounds for their limitations:

• Wearing slip-on shoes instead of admitting difficulty with laces

• Not wearing undergarments such as bras or socks

• Taking sponge baths to avoid getting in and out of tubs

• Limiting fluid intake to manage bathroom trips

• Eating only certain foods to avoid cutting or chewing difficulties

These adaptations, while innovative, mask genuine needs during insurance company assessments and can lead to claim denials.

The Greater Independence

What many don't realize is that accepting help with specific activities can lead to greater independence overall. The benefits from a long-term care policy can provide:

• In-home care that allows aging in place rather than facility living

• Assistance with difficult tasks while maintaining autonomy in others

• Reduced burden on family members

• Improved safety and quality of life

If the insured accepts help getting dressed, she can wear the clothes that make her feel confident and comfortable socializing with others. This in turn improves quality of life. If an insured with a high fall risk accepts assistance getting in and out of the shower, rather than risking a catastrophic slip and fall alone in the bathroom, this can result in significantly lower risk of injury or death.

Moving Forward: Honest Assessment

If you or a loved one has long-term care insurance:

1. Be forthright about limitations during assessments, this is not the time to hide your care needs;

2. Document difficulties with your policy's ADLs specifically;

3. Focus on capabilities that truly exist, not on temporary workarounds; and

4. Remember that acknowledging needs isn't failure—it's self-advocacy and can ultimately lead to greater independence.

Sometimes the strongest demonstration of independence is knowing when to accept help. After all, the purpose of having insurance is to use it when needed. Those monthly premiums you've paid for years were an investment in your future care and independence. If you are refusing care that you need, which results in heightened fall risks or social isolation, you are destroying the value of your coverage.