As we get older, it may become more difficult to complete certain tasks like walking up and down the stairs, doing the laundry, taking a shower or getting dressed in the morning. Medicare doesn’t usually pay for someone to assist you with these tasks known as activities of daily living (ADL), but there are other ways you may be able to get help.
In this review, we define activities of daily living and explore what Medicare does – and doesn’t – cover. Knowing what resources are available in your area can help you live independently for as long as possible.
ADLs are personal care-related activities most people perform daily. These include eating, bathing, dressing, toileting and moving from one place to another.
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When you need help with these daily tasks but don’t need other more extensive health care support, the help with your activities of daily living is referred to as custodial care.
No, Medicare doesn’t typically cover long-term custodial care if that’s the only care you need. Medicare may, however, cover short-term custodial care (e.g., after an illness, injury or surgery) if requested by a medical professional and paired with skilled nursing care.
There are several important differences between skilled nursing care and custodial care.
During your Initial Preventive Physical Exam (often referred to as your “Welcome to Medicare” physical exam), your doctor will likely ask you medical questions as part of a health risk assessment to determine your ability to perform activities of daily living.
They will also assess your ability during Medicare Annual Wellness Visits and as needed thereafter.
One thing you can do is purchase a private, long-term care insurance plan or supplemental Medicare coverage.
Some Medicare Advantage (Medicare Part C) plans, for example, may provide in-home assistance with activities of daily living to prevent and/or delay the need for nursing home care.
Some Medicare beneficiaries may qualify for Medicaid which can cover custodial care.
Medicare PACE programs (Programs of All-Inclusive Care for the Elderly) offer a model of care called Managed Care at Home or LIFE (Living Independence for the Elderly) programs in some states. PACE covers all Medicare- and Medicaid-covered programs and services as well as other medically necessary care, including home care, some nursing home stays and more.
There might also be state-funded, non-Medicaid programs available in your area. Ask your doctor for more information. You can also visit your state-specific Office for the Aging website to find resources in your area.
Talk to your doctor who may be able to prescribe durable medical equipment or suggest other solutions that can help you function more easily.
For example, something as simple as a toilet seat riser, prescription drug organizer, bed rail or walker can be a big help. The good news is that Medicare Part B may even cover medically-necessary durable medical equipment (DME), meaning you’d typically be responsible for Part B deductible ($203 in 2021) and 20% of the Medicare-approved amount. Note that Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare.
Learn more about how Medicare Advantage plans can cover all of your Part A and Part B benefits, and many Medicare Advantage plans offer extra benefits that Original Medicare doesn't cover. These extra benefits can include things like prescription drug coverage, allowances for over-the-counter (OTC) items, transportation to doctor's office visits and more.
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Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.
Lisa studied creative writing at Hamilton College and obtained a master’s degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.
Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.
LinkedIn: Lisa Eramo