What Is Hands-On Assistance in Long-Term Care?

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Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

You may have heard the term hands-on assistance if your loved one is in long-term care and wonder why it’s important. Everything from the cost of care to deciding on the best care option and qualifying for long-term care insurance depends on hands-on care. Each entity may have a slightly different definition of hands-on care. Still, there are consistent activities that inform healthcare providers and insurance companies about the level of support that someone requires.

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As you become more familiar with the term, you can evaluate costs and qualifications for filing a long-term care insurance claim. Long-term care insurance companies are very particular about their criteria, so having a grasp of what they are looking for will give you the best chance of success. Part of decision-making around hands-on assistance is knowing how much your family is willing to provide and how much you or your loved one can pay for it.

No one wants hands-on care, but it can mean the difference between living safely and being at risk for a continued decline when it becomes necessary. Sometimes hands-on care can be a bridge to a meaningful recovery and improved quality of life. 

Definition of Hands-On Assistance

Hands-on assistance is the physical assistance of another person. It involves touch. Without this assistance, the person would be unable to do one or more activities of daily living (ADLs). ADLs are typically defined as dressing, bathing, walking (help to get up from a chair), eating, toileting, continence care, and hygiene. 

Stand-by assistance, companionship, cooking, and cleaning are not considered hands-on assistance. This is not to say that non-hands-on assistance isn’t essential; it is. Functioning well involves many activities, but unfortunately, insurance doesn’t pay for those services. Families usually pay privately or provide non-hands-on activities themselves to fill the gaps in care. 

Nursing tasks like wound care and blood pressure checks are not hands-on assistance since the care may be temporary once the condition is treated. In many cases, Medicare can pay for nursing services under the home health benefit.  Even medication management is not hands-on care.

However, Medicare home health days may count towards the elimination period defined by long-term care insurance. If a home health aide comes to the patient’s residence each week to help with ADLs, that is considered hands-on care.

When Is Hands-On Assistance Needed?

Several different conditions or circumstances could dictate when hands-on assistance is needed. In some cases, the need for this type of assistance could be temporary until functioning has returned to the extent that someone is independent again. Or, hands-on assistance could be an ongoing need. Here are some of the reasons hands-on assistance is needed.

General debility

As people age, they sometimes lose strength and endurance. The reasons for this type of decline are complicated, but if an older adult doesn’t exercise or complete a course of rehabilitation, then decreasing strength and mobility are likely to be the result. An illness or exacerbation of a medical condition can make it harder to rebound. A vicious cycle occurs where there is a weakness which makes it more challenging to regain function, which causes more weakness. 

Dementia

Dementia and Alzheimer’s disease are progressive conditions with no cure. In most cases, people get worse over time. Not everyone suffers physically, but those who do have balance, stiffness, and walking problems. On the mental side of dementia, someone can forget how to dress or forget to eat or bathe. A person with dementia might be confused about all aspects of self-care and not be able to complete those daily tasks.

Chronic health conditions

Chronic health conditions such as cancer, Parkinson’s, kidney disease, Multiple Sclerosis, arthritis, diabetes, and age-related decline, can lead to hands-on care. As these conditions worsen, they can get more challenging to manage. 

After an accident (like a fall)

A fall for an older adult can be devastating. Bone weakness and frailty are risk factors for falls. Balance issues, lack of strength and balance, and osteoporosis make it more likely that when an older adult falls, they will break a bone, often a hip.

Even in ideal circumstances, someone will need rehabilitation. And when they return home, they may still require hands-on assistance to get up, dress, and bathe. For a person with dementia, a fall is even more catastrophic since it could be difficult to follow through with rehabilitation. 

Why Is It Important to Understand What Hands-On Assistance Means in a Long-Term Care Insurance Policy?

Long-term care insurance policies are for people who want to protect their assets when they age and need assistance. Most policies offer a per-day rate for care that is pre-determined at the point of the policy purchase. These policies differ depending on the one you purchase, but traditional long-term care policies generally require that you meet specific hands-on criteria.

Six ADLs are used to determine eligibility, and you must need substantial assistance with two out of the six:

  • Bathing
  • Continence care
  • Dressing
  • Eating
  • Toileting
  • Transferring

Most policies have a 90-day waiting period, which means that you have to show proof that you have received hands-on care consistently with two or more of these ADLs over a three-month period. Once you meet all of the criteria, you can file a claim for reimbursement (a daily amount pre-determined by your policy). 

The definition of long-term care can apply to in-home services, assisted living, memory care, or a nursing home, depending on your policy. If you recover to the extent that you can perform your activities of daily living and no longer require hands-on assistance, you no longer qualify for long-term care insurance benefits.

Examples of Hands-On Assistance in Long-Term Care

Understandably, you may be confused about what exactly an example of hands-on care is. Even though your loved one needs substantial help, you may be disappointed to learn that they don’t meet the criteria for hands-on support for long-term care insurance purposes.

If your loved one is in assisted living and you don’t have an insurance policy, the community is likely to assess hands-on assistance more loosely and can charge you an additional monthly fee for that help. Each of the examples below is from traditional long-term care policy requirements. More recent policies could have different definitions of hands-on assistance and conditions for reimbursement.

The definition of long-term care could be in the home, assisted living, a nursing home, or any senior living community. In-home aides or personal care attendants can be the ones providing hands-on assistance, or it could be family or a combination of both. Assisted living communities are generally equipped to handle substantial hands-on care with levels of care to accommodate increasing needs. Hospice care also involves hands-on care from aides who help with all activities of daily living. 

Bathing

Bathing assistance is help with washing one’s self, a sponge bath, bedbath, and getting in and out of the shower or tub. Having someone stand by while the person bathes does not qualify as hands-on help.

Continence care

When someone is incontinent (either bladder or bowel or both), they may wear Depends or have a catheter or colostomy bag. If you can’t care for the bag or catheter or need assistance changing Depends, this qualifies as hands-on assistance.

Toileting

Toileting, like continence care, involves being able to get to and from the toilet, off and on the toilet, and maintaining personal hygiene. The person assisting would need to help the person get to the bathroom and may need to clean them after they go to the toilet.

Dressing

Dressing is a complex series of physical actions. Dressing is the ability to put clothes on and take them off safely. If you have an artificial limb or brace, it means putting the device on and taking it off. When someone assists with dressing, they take upper and lower clothes off and on and help with shoes. If a person can perform some of the tasks associated with dressing but can’t complete the activity independently, that is considered hands-on care. 

Eating and feeding

Eating and feeding do not mean preparing food. Eating is the ability to bring food to your mouth. For those who need assistance eating, someone has to get each bite of food to the person’s mouth. Someone who is bedbound or has problems with their hands or arms may require someone to feed them. 

Transferring

Transferring is the ability to get in and out of a chair, bed, or wheelchair. Sometimes assistive devices such as Hoyer lifts are required, and if someone has to help with that device, that is considered hands-on care. The person assisting may need to help someone by lifting or with hands-on touch to help the person maintain balance. 

Hands-On Assistance in Long-Term Care

Many people, at some point in their lives, depend on some level of hands-on assistance. If you have broken a bone, you begin to realize how much it impacts your daily functioning. In long-term care settings, hands-on assistance is the foundation of care. Qualifying for reimbursement from a long-term care insurance policy relies on hands-on care.

As you navigate these decisions for your loved one, be as positive as you can as they try to improve their abilities but accept that hands-on care may be permanent. 

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