20. Traumatic injury resulting in inability to perform at least 2 Activities of Daily Living (ADL)
A member will be considered eligible for a TSGLI benefit for inability to perform ADL due to traumatic injury if:
| The member is... | and the member's inability lasts for... |
|---|---|
unable to independently perform* at least two of six ADL (bathing, continence, dressing, eating, toileting and transferring) |
at least 30 consecutive days. |
* The member is considered unable to perform an activity independently if he or she REQUIRES assistance to perform the activity.
REQUIRES assistance is defined as:
- Physical assistance - when a member requires hands-on assistance from another person
- Stand-by assistance - when a member requires someone to be within arm's reach because the patient's ability fluctuates and physical or verbal assistance may be needed
- Verbal assistance - when a member requires verbal instruction in order to complete the ADL due to cognitive impairment. Without these verbal reminders, the member would not remember to perform the ADL.
Without this physical, stand-by, or verbal assistance, the member would be incapable of performing the task.
Accommodating Equipment - If the patient is able to perform the activity by using accommodating equipment, such as a cane, walker, commode, etc.), the patient is considered able to independently perform the activity.
Reviewed/Updated Date: May 4th, 2012
