20. Traumatic injury resulting in inability to perform at least 2 Activities of Daily Living (ADL)
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.
Adaptive Behavior - If the patient is able to perform the activity by using adaptive behavior, the patient is considered able to independently perform the activity. Adaptive behavior is compensating skills, taught by a medical professional or learned on one’s own, that allow the member to perform ADL without physical, stand-by, or verbal assistance.
Accommodating Equipment - If the patient is able to perform the activity by using accommodating equipment, the patient is considered able to independently perform the activity. Accommodating equipment are tools or supplies that enable the member to perform ADL without physical, stand-by, or verbal assistance and include but are not limited to:
- Wheelchair;
- Walker or cane;
- Reminder apps;
- Velcro clothing or slip-on shoes;
- Grabber or reach extender;
- Toilet seat raiser;
- Wash basin;
- Shower chair; or
- Shower or tub modifications such as wheelchair access or no-step access, grab-bar or handle.
**To obtain more information on the requirements for each ADL, view our TSGLI Activities of Daily Living training module.
Reviewed/Updated Date: April 14, 2023
