The Activities of Daily Living are a series of basic activities necessary for independent living at home or in the community. They are performed on a daily basis. There are many variations on the definition of the ADLs, but most organizations agree there are 5 basic categories.
1. Personal hygiene – bathing/showering, grooming, nail care, and oral care.
2. Dressing – being able to make appropriate clothing decisions and physically dress and undress oneself.
3. Eating – the ability to feed oneself, though not necessarily the capability to prepare food.
4. Maintaining continence – being able to mentally and physically use a restroom. This includes the ability to get on and off the toilet and cleaning oneself.
5. Transferring/Mobility- being able to stand from a sitting position, as well as get in and out of bed. The ability to walk independently from one location to another.
The level of independence is based on whether someone can perform these activities on their own or they need help from a family caregiver.
Instrumental Activities of Daily Living are simillar to ADLs. These actions are important to being able to live independently, but are not necessarily required on a daily basis. The Instrumental Activities are not as noticeable as the Activities of Daily Living when it comes to loss of functioning. But functional ability for IADLs is generally lost before ADLs. IADLs can help better determine the level of assistance needed by an elderly or disabled person. The IADLs include:
1. Basic communication skills – such as using a regular phone, mobile phone, email, or the internet.
2. Transportation – either by driving oneself, arranging rides, or the ability to use public transportation.
3. Meal preparation – meal planning, cooking, clean up, storage, and the ability to safely use kitchen equipment and utensils.
4. Shopping – the ability to make appropriate food and clothing purchase decisions.
5. Housework – doing laundry, washing dishes, dusting, vacuuming, and maintaining a clean place of residence.
6. Managing medications – taking the correct amount of medication at the correct time. Managing re-fills, and avoiding conflicts.
7. Managing personal finances – operating within a budget, writing checks, paying bills, and avoiding scams
The inability to perform certain activities helps eldercare financial assistance programs determine eligibility.
An individual’s inability to perform the ADLs and IADLs doesn’t just determin the level of assistance required. It is also a metric for a variety of services and programs related to caring for the elderly and those with disabilities.
Many state-funded, non-Medicaid programs, like Texas Community Care for the Aged/Disabled and New York’s EISEP Program, consider ADL and IADL assesesments. An inability to perform 2 or 3 activities is often a criteria for participation in their assistance programs.
Medicaid often requires elderly participants to be qualified for nursing home care. And often nursing home care qualification is partially determined by how much assistance one requires with ADLs. Medicare doesn’t pay for custodial or personal care, which most of the ADLs are considered. However, Medicare PACE programs, which provide all-inclusive care for the elderly, do consider them a factor. Some Medicare Advantage plans are also now taking the need for assistance with ADLs into consideration. They are providing in-home assistance with these activities to prevent and/or delay nursing home placements.
Long-term care insurance often uses an inability to perform ADLs as a trigger for paying out on a policy. Social Security Disability Insurance (SSDI) also considers ADLs as a qualification factor.
PBS.org and the AARP developed the following Checklist of Activities of Daily Living worksheet to help families. This tool helps determine which ADLs and IADLs their loved ones require assistance with and how much assistance is needed. To complete the checklist, mark one of the four categories for each of the activities listed in the left hand column. Each category indicates how much assistance your loved one needs for that activity.
|ADLs / IADLs
|Requires No Assistance
|Some Assistance Needed
|Complete Assistance Needed
|Uses the Phone
There are other related ADL / IADL measurement scales and tests. Two of which provide point-scoring systems to help families to determine the types and extent of care necessary. One can learn more about these at the links below.
Technologies That Help with Specific ADLs
For people who have difficulty completing their activities of daily living, there are technologies that can help. These technologies allow persons to complete their ADLs with more ease, as well as decrease the amount of time it takes to complete them. This assistance can allow them to maintain their independence. While adaptive equipment can be very simple, it is often the difference between living independently and requiring regular assistance.
Examples of assistive technology include:
Some Area Agencies on Aging offer free activities of daily living assessments.
There are several options available to families who wish to have an assessment of their loved one. Choosing an option largely depends on the reason an assessment of ADLs (also called a geriatric assessment) is desired.
If a family simply wishes to have a scale to judge the ability of their loved one to function independently, there are multiple online tools. Many of these are intended for use by untrained professionals and are easy to complete. A family member answers a series of questions about their loved one who requires assistance and tallies up a point total. The results can then be compare to other individuals. A free, self-administered test for cognitive impairment is available here.
For a more formal ADL assessment, many families turn either to their family doctor or to an occupational therapist. This type of assessment is more focused on one’s medical wellbeing than are free online tools, which tend to focus on non-medical care needs. Depending on the situation, Medicare may pay for an ADL assessment.
The third goal families often have when getting an ADL assessment is to determine if a loved one is eligible for government assistance. Local Area Agencies on Aging (AAAs) often serve as the gateway to assistance programs. Many of these will provide activities of daily living assessments as part of the application process. One should contact their local area agencies on aging and inquire.