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The Activities of Daily Living are a series of basic activities performed by individuals on a daily basis necessary for independent living at home or in the community. There are many variations on the definition of the activities of daily living, but most organizations agree there are 5 basic categories.
1. Personal hygiene – bathing/showering, grooming, nail care, and oral care
2. Dressing - the ability to make appropriate clothing decisions and physically dress/undress oneself
3. Eating - the ability to feed oneself, though not necessarily the capability to prepare food
4. Maintaining continence - both the mental and physical capacity to use a restroom, including the ability to get on and off the toilet and cleaning oneself
5. Transferring/Mobility- moving oneself from seated to standing, getting in and out of bed, and the ability to walk independently from one location to another
Whether or not an individual is capable of performing these activities on their own or if they rely on a family caregiver for assistance to perform them serves a comparative measure of their independence.
Instrumental Activities of Daily Living are actions that are important to being able to live independently, but are not necessarily required activities 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 prior to ADLs. IADLs can help determine with greater detail the level of assistance required 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 hygienic place of residence
6. Managing medications - taking accurate dosages at the appropriate times, managing re-fills, and avoiding conflicts
7. Managing personal finances - operating within a budget, writing checks, paying bills, and avoiding scams
Measuring an individual’s inability to perform the ADLs and IADLs is important not just in determining the level of assistance required, but as a metric for a variety of services and programs related to caring for the elderly and for those with disabilities.
Many state-funded, non-Medicaid programs, such as Texas Community Care for the Aged/Disabled and New York’s EISEP Program use an inability to perform 2 or 3 activities of daily living as one of the eligibility 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. While Medicare doesn’t pay for custodial or personal care, which most of the ADLs are considered, Medicare PACE programs, which provide all-inclusive care for the elderly, do consider them a factor.
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 as a tool to help families determine with which ADLs and IADLs their loved ones require assistance and how much assistance is needed. To complete the checklist, mark one of the four categories, indicating how much assistance your loved one requires to perform the activities listed in the left hand column.
|ADLs / IADLs||Requires No
|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.
Lawton IADL Scale - measures on a scale of low functioning to high functioning
Katz Index of Independence in ADLs – measures on a scale of dependency to independency
There are several options available to families who wish to have an assessment of their loved one's ability to complete the activities of daily living. Choosing amongst these options largely depends on the purpose for which one wants an assessment of ADLs (also called a geriatric assessment).
For families who simply wish to have a scale by which to judge the ability of their loved one to function independently, there are multiple online geriatric assessment 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, tallies up a point total, and compares their results 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 well being than the 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 objective families often have when getting an ADL assessment is to determine if a loved one is functionally eligible for a government assistance program, such as Medicaid. Local Area Agencies on Aging (AAAs) often serve as the gateway to assistance programs, and 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.