What are Activities of Daily Living (ADLs & IADLs)

As seniors age, they tend to find it harder and harder to do specific tasks. The difficulty can result from the natural aging process, a health condition, or a physical or cognitive issue accompanying dementia. When those tasks are essential life tasks, those people may no longer be able to stay at home enjoying independent living. 

What are Activities of Daily Living (ADLs)

Activities of Daily Living, or ADLs, are a series of basic activities and skills that are required for a person to take care of themselves. A person’s ability to complete ADLs define how capable you might be of living on your own at home or in the community – or how much help or hands-on home care you might need.

Lists of ADLs can vary slightly depending on the application, but the basic ADLs include the following six categories¹: 

• Walking, or “ambulating” is your ability to change positions or locations (including in and out of a bed or chair) and to walk independently.
• Feeding is your ability to feed yourself but does not include food preparation.
• Dressing is your ability to select appropriate clothes and dress and undress yourself. 
• Personal hygiene is your ability to wash your face and body in the bath or shower and to groom yourself, including oral, hair, and nail care.
• Continence is your ability to control your bladder and bowel functions.
• Toileting is your ability to get to and from the toilet, use it correctly, and clean yourself.

For each of these basic self-care tasks, your needs could range from needing no help – to a bit of help – and to full help where someone else does the task for you.

What are Instrumental Activities of Daily Living (IADLs)

Instrumental Activities of Daily Living, or IADLs, are the skills and activities required to live independently, though they might not be done on a daily basis. These self-care tasks require more developed skills, including thinking and organizing than ADLs. Losing your IADL skills may not be as noticeable as losing ADLs, but seniors typically will lose them before losing ADLs.

IADLs help determine how much assistance an individual might need if you are elderly or have a disability. 

Managing IADLs involves managing the following activities:

• Transportation and shopping is your ability to drive or arrange for other transport and shop for all the items required for everyday life.
• Managing finances is your ability to pay your bills and manage your financial assets.
• Shopping and meal preparation is your ability to buy and prepare everything you need to get meals on the table.
• House Cleaning and home maintenance is your ability to clean up the kitchen after eating, keep the living areas clean, and stay on top of home maintenance.
• Managing communications is your ability to use a regular phone, mobile phone, email, or the internet. 
• Managing medications is your ability to obtain medications and to take them according to the directions.

When IADLs become challenging to manage independently, people tend to ask for outside assistance. This help is often in the form of in-home care or considering assisted living facilities.

Read More: Independent Living vs Assisted Living

What’s the Difference Between ADLs & IADLs

ADLs are focused on your personal care, whereas IADLs are more involved with your surroundings and support systems. ADLs are routine tasks you should be able to perform daily on your own. IADLs may not be essential to living, but they are critical to keeping your life flowing smoothly. 

Importance of ADLs and IADLs

You might be an older adult who wants a neutral evaluation of your functional status. Or you could be an adult child concerned about an aging family member or someone caring for an older spouse or partner. Whatever the case, ADLs and IADLs provide a way to measure that person’s ability to function – and function safely.

If someone has difficulties managing ADLs and IADLs, those difficulties often reflect physical or cognitive health issues. So, addressing them could be a way to help diagnose and treat health concerns early. But their greatest value may come from highlighting functional difficulties that older loved ones are dealing with, so they can get the support they need.

ADL Assessments

Assessments play an important role in elder care in three ways: identifying issues you might be experiencing yourself or as a caretaker; as the basis for a doctor’s medical care (or Plan of Care); and as a gateway to financial help to pay for long-term care.

How to get an ADL assessment

Your reason for wanting an Activities of Daily living assessment will influence where you get one. For example, if you are looking for an evaluation to measure someone’s ability to live independently, many free tests are available online. They are easy to administer by answering a series of questions and tallying up the points.

If you are more concerned about someone’s medical wellbeing, you might request a more formal assessment by a family doctor or occupational therapist. And if you are trying to access government assistance, an assessment may be needed as part of the application process.

What to expect when going in for an assessment

Various tests exist to measure ADLs and IADLS. But the most frequently used measure for ADLs is the Katz Index of Independence in Activities of Daily Living (also known as the Katz ADL Index). It consists of a simple checklist. One point is given for each activity for which the person does not need help completing the ADL. Zero points are given if the person requires assistance. A score of six means the person is very independent, and a score of zero means high dependency. 

The most frequently used measure for IADLs is the Lawton Instrumental Activities of Daily Living. Several statements are listed under each category, and you are asked to indicate the one most relevant to you. Some statements are assigned a score of zero, and others have a score of one. A low total score means you are low-functioning, and a high score means high-functioning. 

Activities of Daily Living Checklist

Below are checklists for Activities of Daily Living and Instrumental Activities of Daily Living, which can be used as an informal functional assessment of essential activities of daily living.

ADL Checklist

Here is an activities of daily living checklist:

How Often Should You Evaluate ADLs and IADLs?

ADL and IADL evaluations are not complicated and can be used as often as needed. If you have a local Area Agency on Aging (AAA) near you, they may pay for assessments

Assessments can measure how the aging process affects a loved one’s situation to see if more extensive care is needed. In medical environments, tests may be performed during doctor’s visits, during hospitalizations, and before discharging a patient to ensure appropriate support is available.

And the ADL assessment, in particular, is needed any time you want to check eligibility to access long-term care insurance policies, disability insurance benefits, and government assistance.

Paying for Assistance With ADLs

If you need help managing ADLs, you may want to check the following options for financial assistance.

Does Medicare Cover Help With ADLs?

Most people who cannot perform ADLs need custodial care, which is considered non-medical care, so Medicare does not cover it. However, if you are enrolled in Medicare, you may get help with custodial care if medically necessary care is also involved. Care must be authorized by a licensed physician and must occur in a certified skilled nursing facility (SNF), usually for up to 100 days.

Related: Does Medicare Cover Assisted Living

Medicare PACE (Programs of All-Inclusive Care for the Elderly) covers some personal care along with your medical needs. The program’s goal is to help keep you at home instead of in a skilled nursing home. Unfortunately, these programs are not available nationwide, but it is worth checking if one is available near you.

Related: Does Medicare Cover Home Health Care

More recently, some Medicare Advantage programs are providing in-home assistance with some ADLs to prevent or delay placements in nursing homes.

Does Medicaid Cover Help With ADLs?

Medicaid might be available to cover help with ADLs if you have low income and have spent down any personal assets and savings. However, access to custodial care will have to comply with your state’s Medicaid requirements. Care is provided in a nursing facility, and the level of care depends on how many of the six ADLs you cannot perform. 

Does Long Term Care Insurance Cover Help with ADLs?

Private long-term care insurance offers the best custodial care coverage, but it is expensive (though significantly less than the cost of care). Planning ahead of time will help reduce the cost of long-term care insurance. Your policy buys you a certain daily dollar amount of custodial care for a fixed benefit period. Your inability to perform a certain number of ADLs is what triggers the policy to pay out, but usually only after you have paid for the care during a waiting period of 30 or more days.

Related: Does Long-term Care Insurance Cover Assisted Living

Resources

1. https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Downloads/2008_Appendix_B.pdf and https://www.ncbi.nlm.nih.gov/books/NBK470404/ ]