Before determining what type of care your loved one needs, to successfully age in place, it’s important to have a basic understanding of what the activities of daily living (ADLs) are and what role they play in determining the needs of an older adult. Thinking about ADLs will also help you make a sound plan.

ADL is also important because it is the language used by medical professionals, insurance companies, and government programs so understanding the difference between an ADL and a medical need will help you navigate the various types of care and financial assistance offered.

What activities are crucial for living independently?

The basic tasks a person needs to be able to do on their own to live independently are called Activities of Daily Living (ADLs). Health issues and aging can make it difficult for seniors to take on certain everyday self-care tasks that are important to keeping them healthy and safe. If your loved one needs help with ADLs, a Care Companion or In-home Caregiver may help them age in place.  Medical care, in contrast, requires a higher level of licensure and is usually provided by a Home Health agency. 

Doctors, Occupational Therapists, and other clinicians use the Katz Index of Independence in Activities of Daily Living to assess the overall health and functional status of older adults and those with disabilities. 

What are activities of daily living (ADLs)?

The basic ADLs include 6 essential skills:

  1. Bathing and showering: the ability to bathe oneself and maintain hair, dental, and nail hygiene
  2. Continence: having complete control of bowels and bladder
  3. Dressing: the ability to select appropriate clothes and to dress self independently
  4. Mobility: being able to walk or transfer from one place to another, specifically in and out of a bed or chair
  5. Feeding (excluding meal preparation): the ability to get food from plate to mouth, and to chew and swallow
  6. Toileting: the ability to get on and off the toilet and clean self without assistance

What are instrumental activities of daily living (IADLs)?

Another great tool that is commonly used to determine if living independently is the right choice is the Instrumental Activities of Daily Living, or IADLs, which are more complex activities that often involve thinking and organizational skills. Lawton’s Instrumental Activities of Daily Living (IADL) Scale covers:

  • Cleaning and housekeeping, including maintenance and other home care chores
  • Doing laundry
  • Managing finances
  • Managing medications and taking medicines as directed
  • Preparing meals
  • Shopping for groceries and other necessities
  • Transportation, including changing residences and moving
  • Using communication devices, including the telephone or computer

What is the difference between an ADLs and an IADLs?

The best way to think about the difference between these two types of care is one is “hands-off” care and the other is “hands-on” care.

IADLs is the “hands-off” care because they are the type of activities that someone can do for another person without physical contact, like running errands, cleaning the house, and meal preparation.

ADLs is the “hands-on” care because they are the activities that would require personal contact should someone need assistance with them. They’re those activities we do every day like bathing, dressing, and eating. 

What is the importance of the measurement of ADLs and IADLs in older adults?

ADLs represent everyday tasks that challenge both mental and physical capabilities when living independently. A person needs to have the physical ability to perform ADL tasks themselves, and the planning and mental capacity to conceptualize the tasks and understand what needs to be done. 

It’s a good idea to test ADLs as soon as possible while working with your, or your loved one’s doctor so that any decline in the ability to complete basic ADLs can be detected early. Setting a baseline will help in noticing the onset of dementia or physical limitations.

3 reasons ADLs and IADLs are Important in Determining Level of Care

  1. Insurance and government programs use ADLs to determine eligibility.
  2. ADLs and IADLs help you determine what caregivers are needed
  3. Monitoring ADLs and IADLs alerts you when the level of care should be increased

A good framework for tracking the status of ADL

Keep these questions in mind:  

  • Do you or someone in your loved one’s social network need to check on your aging parent routinely?
  • Does your aging loved one need physical therapy?
  • Is your aging parent able to continue living independently?
  • Is it time to reevaluate the plan to age in place and consider other options? 

ADLs Instrumental in Deciding Course of Action for Aging in Place Plan 

Understanding ADLs is crucial to building an accurate care plan as it will help everyone in your, or your loved one’s care circle, including their doctor.

Signs that it’s time for an ADLs and IADLs assessment

Watching out for specific safety factors, including:

  • Finances: Are there problems paying bills? Are you concerned about scams?
  • Driving: Have there been any accidents or close calls?
  • Health: Has your loved one had any falls?
  • Elder abuse: Do you have any concerns about emotional, financial, physical, or verbal abuse?
  • Emergency room use: Have there been trips to the ER?
  • Memory and thinking: Have there been problems with forgetting, getting lost, or wandering? Is there concern about poor awareness or poor judgment?

If you answered “yes” to any of the above questions, it may be time to assess your, or your loved one’s ADLs and IADLs.

TAKE ACTION: Call your doctor or your Area Agency on Aging and ask for an evaluation.

As explained above, ADLs are how insurance and government programs determine eligibility so getting an assessment is crucial and a prescription from your doctor is the first step.  The evaluation is usually covered by insurance, Medicare, or local government programs so cost should not be a barrier.

Also, the evaluation looks at the entire setting, including safety issues such as smoke detectors and fall hazards such as rugs or missing handrails, evidence of abuse or neglect, and undiagnosed medical conditions.

If the evaluation is done by an Occupation Therapist, they can suggest equipment such as toilet risers or non-slip bowls to solve many problems without the need for ongoing care. So even if Home Health visits are not determined to be covered, the evaluation will give you and your family good information for planning.