You may have heard the terms Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), especially if your loved one has needed help in the home, senior living, or long-term care. Using these terms helps home care agencies and other support services determine exactly what kind of assistance someone needs.
Jump ahead to these sections:
- What Does ‘Activities of Daily Living’ Mean?
- The 13 Activities of Daily Living
- How Are ADLs Evaluated and Used in Long-Term Care?
On a practical level, understanding what ADLs and IADLs are can help you recognize when your loved one needs care before it becomes a crisis. Intervening early when ADLs become a problem can prevent further decline and keep someone safe.
In considering long-term care options, you can advocate for your loved one if you know what they need help with.
What Does ‘Activities of Daily Living’ Mean?
ADLs are all of the tasks that a reasonably healthy person does each day to stay independent. Most of these activities we take for granted until an accident, illness, or surgery affects one or more of these activities.
Almost everyone, regardless of age, can incur the impact of one or more activities of daily living at some point in their lives. For anyone involved in caregiver duties, you know what these activities entail. Some individuals may need maximum assistance with some ADLs and minimal assistance with others.
The 13 Activities of Daily Living
There is no set number of activities of daily living, but there are some generally accepted categories. For the purposes of this article, we will group ADLs and Instrumental Activities of Daily Living (IADLs) together because all of the activities are crucial for independent functioning, safety and well-being.
Mobility is the ability to walk, get out of bed, go up and down the stairs, and transfer from a chair and a wheelchair. Mobility also involves using a walker and getting in and out of a car. If you have ever sprained an ankle or broken a leg or hip, you know what we mean by mobility.
For some, mobility problems are permanent due to neurological conditions like Parkinson’s disease or Multiple Sclerosis. People with dementia often develop mobility difficulties as well and gradually have trouble walking, and may have frequent falls. Mobility has an impact on almost all other ADLs.
If you can’t walk, it is difficult to safely access the kitchen to cook or get in and out of the shower. Driving might become impossible, and accessing outside activities with friends and family is impacted along with getting to healthcare appointments.
Hygiene is a collection of activities that includes getting in and out of a shower or tub safely, brushing your teeth, washing hair, shaving, and nail care. When your loved one has trouble bathing, it can increase their risk of falling.
Independent dressing is the ability to put clothes on and take them off. Dressing involves being able to fasten buttons, use zippers and bend down to tie shoes.
For people with dementia, dressing also includes putting on clothes correctly and choosing appropriate attire for the weather.
4. Eating and drinking
The physical act of eating involves the ability to use utensils properly and get food to the mouth. To drink water, you have to fill a glass or container with water and bring it to your lips.
Eating is not just the physical task itself but, for some, involves using modified diets for swallowing problems to prevent choking or aspiration. Preparation of modified diets involves cutting food into small pieces or pureeing food, and using thickened liquids.
5. Toileting or continence
The term toileting refers to any activity involved in getting to and using the toilet. Continence problems can include bladder or bowel problems, catheter care, or use of continence products like Depends.
Your loved one might need help getting to the bathroom or using a bedside commode. In some cases, using a catheter is necessary for emptying the bladder.
6. Shopping and meal preparation
If your loved one can’t shop for groceries or prepare meals, they need help. Meals, snacks, and hydration help a person recover and contribute to strength and endurance.
Possible challenges include not driving, being unable to physically prepare meals, or the inability to sequence the tasks necessary to plan a meal.
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7. Medication management
Medication management involves several complicated steps. Ordering refills, taking medications exactly as prescribed, and eliminating expired medications are critical tasks to avoid medication errors.
Medication management also might involve checking blood sugar levels and administering insulin.
8. Managing finances and paying bills
Difficulty managing finances and paying bills can start slowly. You might notice that your loved one has become confused about their financial situation or misses paying bills.
Scams and fraud can be significant problems for older adults, so having a handle on finances is critical. Sometimes older adults fall prey to online attempts to get their personal information or authorize work that isn’t needed.
Older adults stop driving once they have physical or cognitive disabilities that prevent them from driving safely.
Once that happens, being unable to get out can increase loneliness and impact independence. This puts pressure on your family to shop, take your loved one to the doctor, and pick up prescriptions.
10. Housework and maintenance
Many older adults live in the same house for many years. Keeping a home clean and clutter-free and taking care of routine maintenance issues might become harder and harder to do.
Eventually, the inability to take care of and maintain a home can create safety problems. Neglect of repairs can lead to dangerous situations.
Dementia, Parkinson’s, or other neurological conditions can impair communication and speech.
Communication problems affect a person’s ability to ask for what they need, express pain, and connect with other people in meaningful and fulfilling ways. More and more healthcare providers include telehealth visits as part of their practice. Telehealth visits require technological expertise to set up and activate independently.
Most people don’t think about working as an ADL, but when older adults work, and many do, accidents, illness, or injury can interfere with someone’s ability to continue to work.
The interruption of income can have a significant impact on financial stability and self-esteem.
13. Leisure and recreational activities
Card games, pickleball, walking groups, traveling, and other leisure activities give older adults purpose and social connection. When these are disrupted due to challenges with activities of daily living, a significant part of people’s lives is affected.
Dementia can prevent people from participating in social gatherings or understanding how to play games they used to be familiar with. A decline in leisure and recreational opportunities can contribute to social isolation and loneliness.
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How Are ADLs Evaluated and Used in Long-Term Care?
Evaluation of ADLs determines the level of care an older adult needs in long-term care, including assisted living and nursing homes.
An assessment is not needed in independent senior living since, presumably, older adults can care for themselves. If they need help, the family or professional caregivers will need to provide it. ADLs are also used as eligibility criteria for many elder care services, benefits programs, and insurance coverage.
Veteran’s Aid and Attendance Program
Needing help with ADLs is also one of the eligibility criteria for the VA Aid and Attendance pension program, which requires an evaluation of ADLs as part of their criteria for participation.
The Aid and Attendance program assists qualified veterans by paying a monthly amount for caregivers to help with ADLs.
An older adult must have a documented need for a nursing home level of care which often includes deficits in specific numbers of ADLs to qualify for Medicaid reimbursement.
Each state will have a functional assessment to determine if the person meets the nursing home criteria.
An initial evaluation of ADLs by a nurse determines whether your loved one can qualify for an assisted living facility.
For someone going into assisted living, pricing is often dependent on the number of ADLs the person requires. If care needs are too great or complicated and require more medical intervention, the assisted living community may recommend a nursing home.
A home health agency will also evaluate ADLs with specific goals related to ADL deficiencies. Disciplines like physical, occupational, and speech therapy are then assigned to help the patient recover.
Insurance requires a detailed plan to reimburse for these services. For home health to recertify for continued home health services, they will complete another ADL evaluation.
Home care agencies also do a plan of care for helping with ADLs so that private caregivers know what the patient needs assistance with.
The plan is adjusted as the client improves or declines. Home care is designed to help with ADLs because many of these tasks are non-medical.
Long-term care insurance
Long-term care insurance companies evaluate client ADLs to determine reimbursement of services. Most long-term care insurance companies regularly re-evaluate to ensure the client continues to meet the criteria for payment.
In summary, evaluation of ADLs by long-term care settings guides the treatment and care team. Problems in any area of ADLs or IADLs provide a roadmap for medical and non-medical professionals to help your loved one recover and regain independence.
Activities of Daily Living for Aging Adults
For an aging adult, taking care of yourself is the foundation of independence and well-being. By focusing on improving activities of daily living, you and your family can ensure many years of safe functioning.