While touring senior living options for an aging loved one, families often come across a term—”ADLs.” Hearing community staff claim they offer tailored assistance with “ADLs” may sound unfamiliar and confusing. Even if they know their loved one is struggling with daily living needs, they may not know what ADLs, or activities of daily living for seniors, mean.
Activities of Daily Living (ADLs) are basic self-care tasks seniors need for fundamental daily self-care. Another term, IADLs, stands for instrumental activities of daily living and includes more complex tasks needed to manage a household and live independently.
Understanding the differences between these terms, i.e., ADLs & IADLs, is vital for families to find an ideal care option for their loved one struggling with aging challenges. Today’s blog is a guide for families, explaining what ADLs & IADLs mean, how this decline is assessed, and how ADLs shape the choice of care.
Medical Disclaimer: This blog is for informational and educational purposes only and should not be taken as medical advice. Clinical assessment instruments (such as the Katz Index or Lawton-Brody Scale) and health warning signs mentioned in this guide should always be evaluated in consultation with a qualified medical professional or physician.
The Six Basic ADLs, Explained
So what are ADLs in plain language? ADLs relate to essential health, safety, & self-care. Activities of daily living include the daily routine tasks a person performs to care for themselves and meet their physical needs without relying on others. In total, six basic ADLs are grouped and recognized as necessary for an individual’s overall well-being.
Here’s a brief list of the six ADLs typically measured by the Katz Index on a 0-to-6 scale.
Bathing
- Cleaning the body using soap, water, and a towel.
- Rinsing the entire body and drying the skin.
- Stand, sit, and move as needed to clean the body thoroughly.
- Maintaining personal hygiene, including hair care, oral hygiene, and nail care.
Dressing
- Choosing season-appropriate clothes.
- Putting on the chosen clothes using buttons, zippers, snaps, or other fasteners.
- Wearing shoes and tying them.
Eating
- Feeding oneself using utensils properly.
- Ability to eat different types of food independently, whether it’s solid, semi-solid, or pureed.
Toileting
- Ability to get on the toilet, use it, clean oneself, and get off independently.
Continence
- Ability to control bladder and bowel function.
Transferring/Ambulating
- Moving from one place to another.
- Walking around the home.
- Sitting and standing independently.
Note: A senior’s inability to complete even one of these 6 basic ADLs indicates they need assistance to complete it safely, or they may face a safety risk.
IADLs: The Skills That Often Slip First
IADLs, or instrumental activities of daily living, involve more complex cognitive and organizational tasks that take more effort to complete than standard ADLs. Understanding the difference between activities of daily living and instrumental activities of daily living is crucial for families, as these self-sufficiency tasks are often the first to slip.
Seniors typically face a decline in IADLs before ADLs due to the phenomenon called “hierarchy of functional decline.” As people age, age-related changes begin to affect their body and mind, eroding the cognitive reserves needed for executive functions. These functional abilities are lost in the reverse order in which the person acquired them during life.
Let’s cover the eight main IADL categories as measured by the Lawton-Brody Scale.
- Telephone Use: Operating a phone, looking up numbers, and placing/receiving calls independently
- Shopping: Planning, going out, buying food/items, navigating stores, and managing transactions.
- Food Preparation: Planning, preparing, cooking, and serving adequate meals safely
- Housekeeping: Maintaining a clean home, taking out trash, washing dishes, light repairs
- Laundry: Washing, drying, folding, and organizing clothes and linens independently.
- Transportation: Driving oneself or arranging/using public transportation, taxis, or rideshares.
- Medication Management: Taking correct doses at right times, requesting refills, and sorting pills safely
- Finances: Visiting bank, writing checks, paying bills, and tracking income/expenses.
How to Spot ADL Struggles in a Parent
Both ADLs and IADLs are essential for a senior to live a sustainable, healthy life. Tracking whether a loved one can complete all necessary activities of daily living on their own may seem challenging at first for a family.
Here’s detailed information on how families can spot a parent struggling with ADLs and IADLs:
Basic ADLs
- Look for unwashed hair, body odor, neglected dental care, or wearing the same clothes for multiple days.
- Notice difficulty buttoning shirts, zipping pants, or wearing clothing that isn’t appropriate for the weather.
- Watch for urinary tract infections, a bedroom moved closer to the bathroom, urine-scented laundry, or hidden bathroom accidents.
- Notice a slower gait, frequent tripping, unexplained bruises from falls, or trouble standing up from a couch or bed.
- Check for sudden weight loss, a weak grip on utensils, or difficulty chewing and swallowing.
IADLs
- Check the fridge for expired food, the pantry for emptiness, or for a lack of cooked meals.
- Look for missed doses, pills left in organizers, or duplicate prescription bottles.
- Look for unwashed dishes, overflowing trash, unopened mail, or neglected yard work.
- Look for accumulated unpaid bills, final notices, or confusion about recent bank transactions.
How ADLs Shape Care Options and Costs
When a senior struggles with ADLs, it’s a warning sign for the family to find a care and assistance option that provides a safe living environment. A senior’s ADL struggles will determine not only their care options but also their eligibility for payment options.
Home Care
It’s the best professional care option for older adults who need help with daily living activities (ADLs) but want to live at home. Choosing a home care agency lets them age in place and receive help with activities of daily living (ADLs) like bathing, eating, dressing, or toileting. This care is provided on an hourly basis, so seniors needing round-the-clock assistance are charged more.
Assisted Living Care Levels
It’s ideal for seniors who have begun needing help with two or more activities of daily living (ADLs) but don’t necessarily require intensive care or medical support. Assisted living offers multiple tiers of care on the same campus. Based on their particular healthcare and lifestyle needs, residents are assigned a level of care. Staff step in only when necessary, letting residents maintain maximum independence and dignity.
Long-Term Care Insurance Triggers
Many long-term care insurance providers (companies) require the individual to prove their need for assistance with ADLs to receive the long-term care benefits available to them. Coverage triggers when a senior can’t perform a specific number of ADLs.
How Are Activities of Daily Living (ADLs) Assessed?
It all depends on who is assessing them. Most geriatric experts and medical professionals assess ADLs. They use different methods to evaluate a senior’s ability to perform ADLs. The most commonly used assessment tool among healthcare professionals is the Katz ADL scale, which helps them evaluate how well a person performs ADLs.
The Katz ADL scale is a checklist healthcare providers use to assess a person’s ability to complete basic ADLs independently. It includes six ADLs—bathing, dressing, toileting, transferring, continence, and feeding. The person receives a point for completing each activity. Healthcare professionals may also perform other evaluations as needed to get a full picture of the support a senior may need. For instance, they may use the Lawton Instrumental Activities of Daily Living Scale to assess how well a person handles more advanced tasks like cooking, maintaining the home, shopping, etc.
But long-term care insurance companies employ somewhat different measures to assess a person’s ability to complete ADLs. They may hire private assessors to check on a policyholder’s eligibility to use their long-term care benefits.
FAQ
- What are the six activities of daily living?
The six basic Activities of Daily Living (ADLs)—as defined by the Katz index of independence in ADLs—are fundamental self-care tasks required to live independently. This includes bathing, dressing, eating, toileting, transferring, and continence.
- What is the difference between ADLs and IADLs?
Activities of Daily Living (ADLs) are basic self-care tasks needed for physical survival. Examples include bathing, dressing, and eating. Instrumental Activities of Daily Living (IADLs) are more complex tasks needed to live independently in the community. Examples include managing medication, preparing meals, doing laundry, and using a phone.
- How are ADLs assessed?
ADL assessment includes evaluating a senior’s ability to perform basic self-care and independent living tasks. Clinicians use standardized scales, direct observation, or patient/caregiver interviews. Clinicians and caregivers use standardized tools such as the Katz ADL scale, Barthel Index, Lawton IADL Scale, or Functional Independence Measure (FIM).
- How many ADLs does someone need help with to qualify for assisted living?
While needing help with at least two ADLs is a common industry rule of thumb, California assisted living admission isn’t governed by a rigid ADL count. Instead, admission depends on a standard pre-admission appraisal and a physician’s report that evaluates individual care needs and confirms the community can support them within its licensed capacity.
- Does long-term care insurance require ADL limitations?
Yes, most long-term care insurance (LTCI) policies require proof of Activities of Daily Living (ADL) limitations or a severe cognitive impairment to trigger benefit payouts.
Vista at Simi Valley—Dedicated to Exceptional Senior Living
At Vista at Simi Valley, we recognize ADLs as a core part of healthy aging. They are so essential that a family never notices their importance until their aging loved one starts struggling with them. They often don’t realize how essential they are until their loved one struggles with one or two daily living tasks, prompting them to search for a reliable senior living option.
Families should understand that choosing professional care support at the right time helps ensure their loved one gets the care they need to live well.
That is why we invite families to schedule a tour of our premier assisted living community—Vista at Simi Valley. We offer two accommodation options, including studio and one-bedroom apartments, each outfitted with kitchenettes, controlled heating and air conditioning, emergency communication systems, and many other advanced features. Staff help with daily housekeeping and coordinate health services to support residents’ holistic wellness.
Note: Families can use the sections (bullet points) covered in the blog as an ADL/IADL checklist to assess their loved one/parent’s ability to manage ADLs & IADLs independently.
