Do you know the term every family hears first when seeking compassionate, caring professional care for a loved one? It’s ADLs. Whether it’s a doctor’s medical evaluation or a care assessment for senior living, the term “ADLs” may sound unfamiliar and even strange. One sibling might be eager to know what the term means, while the other one may get a bit worried, thinking their parent has been diagnosed with something severe.
ADLs mean activities of daily living: everyday self-care tasks that form the foundation of independent living. Likewise, IADLs are often considered the next step after ADLs. IADLs, or Instrumental Activities of Daily Living, are more complex skills needed to live independently in a community. While ADLs are basic self-care tasks, IADLs involve complex everyday tasks an individual does to manage their own affairs.
Understanding these terms is the first step for adult children like you in making a clear decision about loved ones’ future care. While a physician or senior care expert can easily explain the needed care and assistance, the family needs to understand what Activities of Daily Living (ADLs) mean and how ADL results affect care decisions.
What ‘Activities of Daily Living’ Actually Means
Activities of Daily Living (ADLs) are fundamental, routine self-care tasks required for physical survival and basic well-being. They include all the activities we do to stay alive and do well. These aren’t occasional tasks but everyday essentials done through different activities to keep the body functioning.
However, as seniors age, their bodies undergo biological changes that impact their ability to complete these activities on their own. In other words, their ability to live independently diminishes.
ADL assessment plays a major role in evaluating a senior’s ability to live independently. But how do ADLs determine the level of care needed? It’s done by testing their ability to complete different ADLs. By tracking a senior’s ability to manage ADLs on their own, a physician can determine the level of care they need. An ADL assessment can also indicate underlying health issues someone may be facing or at risk of facing.
The 6 Basic ADLs Explained
So what are the 6 ADLs? The 6 ADLs, also called physical activities of daily living, relate to the body’s needs and measure an individual’s ability to live independently without assistance. Here’s what the 6 basic ADLs include:
Bathing
Washing the body using soap, water, and other supplies while being able to sit, stand, or move sideways to rinse every body part.
Eating And Feeding
Ability to feed oneself, use utensils, chew, and swallow without assistance.
Dressing
Selecting appropriate apparel for a season/occasion, wearing clothes in the right order, and managing zippers, buttons, snaps, and Velcro as required.
Personal Hygiene And Grooming
Washing the face and hair, cleaning teeth, and using dental orthotics and prosthetics. Keeping the hair adequately styled and trimmed, using supplies like cosmetics, deodorant, tweezers, scissors, and nail clippers for grooming.
Moving/Transferring
Moving from one spot to another as a part of normal daily routines. For instance, rising from a chair or waking up from a lying position in bed.
Toileting And Continence
Reaching the toilet, getting into position, using it, and cleaning afterward. Using supplies like toilet paper and controlling bladder function and bowel function.
The 8 IADLs (And Why They Decline First)
IADLs are built on ADLs. These define a set of activities that require more advanced skills than basic ADLs. IADLs require higher-order cognitive processing, complex executive functions, and multi-step planning compared to basic self-care tasks. While IADLs aren’t essential to life, they are vital to living independently and supporting a high quality of life.
Here are details on the 8 standard IADLs:
Managing Finances
Paying bills, balancing a checkbook, and handling banking.
Managing Medications
Knowing correct dosages, timing, and how to refill prescriptions. Scheduling appointments, getting prescriptions filled, and communicating with physicians.
Transportation
Walking, driving, or using other transportation to travel from one place to another.
Shopping
Planning, making lists, selecting items to buy (including groceries and household items), paying for the supplies, and bringing them home.
Food Preparation
Planning and cooking meals using kitchen equipment. Doing everything safely and cleaning afterward.
Housekeeping
Doing homeownership essentials like daily chores, dishes, cleaning, and maintaining a tidy living space. Contacting the right person for repairs or maintenance.
Laundry
Washing, drying, and folding clothes.
Telephone Use
Operating a phone, dialing numbers, and managing communication via calls or messaging.
Signs A Loved One Is Quietly Struggling With ADLs
As a loved one, you can notice right away what might be bothering your parent right now. Identifying which ADLs they are struggling with is key before moving to the next steps, where you can consider a professional checkup.
Here are signs across different facets of well-being that suggest your parent may be struggling with certain ADLs.
Personal Care & Hygiene
- Skipping showers as they fear falling.
- Wearing the same clothes because dressing takes too much effort.
- Decline in appearance due to untidy hair or unclipped nails.
Mobility & Physical Safety
- Leaning on walls, grabbing furniture, or clinging to handrails to move around.
- Difficulty standing up, sitting, or using the toilet.
- Frequent bruises, scratches, or minor bumps from hidden falls or near-misses.
- Furniture rearranged due to navigation issues.
Nutrition & Eating
- Unexplained weight loss, signs of poor nutrition, and dehydration.
- Neglected kitchen and refrigerator.
- Trouble handling utensils or physically getting food from the plate.
Cognitive & Behavioral Shifts
- Frustration completing routine tasks.
- Pulling away from hobbies and skipping meetings with friends because of embarrassment or exhaustion.
What Families Can Do Next
As adult children, you can have an open conversation with them about their struggles with daily living needs. Or you can step in to help with the activities they may be struggling to do. In the meantime, it’s best to track specific changes in a journal to share with a doctor.
Taking them for a medical evaluation can help rule out treatable issues like urinary tract infections, vision changes, medication side effects, or early cognitive decline to confirm whether their issues are really related to aging.
How Professionals Assess ADLs (Katz Index, Functional Assessments)
While family members can get a general idea of a loved one’s ability to complete daily living activities (ADLs) through in-person observation, professionals usually use standardized tools to evaluate a senior’s functional status.
Two main tools are used: one for ADLs and one for IADLs, i.e., the Katz Index of Independence and the Lawton IADL Scale. These tools aren’t just forms to fill out; they’re real-world, clinical evaluations. Here are their details:
Katz Index of Independence
The primary and one of the most commonly used tools for assessing basic ADLs is the Katz Index of Independence in Activities of Daily Living, also known as the Katz Index of ADLs. This tool uses an ADL checklist to measure six basic self-care functions and guide care planning.
Here are the self-care functions this tool measures:
- Bathing: The person’s ability to bathe independently or needing help with parts of the body.
- Dressing: Selecting clothes and putting them on without assistance.
- Toileting: Getting to and from the toilet, cleaning self, and managing clothes.
- Transferring: Moving in and out of beds or chairs independently.
- Continence: Controlling bladder and bowel function.
- Feeding: Getting food from a plate into the mouth by oneself.
Each activity is rated 1 (independent) or 0 (dependent/needs assistance). The Katz Index takes less than five minutes, as clinicians give the score based on direct observation and a brief chat with the family about recent daily routines.
A score of 6 means the individual is completely independent; 4 denotes moderate functional impairment, and 2 or less means severe functional impairment and high dependency.
Lawton IADL Scale
The Lawton IADL Scale is an 8-item assessment tool used to evaluate an older adult’s independent living skills and identify early signs of functional decline. Clinicians use it to assess higher-level tasks like managing finances, medications, meal preparation, and more.
Here are eight complex domains it assesses:
- Using the telephone
- Shopping
- Food preparation
- Housekeeping
- Laundry
- Mode of transportation
- Responsibility for own medications
- Ability to handle finances
Each item is typically scored as 0 (unable to do or partial function) or 1 (independent). The total score ranges from 0 to 8. Historically, men were scored on 5 tasks by excluding domestic chores like cooking or laundry, but modern assessments evaluate all 8 areas to ensure complete safety.
Clinicians generally assess IADLs (Instrumental Activities of Daily Living) first, or evaluate both together, because higher-level cognitive and functional declines usually affect complex tasks before basic self-care.
What ADL Results Mean For Care Decisions
Both ADLs and IADLs reflect a person’s ability to live independently. If the clinician confirms a good score for an older adult, it means the person can live autonomously and safely. A low score usually signals that they need care. If they struggle with even a few tasks, it usually indicates a need for care; otherwise, they may face challenges related to nutrition, medication management, or quality of life.
In simpler terms, scores aren’t just numbers; they are evaluations professionals use to determine the best care option for a particular individual. Scoring systems evaluate whether a person needs independence, setup assistance, supervision, or total physical dependence.
ADL assessments also form the basis for activating long-term care insurance benefits, as most policies activate when a person can’t perform a specific number of ADLs—most commonly 2 out of 6.
Standby Vs Hands-On Assistance
Functional assessments of daily living activities determine whether a person needs standby or hands-on assistance. Standby assistance means the caregiver is available within easy reach for supervision and safety needs, while hands-on assistance means the caregiver is available around the clock.
How ADLs Map To Levels Of Care And Pricing
Activities of Daily Living (ADLs) provide the foundation for evaluating a person’s functional independence and determining a care option. Deficits across the evaluated core tasks determine the required care level and influence the billing model and insurance payouts.
FAQ
- What are the 6 basic activities of daily living?
The six core Activities of Daily Living (ADLs) are bathing, eating, dressing, transferring, toileting, and continence.2. What is the difference between ADLs and IADLs?
Activities of Daily Living (ADLs) are basic self-care tasks needed for survival, while Instrumental Activities of Daily Living (IADLs) are complex tasks required to live independently in the community.3. Who performs an ADL assessment and what does it involve?
An occupational therapist (OT), nurse, physician, or geriatric care manager typically performs an ADL assessment. This assessment evaluates a person’s basic self-care and functional abilities.4. Can someone with only IADL difficulties still live independently?
Yes, a senior with only Instrumental Activities of Daily Living (IADL) difficulties can still live independently if they receive targeted outside support for those specific complex tasks.5. Does Medicare or insurance care about ADL scores?
Original Medicare doesn’t consider Activities of Daily Living (ADL) scores because it covers medical care, not long-term custodial care. However, Medicare Advantage Plans may track ADLs to unlock non-medical extras.
Vista at Simi Valley—A Vibrant Assisted Living Community
At Vista at Simi Valley, we understand that older adults may need more care and daily living support as they progress into their later years. After evaluating a senior’s ADLs and IADLs scores, a physician recommends a care option. This guide explains what an ADL assessment for seniors may look like and how it shapes a senior’s future care decisions.
Because ADLs are part of everyday life, families often don’t recognize their importance until they notice a loved one can’t complete these essentials on their own. It is when they notice a missed shower or a fall that worry about their loved one’s well-being begins.
Wondering how much daily support your loved one needs? Contact us at Vista at Simi Valley to schedule a complimentary care assessment and take the first step toward your loved one’s well-being as they age. Our professional, compassionate staff manages grooming, bathing, medication management, and household chores and coordinates with healthcare services to ensure residents live a fulfilling life without the worries of aging. Our engaging senior living activities help residents live fulfilling, connected lives.
