Assisting on ADLs and IADLs

In this module you will learn about ways you can help a resident with everyday activities while supporting his/her independence and helping the resident keep a sense of self-respect. You will be introduced to some of the ways in which you are likely to be needed to aid residents before and during mealtime.

What Are Activities of Daily Living?

Activities of daily living (ADLs) are routine activities people do every day without assistance. There are six basic ADLs: eating, bathing, getting dressed, toileting, transferring, and continence. The performance of these ADLs is important in determining what type of long-term care and health coverage, such as Medicare, Medicaid, or long-term care insurance, a person will need as he or she ages.

·        ADLs are used as a measurement of a person’s functional status

·        First proposed in 1950 by Sidney Katz, who developed the first evaluation tool called the Katz ADL scale

·        Other assessment methods include the Barthel ADL Index, as well as the Roper–Logan–Tierney model of nursing

·        ADLs consist of Basic ADLs and Instrumental ADLs

·        Basics ADLs are more essential for survival than IADLs

·        Instrumental ADLs (IADLs) are not necessary for fundamental functioning, but they let an individual live independently in a community

The Activities of Daily Living are a series of basic activities performed by individuals on a daily basis necessary for independent living at home or in the community. There are many variations on the definition of the activities of daily living, but most organizations agree there are 5 basic categories.

1. Personal hygiene – bathing/showering, grooming, nail care, and oral care

2. Dressing - the ability to make appropriate clothing decisions and physically dress/undress oneself

3. Eating - the ability to feed oneself, though not necessarily the capability to prepare food

4. Maintaining continence - both the mental and physical capacity to use a restroom, including the ability to get on and off the toilet and cleaning oneself

5. Transferring/Mobility- moving oneself from seated to standing, getting in and out of bed, and the ability to walk independently from one location to another

Whether or not an individual is capable of performing these activities on their own or if they rely on a family caregiver for assistance to perform them serves a comparative measure of their independence.

What are the Instrumental Activities of Daily Living (IADLs)?

Instrumental Activities of Daily Living are actions that are important to being able to live independently but are not necessarily required activities on a daily basis. The instrumental activities are not as noticeable as the Activities of Daily Living when it comes to loss of functioning, but functional ability for IADLs is generally lost prior to ADLs. IADLs can help determine with greater detail the level of assistance required by an elderly or disabled person. The IADLs include:

1. Basic communication skills - such as using a regular phone, mobile phone, email, or the Internet

2. Transportation - either by driving oneself, arranging rides, or the ability to use public transportation

3. Meal preparation - meal planning, cooking, clean up, storage, and the ability to safely use kitchen equipment and utensils

4. Shopping - the ability to make appropriate food and clothing purchase decisions

5. Housework - doing laundry, washing dishes, dusting, vacuuming, and maintaining a hygienic place of residence

6. Managing medications - taking accurate dosages at the appropriate times, managing re-fills, and avoiding conflicts

7. Managing personal finances - operating within a budget, writing checks, paying bills, and avoiding scams

Why are the ADLs and IADLs Important?

Measuring an individual’s inability to perform the ADLs and IADLs is important not just in determining the level of assistance required, but as a metric for a variety of services and programs related to caring for the elderly and for those with disabilities.

Many state-funded, non-Medicaid programs, such as Texas Community Care for the Aged/Disabled and New York’s EISEP Program use an inability to perform 2 or 3 activities of daily living as one of the eligibility criteria for participation in their assistance programs.

Medicaid often requires elderly participants to be qualified for nursing home care, and often nursing home care qualification is partially determined by how much assistance one requires with ADLs. While Medicare doesn’t pay for custodial or personal care, which most of the ADLs are considered, Medicare PACE programs, which provide all-inclusive care for the elderly, do consider them a factor. Some Medicare Advantage plans are also now taking the need for assistance with ADLs into consideration and are providing in-home assistance with these activities to prevent and / or delay nursing home placements.

Long-term care insurance often uses an inability to perform ADLs as a trigger for paying out on a policy. Social Security Disability Insurance (SSDI) also considers ADLs as a qualification factor.