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Comprehending Activities of Daily Living: Checklists, Evaluations, and More

When it becomes evident that a loved one struggles with daily routines without assistance, it's time to explore resources that can provide the necessary support. One of the initial inquiries from long-term care insurance companies, home care providers, adult day care centers, or assisted living communities will be about the senior’s ability to perform basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

What are Activities of Daily Living?

The Katz Index of Independence in Activities of Daily Living outlines ADLs as fundamental skills required to care for oneself and fulfill physical needs. The six activities of daily living include:

  1. Eating — the ability to successfully move food and drink to one’s mouth.

  2. Dressing — the ability to choose appropriate clothing and put it on.

  3. Bathing — the ability to maintain personal hygiene, including nail care, hair care, and oral hygiene.

  4. Toileting — the ability to use the toilet and cleanse oneself.

  5. Continence — the ability to control bladder and bowel functions.

  6. Ambulating — the ability to walk and move in and out of a bed or chair.

What do instrumental activities of daily living involve?

Instrumental activities of daily living (IADLs) encompass more complex tasks essential for independent living. These activities require a combination of physical and cognitive abilities. As outlined by the Lawton-Brody Scale, IADLs include:

  • Cooking: Planning, preparing, and serving meals adequately.

  • Managing medications: Ensuring correct medication doses at appropriate times.

  • Shopping: Procuring necessities like clothing, personal care items, and groceries.

  • Communicating: Using phones, computers, or other communication tools effectively.

  • Managing money: Budgeting, writing checks, paying bills, visiting banks, and tracking finances.

  • Housekeeping: Cleaning and maintaining one's living environment.

  • Transportation: Driving, using public transport, or arranging other means of travel.

  • Laundering clothing: Washing and drying personal garments.

What is assessed by activities of daily living?

Functional status is assessed through both basic and instrumental activities of daily living.

It’s crucial to recognize that functional capabilities can vary across all ADLs and IADLs. For instance, a senior who requires a mobility aid to walk may rely on assistance for physically demanding IADLs such as housekeeping and laundry, yet they may independently manage basic ADLs like bathing, toileting, and dressing. Even if assistance is needed with some ADLs or IADLs, individuals may still actively participate in their own care.

Depending on the task, individuals may:

  • Be entirely self-sufficient

  • Need reminders, supervision, or prompts

  • Utilize durable medical equipment or other aids

  • Require moderate physical assistance

  • Depend entirely on others

How do age and health conditions impact functional abilities?

As individuals age, they may naturally experience a decline in functional abilities or impairment in activities of daily living (ADLs). According to the American Psychological Association, "less than one-fifth of older adults aged 65 to 74 require assistance with activities of daily living." However, those over 85 generally need some level of support for daily tasks.

Health conditions affecting musculoskeletal, neurological, circulatory, or sensory systems can also impact a senior’s capability to perform instrumental activities of daily living (IADLs) and ADLs. Additionally, subtle factors such as social isolation, medication side effects, and the specific characteristics of a senior's living environment can contribute to increased difficulty and potential risks in self-care.

Given their intricate nature, IADLs typically decline in the early stages of illness or cognitive decline, while ADLs often deteriorate in the middle to later stages of impairment.

Why are ADLs and IADLs crucial?

The functional status and ability to manage daily tasks independently significantly impact a senior’s quality of life. Changes in ADLs and IADLs can stem from underlying medical conditions, but overlooking these evolving needs can exacerbate physical and mental health issues. Unmet assistance needs for activities of daily living can lead to:

  • Malnutrition

  • Poor personal hygiene

  • Social isolation

  • Illnesses such as urinary tract infections (UTIs)

  • Falls

Studies have linked ADL disabilities with higher mortality risks. Providing seniors with necessary ADL care can help prevent new health complications, reduce overall care expenses, and delay or eliminate the need for institutional care. Therefore, both a senior’s medical requirements and functional capabilities should guide critical care decisions.

Moreover, various elder care services, benefit programs, and insurance providers use basic ADLs as eligibility criteria. For instance, seniors may need documented nursing home-level care to qualify for long-term care Medicaid programs, which typically mandate an inability to perform specific ADLs among other criteria. ADL needs also factor into eligibility for VA Aid and Attendance pensions and Social Security disability benefits. Understanding a loved one’s functional abilities and limitations facilitates finding suitable care options and supportive services they qualify for.

Evaluating Activities of Daily Living

Healthcare professionals and long-term care providers conduct assessments of activities of daily living to evaluate an individual’s daily functioning and determine their required level of care. These functional assessments play a critical role in several common care decisions:

  • Assessing whether an older adult can maintain independent living at home

  • Determining the type and extent of in-home care services needed by a senior

  • Providing guidance for hospital discharge planning

  • Identifying the appropriate senior living community that matches the needs of older adults

Seniors often hesitate to acknowledge difficulties with self-care tasks and daily routines. However, Carmel Froemke, program director at the Community Action Partnership of North Dakota, emphasizes the importance of ADL assessments. The results inform the development of personalized care plans that support older adults in living safely and independently while ensuring their specific needs are addressed.

When to Pursue an ADL Assessment

If you notice even subtle changes in a loved one’s functional abilities, it's crucial to take action promptly. Early intervention allows you to establish a baseline, find appropriate solutions, and support their independence, safety, and well-being.

"Family members often observe signs of decline through changes in routines or appearance," notes Froemke. "These indicators typically suggest an underlying issue that affects their ability to manage daily tasks independently."

How to Arrange an ADL Assessment

Various elder care experts and medical professionals conduct formal assessments of Activities of Daily Living (ADLs). However, most programs providing or covering long-term care services have their own distinct processes, assessors, rules, and guidelines. For instance, long-term care insurance companies typically engage private assessors to determine eligibility for policyholders seeking to use their benefits.

If you wish to arrange an independent assessment of your loved one’s needs, it’s advisable to consult specialists such as geriatric care managers, nurses, occupational therapists, or social workers. These professionals can identify areas of concern and recommend potential solutions. A comprehensive geriatric assessment conducted by a physician can also evaluate both ADLs and Instrumental Activities of Daily Living (IADLs), as well as consider lifestyle factors, medications, and overall physical and mental health to provide a thorough understanding of the senior’s circumstances and requirements.

A valuable resource to initiate this process is your local Area Agency on Aging (AAA), which can provide referrals to service providers and, in some cases, conduct functional assessments. These offices also offer guidance on support programs, benefits, and assistance with applications.

Sources of Assistance for IADLs and ADLs

While family caregivers often assist with daily tasks, their capacity may be limited. Sometimes, durable medical equipment or home modifications can aid elderly individuals with Activities of Daily Living. However, if additional support is necessary even after implementing modifications, seeking external assistance is advisable. Fortunately, there are numerous options available to support seniors and alleviate caregiver burdens.

Seniors can collaborate with physical therapists, occupational therapists, and speech therapists to enhance their functional abilities. Although some ADLs and IADLs may be challenging to improve due to degenerative conditions like dementia, professional guidance can still be beneficial. Medicare may cover these services, which can be delivered in a senior’s residence by a home health care agency, in outpatient settings, or in skilled nursing facilities for short-term rehabilitation post-hospitalization.

Alternatively, formal assistance is available for Instrumental Activities of Daily Living, known as companion care or homemaker services. These non-medical supports can be provided at home by home care companies. For seniors needing assistance with specific IADLs, standalone services might be more suitable. For example, transportation needs can be met through ride-hailing services, while housekeeping tasks can be managed by regular cleaning services.

Assistance with Activities of Daily Living falls under personal care or custodial care. Home care is particularly well-suited for seniors who prefer aging in place but require help with ADLs.

Navigating through care decisions and comparing various care types can be daunting. If your loved one’s needs are escalating and you’re ready to explore options, start a consultation with one of our advisors at no cost. We can assist you in finding local home carers that align with their unique needs, care objectives, and financial considerations.

For more information about caregiving support, please visit AmoryCare or contact us at:

Phone: 908-854-3220

Fax: 908-854-3221

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