What are Activities of Daily Living (ADLs)?

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Definition:

Activities of daily living (ADLs) are the basic skills that people need to be able to perform to properly care for themselves: eating, bathing, getting dressed, toileting, transferring, and continence.

🤔 Understanding ADLs

Healthcare professionals use the concept of activities of daily living (ADLs) to determine whether an individual can live on their own and care for themselves. Medical providers often use ADLs to measure the skill-level of elderly individuals and those with disabilities. Those who can’t perform the basic ADLs often have to live in nursing homes or other facilities where they can receive regular care. Someone’s performance on ADLs also helps to determine eligibility for certain health coverage. The basic ADLs are moving independently, feeding oneself, dressing oneself, personal hygiene, continence, and toileting. There are other skills known as instrumental ADLs that are more challenging than the basic ADLs, but that people usually must be able to perform to live on their own.

Example

One example of an activity of daily living (ADL) is the ability to move independently. First, this includes someone’s ability to get themselves up from their bed or from a chair, functions they would have to perform to get their day started. It also includes someone’s ability to move around his or her home or to get to other locations they have to visit as a part of their daily routine. If someone isn’t able to move independently in his or her home, medical professionals might determine that the person isn’t equipped to live alone.

Takeaway

The activities of daily living assessment is like the grading scale that teachers use…

Every year, teachers have to evaluate their students’ performance to decide if they’ll be able to move onto the next grade. Medical professionals use a similar concept for elderly and disabled individuals, but they use it to determine if someone can live on their own, rather than whether someone can move along to the next grade level.

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What are the activities of daily living?

Activities of daily living (ADLs) are the primary skills that each of us has to perform every day to care for ourselves. Think of all of the most basic functions you perform when you wake up each morning: you get out of bed, shower, get dressed, and make yourself breakfast. Each of these activities fall into the category of ADLs. To safely live alone, someone should be able to perform each of the basic ADLs. There are also more advanced ADLs such as money management and transportation that aren’t as central to keeping ourselves alive, but that are still important.

If someone can’t perform ADLs on their own, medical professionals usually see it as a sign that they shouldn’t be living on their own anymore. Failure to perform ADLs might also be a sign of greater health issues. Finally, someone who can’t handle the basic daily activities might be eligible for certain government insurance and services such as long-term care.

What are the different ADLs?

Basic activities of daily living (ADLs) are the most base-level functions that someone has to perform to care for themselves properly. If he or she can’t perform these activities, he or she can’t live alone without the help of a care provider.

The basic ADLs are:

  • Ambulating, meaning getting out of bed in the morning and moving independently around their home
  • Feeding themselves
  • Dressing themselves
  • Personal hygiene, including bathing and dental care
  • Continence, meaning bladder and bowel control
  • Toileting, including moving onto and off the toilet and cleaning themselves

What are instrumental ADLs?

Instrumental activities of daily living (IADLs) are a more advanced set of skills than the basic ADLs. These skills aren’t the ones that someone would need to function on the most basic level. However, they’re still necessary.

The instrumental ADLs are:

  • Transportation: Someone doesn’t necessarily need to be able to drive themselves around, but they should be able to line up transportation for themselves.
  • Money management: Someone should be able to pay all of their bills on time and ensure the management of their financial assets.
  • Shopping and meal preparation: Not only is it necessary that someone be able to shop for or acquire groceries and other necessities, but they should also be able to prepare adequate meals for themselves.
  • Housecleaning: Someone should be able to keep their home clean and properly maintained.
  • Communication: It’s vital that people be able to communicate with the outside world through means such as phone, mail, and email.
  • Medication management: For individuals who need to take medication, they should be able to acquire and take those medications.

The difference between the basic ADLs and the instrumental ADLs is that the instrumental ones are easier to outsource. For someone to live alone, it’s not necessary that they do all of these tasks alone — It’s only necessary that they can make them happen.

If someone can successfully use a phone, they can outsource nearly everything on this list. They can line up transportation without having to drive themselves. They can hire a financial professional to manage their assets. They can order groceries for delivery and purchase pre-made meals, so they don’t have to cook. They can hire someone to clean their home.

What is a functional assessment?

If there is concern that someone can’t perform the activities of daily living (ADLs), they might have to undergo a functional assessment. A functional assessment is when a physician or other care worker evaluates how well an individual can perform basic ADLs and instrumental ADLs.

One of the most popular models for performing a functional assessment is by using the Katz Index of Independence in Activities of Daily Living (aka the Katz ALD Index). Doctor Sidney Katz developed the index to help determine whether patients were able to live on their own.

Though the Katz ADL Index is the most popular assessment in measuring whether someone can perform the basic ADLs, another assessment called the Lawton Instrumental Activities of Daily Living Scale measures whether someone can complete the instrumental ADLs.

Who is qualified to perform an ADLs assessment?

Any number of different healthcare workers can perform ADL functional assessments. In fact, it’s rarely just one provider handling the assessment. Instead, it’s a collaborative effort that involves all of the doctors, nurses, and physical therapists that provide care to a particular patient. Nurses and care workers are those most involved with a functional assessment, and physicians can then use the information from the assessment to determine the next steps for a patient.

How often should ADLs be evaluated?

How often a medical team should evaluate someone’s activities of daily living (ADLs) depends on their current situation. To qualify for certain government services or to make the call that someone can no longer live alone, someone might need to undergo just one assessment. However, functional assessments are an ongoing process. For people who are at risk of not being able to perform any of the ADLs, assessments occur regularly. And for patients currently undergoing a hospital stay, ADL assessments are done daily.

Why are ADLs important?

Activities of daily living (ADLs) are critical functions that an adult has to be able to perform to care for themselves properly. Once someone is no longer able to handle these activities on their own, it’s likely that they may not be able to live on their own anymore.

A lack of ability to perform ADLs is not only a sign that someone can no longer care for themselves, but it also might be a sign of greater physical or cognitive health problems. Identifying what ADLs someone struggles with can help doctors to get a better idea of what is going on.

ADLs are also important for determining the level of government services for which someone might be eligible. In some cases, whether or not someone receives in-home or long-term care services comes down to whether they’re able to perform ADLs on their own.

How are ADLs related to financial aid?

Not only does someone’s ability to complete activities of daily living (ADL) determine whether they can care for themselves, but it also determines their eligibility for certain government services.

First, some individuals may receive some help under Medicare if they meet the eligibility requirements. To be eligible for Medicare, someone must be age 65 or older, and the individual or his or her spouse must have worked for about 10 years. Someone could also be eligible for Medicare if they meet certain disability requirements such as receiving Social Security disability benefits or have specific medical problems.

Though Medicare does not pay for long-term care, it does pay for in-home care services for people who aren’t able to manage all of the ADLs by themselves. Because these in-home services don’t include many of the ADLs, this type of care may not be comprehensive enough.

Medicaid, the health coverage jointly run by the federal and state governments, is more conducive to providing services for those unable to care for themselves at home. To be eligible for Medicaid, someone has to meet income requirements specific to their state. For someone eligible for Medicaid, a medical provider will evaluate an individual’s performance of the ADLs to decide if they need and qualify for long-term care.

Long-term care services under Medicaid are specifically designed for those people who struggle to meet their own daily needs such as dressing, bathing, and mobility. People can receive long-term care at home or a facility in their communities.

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