Activities of Daily Living (ADLs) are fundamental skills used to measure a person’s capacity for independent self-care. First introduced by Dr. Sidney Katz in the 1950s, the term refers to the basic tasks most people perform daily without assistance. An individual’s ability to perform ADLs is a primary indicator of their functional status. This framework helps healthcare providers assess a person’s need for assistance due to aging, illness, or injury.
The Two Types of ADLs
Healthcare professionals categorize daily living activities into two distinct groups. The first, Basic Activities of Daily Living (BADLs), encompasses the most fundamental self-care tasks. These are the core functions required to care for one’s own body.
The six core BADLs are widely recognized. These include bathing (cleaning oneself), dressing (putting on clothing), and eating (feeding oneself). They also include transferring (moving from a bed to a chair), toileting (using the toilet and cleaning oneself), and continence (controlling bladder and bowel functions).
Instrumental Activities of Daily Living (IADLs) are more complex skills necessary to live independently within a community. These tasks require higher cognitive and organizational abilities than basic self-care. Difficulty with IADLs can indicate a need for support even if a person can manage their BADLs.
IADLs include:
- Managing finances, which involves paying bills and handling financial assets.
- Meal preparation, covering the entire process of planning and cooking meals.
- Managing medications, which involves taking the correct doses at the correct times and organizing refills.
- Shopping for groceries and other necessities.
- Performing housework and laundry.
- Managing transportation, whether by driving or arranging other means.
How ADL Performance is Evaluated
Evaluations are performed by physicians, nurses, or occupational and physical therapists to create an objective record of a person’s abilities. The assessment involves various methods, including direct observation of the person performing tasks, interviews with the individual and their caregivers, and self-reported information.
To ensure consistency and objectivity, professionals use standardized assessment tools. These instruments provide a structured framework for the evaluation, which allows for reliable tracking of changes over time and provides a clear, quantifiable measure of a person’s dependency level.
For evaluating Basic ADLs, one of the most widely used tools is the Katz Index of Independence in Activities of Daily Living. This scale assesses the six core BADLs and assigns a point for independence in each, providing a straightforward score of functional status. For Instrumental ADLs, the Lawton-Brody IADL Scale evaluates eight different tasks required for independent community living, offering a more nuanced view of a person’s abilities.
Significance of ADL Assessments
The results of an ADL assessment carry significant real-world consequences, directly impacting an individual’s eligibility for care and support services. Insurance providers and government programs rely on these assessments to make coverage decisions.
A common trigger for benefits under long-term care insurance policies is the inability to perform a specific number of ADLs without assistance, often two out of the six basic ADLs. This determination activates the policy, allowing the individual to receive financial support for care.
Government programs like Medicaid also use ADL assessments to determine eligibility for services such as nursing home care or in-home support. For instance, qualifying for nursing facility level of care through Medicaid may require demonstrating a need for assistance with three or more ADLs.
Beyond insurance and government benefits, ADL assessments are fundamental to creating personalized care plans. The detailed information gathered helps families and healthcare providers determine the most appropriate level of support. This can range from arranging for part-time in-home help with specific IADLs to deciding on a move to an assisted living facility or a skilled nursing facility that can provide 24-hour care.