There are six basic activities of daily living (ADLs). These are the core physical tasks you need to perform every day to take care of your body: bathing, dressing, eating, transferring (moving around), toileting, and personal hygiene/grooming. This list of six comes from the Katz Index of Independence, the most widely used ADL assessment in healthcare and insurance.
The Six Basic ADLs
Each ADL covers more than the obvious task. Here’s what clinicians and insurers actually evaluate:
- Bathing: Using soap and water to wash your entire body, plus the physical ability to stand, sit, or move in and out of a tub or shower.
- Dressing: Retrieving clothes, putting them on in the right order, and managing fasteners like buttons, zippers, and snaps. This also includes putting on or removing any prosthetic devices or splints.
- Eating: Getting food from a plate or bowl into your mouth. This doesn’t include cooking or meal preparation, just the act of feeding yourself.
- Transferring: Moving from one spot to another as part of your daily routine. Think getting from your bed to the bathroom, or from a chair to standing position.
- Toileting: Getting to the toilet, positioning yourself, using toilet paper or other supplies, and managing any devices like a catheter.
- Personal hygiene and grooming: Brushing your teeth, washing and styling your hair, shaving, trimming nails, and applying deodorant.
Some versions of the list fold hygiene into bathing or separate continence (bladder and bowel control) into its own category. The total stays at six, but the exact labels shift slightly depending on which assessment tool is being used.
Basic ADLs vs. Instrumental ADLs
Beyond the six basic ADLs, there’s a second category called instrumental activities of daily living (IADLs). These are more complex tasks that require planning, decision-making, or interacting with the outside world: managing finances, shopping, cooking, doing housework, using a phone, taking medications correctly, and arranging transportation. Sidney Katz, the same researcher who developed the original ADL scale in the 1970s, later created a separate scale for these instrumental tasks.
The distinction matters because basic ADLs are about physical survival, while IADLs reflect the ability to live independently in a community. A person might manage all six basic ADLs but struggle with IADLs like paying bills or grocery shopping. In 2014 CDC data, about 10.6% of adults aged 75 and older needed help with basic ADLs, while a larger share, 18.8%, needed help with IADLs. That gap reflects how cognitive and organizational skills often decline before the most fundamental physical abilities do.
Why the Number Six Matters for Insurance
The six-ADL framework isn’t just a clinical tool. It’s the standard measure that triggers long-term care insurance benefits. Most policies start paying when you need help with two or more of the six basic ADLs, or when you have a cognitive impairment like dementia. This is why you’ll see ADLs referenced so often in insurance documents and eldercare planning. The specific number of ADLs you need help with directly determines whether you qualify for coverage.
The Barthel Index: A 10-Item Alternative
Not every assessment sticks to six items. The Barthel Index, another common tool, evaluates 10 activities: feeding, bathing, grooming, dressing, bowel control, bladder control, toilet use, transfers, mobility, and stair climbing. It scores each on a scale, with a total possible score from 0 to 20, where lower scores mean greater disability. The Barthel Index is more granular. It breaks continence into separate bowel and bladder categories and adds stair climbing and general mobility as distinct items. Hospitals and rehabilitation facilities often prefer it because the finer detail helps track recovery progress.
So while the standard answer is six basic ADLs, the number you encounter depends on context. Insurance and most clinical shorthand use six. Rehab settings may assess eight or ten.
How ADL Ability Declines in Dementia
ADL loss in dementia follows a fairly predictable pattern. Instrumental activities go first: managing money, cooking, and navigating travel become difficult in the mild stages. As dementia progresses to moderate severity, basic ADLs start to fall away in a specific order. Choosing appropriate clothing is typically the first basic ADL affected. Then dressing independently becomes difficult, followed by bathing, then toileting. Continence is lost after that, first urinary, then fecal. In severe dementia, the ability to walk, sit upright, and eventually hold up the head are lost in sequence.
This progression, mapped out by the Functional Assessment Staging Tool (FAST), helps families anticipate what kind of support will be needed and when. It also provides a framework for hospice eligibility decisions in advanced Alzheimer’s disease.