ADLs are the fundamental self-care tasks required for personal well-being and independent living. Healthcare providers, long-term care insurance companies, and rehabilitation specialists use ADLs as a standardized metric to determine an individual’s functional status. Assessing a person’s ability to complete these tasks provides a clear measure of their independence and helps identify the level of assistance they may require.
Defining the Core 6 Activities of Daily Living
The core six Activities of Daily Living are the essential physical functions necessary for self-maintenance, originally standardized by Dr. Sidney Katz in the 1960s. These six categories provide a clear framework for measuring a person’s need for assistance in the most basic areas of life. A decline in the ability to perform any of these tasks can signal a need for support, which may involve home care, assistive devices, or placement in a facility.
Bathing
Bathing involves the ability to safely and thoroughly wash the body, including getting in and out of a shower or bathtub and reaching all body parts for cleansing. This task requires both balance and flexibility. Independence in this area means managing the process without the assistance of another person.
Dressing
Dressing refers to the ability to select appropriate clothing and put on and take off all garments. This includes managing fasteners like zippers, buttons, and snaps, which demands fine motor control and dexterity. The task is complete only when the individual can dress and undress themselves fully and appropriately.
Toileting
Toileting requires the ability to get to and from the toilet, use it correctly, and perform the necessary cleanup afterward. This activity also encompasses the ability to manage any related equipment, such as catheters or colostomy bags. A person is considered independent if they can manage the process from start to finish without physical help.
Transferring
Transferring measures the capacity to move from one position or location to another. Examples include moving from a bed to a chair, from a chair to a wheelchair, or standing up from a seated position. The ability to transfer safely is a direct reflection of an individual’s strength and mobility.
Continence
Continence assesses the ability to maintain voluntary control over bladder and bowel function. This ADL is distinct from toileting, as it focuses on the physiological control to manage when and where urination or defecation occurs. Loss of continence is a significant factor in determining the level and setting of long-term care.
Feeding
Feeding is defined as the act of getting nourishment from the plate or container into the mouth. This includes using utensils, chewing, and swallowing, but it does not encompass the preparation of the meal itself. Independence in feeding means being able to safely ingest the food.
Instrumental Activities of Daily Living
Instrumental Activities of Daily Living (IADLs) represent the more complex cognitive and organizational tasks required to live independently within a community. They are necessary for managing a household and navigating the broader environment, often requiring a higher level of executive function and planning skills. These activities typically decline earlier than the basic ADLs, serving as an important early indicator of functional change.
The ability to perform IADLs suggests a person can live alone, potentially with minor support. In contrast, difficulty with ADLs typically indicates a need for constant personal assistance.
Examples of IADLs
- Managing personal finances, such as paying bills and budgeting.
- Using communication devices like a telephone or computer.
- Preparing meals, which involves planning, shopping, cooking, and safely using kitchen appliances.
- Arranging and using transportation, whether driving or using public transit.
- Managing medications correctly, including remembering to take prescriptions and refilling them.
- Shopping for groceries and personal items.
- Performing light housekeeping and doing laundry.
The Role of ADL Assessment in Care Planning
ADL assessment is a core practice in healthcare, social work, and insurance to determine an individual’s functional independence. By evaluating the assistance a person needs for the six core activities, professionals determine the appropriate setting and type of care. Standardized tools, such as the Katz Index, allow for an objective measure of functional status.
Assessment results have practical implications across multiple domains. For long-term care insurance, difficulty with a specified number of ADLs, often two or more, is a common threshold for triggering benefit eligibility. This quantification justifies the need for financial assistance to cover home care or facility-based services.
In rehabilitation, ADL assessment guides the development of therapy goals for occupational and physical therapy. Therapists use the findings to structure interventions aimed at restoring function or teaching compensatory techniques. Regular reassessment allows care teams to track a patient’s progress or decline, helping to make informed decisions about discharge planning and necessary modifications to the living environment.