The six ADLs (Activities of Daily Living) are bathing, dressing, eating, transferring, toileting, and continence. These are the basic self-care tasks a person needs to perform independently to live without assistance, and they serve as the standard measure healthcare providers and insurers use to assess someone’s functional ability.
The 6 ADLs Explained
Bathing means washing your entire body, whether in a shower, tub, or sponge bath. You’re considered independent if you can bathe yourself completely or only need help with a single area, such as your back or a limb with limited mobility. Needing help with more than one body part, or needing someone to help you get in and out of the tub, counts as dependence.
Dressing covers the full process of getting clothes from your closet or drawers and putting them on, including fastening buttons, zippers, and clasps. Needing help tying shoes doesn’t count against you. But if you need another person to help you get dressed or select appropriate clothing, that qualifies as a limitation.
Eating refers specifically to getting food from your plate into your mouth, not cooking or preparing meals. Someone else can prepare the food for you and you’re still considered independent for this ADL. Dependence means you need partial or complete help with the physical act of feeding yourself.
Transferring is the ability to move between positions: getting out of bed into a chair, out of a chair to standing, or the reverse. Using a walker, grab bar, or other mechanical aid on your own still counts as independent. What matters is whether you need another person to help lift or support you during the movement.
Toileting includes the entire sequence of getting to the toilet, getting on and off, adjusting clothing, and cleaning yourself afterward. If you need help with any part of that process, or if you rely on a bedpan or commode, you’re considered dependent in this area.
Continence is having complete control over both bladder and bowel function. Even occasional accidents count as partial dependence on this measure. This ADL is slightly different from the others because it’s less about a physical task and more about a bodily function, but it’s included because loss of continence is one of the strongest predictors of needing ongoing care.
How the 6 ADLs Are Scored
The most widely used tool for measuring ADLs is the Katz Index of Independence in Activities of Daily Living. It assigns 1 point for each ADL you can perform independently and 0 points for each one where you need supervision, direction, or hands-on help. The maximum score is 6, meaning full independence. A score of 4 indicates moderate impairment, and 2 or lower signals severe functional impairment.
The scoring is deliberately binary for each activity. There’s no partial credit. You either perform the task without another person’s involvement, or you don’t. This simplicity makes it easy for clinicians to administer quickly and track changes over time, particularly in older adults recovering from surgery, managing chronic illness, or showing signs of cognitive decline.
Why ADLs Matter for Insurance and Benefits
ADL scores aren’t just clinical tools. They directly determine eligibility for certain types of care and financial benefits. Most long-term care insurance policies begin paying benefits when you need help with two or more of the six ADLs, or when you have a cognitive impairment such as dementia. This “benefit trigger” threshold is written into federal tax law and adopted by most private insurers.
Medicare does not cover long-term care, which is the type of help most people need when they lose ADL independence. If your only care need is assistance with bathing, dressing, or other daily tasks, you pay 100% of those costs yourself. Medicare covers skilled nursing and rehabilitation after a hospital stay, but once your needs shift to ongoing personal care, that coverage ends. This gap is the primary reason people buy long-term care insurance or plan for Medicaid eligibility.
Among adults 75 and older in the U.S., roughly 1 in 10 needs another person’s help to perform basic ADLs. That percentage climbs sharply with age and with conditions like stroke, Parkinson’s disease, and advanced arthritis.
ADLs vs. IADLs
You’ll often see ADLs mentioned alongside IADLs, or Instrumental Activities of Daily Living. The six basic ADLs cover fundamental self-care. IADLs are a step up in complexity and include tasks like managing finances, preparing meals, shopping, doing housework, using a phone, managing medications, and arranging transportation. These require more cognitive ability, planning, and interaction with the outside world.
A person might score perfectly on basic ADLs (they can dress, bathe, and eat without help) while struggling significantly with IADLs (they can’t manage a bank account or remember to take medications). This distinction matters because IADL limitations often appear earlier in conditions like Alzheimer’s disease, sometimes years before basic ADL function starts to decline. Tracking both gives a much fuller picture of how independently someone can actually live.