Activities of Daily Living (ADLs) are the fundamental self-care tasks people must be able to perform to live independently. Medical professionals, social workers, and insurance providers consistently use ADLs to assess a person’s functional status and measure the level of assistance they may require. Evaluating the ability to complete these tasks offers a standardized, objective measure of overall functional health. The resulting assessment helps determine an individual’s need for care, ranging from minor home health assistance to full-time long-term care.
The Six Standard Activities of Daily Living
The standard model for functional assessment centers on six specific activities, universally recognized as the core set of self-care tasks. These six ADLs were originally outlined in the Katz Index of Independence in Activities of Daily Living, an assessment tool developed in the late 1950s. The six activities include Bathing, Dressing, Toileting, Transferring, Continence, and Feeding.
Bathing involves the ability to safely get into and out of a shower or tub and to wash and dry oneself completely. Dressing refers to the physical and cognitive ability to select appropriate clothes, put them on, and manipulate fasteners like zippers and buttons. Toileting requires the capacity to use the toilet, manage personal hygiene afterward, and safely get on and off the commode.
Transferring refers to the ability to move from one position to another, such as getting out of bed, standing up from a chair, or moving to a wheelchair. Continence is the capacity to maintain control over bladder and bowel function or, if control is lost, the ability to manage a catheter or colostomy bag independently. Feeding is defined as the act of getting food from a plate or receptacle into the body, not the process of cooking or preparing the meal.
The Critical Threshold for Functional Impairment
The minimum number of ADLs defining functional impairment is the threshold of two. For the purpose of triggering benefits from long-term care insurance and eligibility in many government-funded programs, an individual is considered functionally disabled when unable to perform at least two of the six standard ADLs. This number serves as the benchmark for demonstrating a substantial loss of functional capacity.
The inability to perform an ADL must require “substantial assistance,” not just difficulty. Substantial assistance includes hands-on assistance and stand-by assistance. Hands-on assistance involves the physical help of another person to complete the activity, such as a caregiver helping a person get dressed or into the shower. Stand-by assistance (supervision) means a person must be physically present to guide, cue, or prevent injury, especially with cognitive impairment or high fall risk.
The inability to perform two ADLs must also be expected to last for a significant duration, which many policies define as at least 90 days. This ensures the impairment is chronic or long-lasting, rather than a temporary condition from an acute illness or minor injury. The inability to perform two ADLs, or the existence of severe cognitive impairment, are the two main criteria establishing eligibility for long-term care services.
Determining Dependency and Eligibility for Care
Determining a person’s ADL dependency is carried out through a formal assessment, typically conducted by a licensed healthcare practitioner, such as a registered nurse or a physician. These professionals use standardized, validated assessment tools to objectively score the individual’s level of independence for each of the six ADLs. Widely used instruments, including the Katz Index and the Barthel Index, provide a systematic way to measure functional ability.
The assessor evaluates whether the individual requires physical assistance or constant supervision. For example, a person needing help stepping over a tub wall requires hands-on assistance for Bathing. A person with dementia who needs a caregiver present to remind them of the dressing sequence requires stand-by assistance.
If the assessment confirms the individual meets the minimum threshold of needing substantial assistance with two or more ADLs, this status directly triggers eligibility for various care services. For those with long-term care insurance, policy benefits become payable at this point. Meeting the ADL threshold may qualify others for government-subsidized home health aide services or placement in a facility. The documented assessment provides the necessary evidence to transition from informal support to receiving formal, funded long-term care.