Activities of Daily Living: What Are ADLs and IADLs?
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What are activities of daily living?
Activities of daily living (ADLs) are routine personal tasks such as eating, using the toilet and dressing, as well as skills needed to prepare meals, clean house and keep track of medications. They indicate someone’s ability to care for themselves independently.
Someone who can’t perform ADLs may be at risk and experience reduced quality of life. ADL measurement can predict a person's need for daily assistance, such as in a nursing home, or measure progress in rehabilitation after an illness or injury. An assessment of a person's ADLs can help determine whether someone is eligible for government assistance such as Medicare, Medicaid or long-term care insurance benefits.
What are the 6 primary ADLs?
Basic ADLs refer to skills that allow someone to tend to their own physical needs. They typically include:
Mobility: Ability to move from one position to another, such as getting in and out of a bed and walking independently. May also be called “ambulating” or “transferring.”
Eating: Ability to feed oneself, which does not include cooking, grocery shopping or other food preparation.
Personal hygiene: Ability to bathe or shower, as well as other maintenance tasks such as brushing hair and teeth and trimming nails.
Dressing: Ability to choose appropriate clothes, put them on and take them off.
Continence: Ability to control bladder and bowel functions.
Toileting: Ability to get to, use, and get on and off the toilet and clean oneself afterward.
Instrumental activities of daily living
Instrumental ADLs (IADLs) are more advanced ADLs. They require more planning and complex thinking than basic ADLs. Common IADLs include:
Shopping: Ability to get groceries and other necessities, which includes the ability to get to stores by driving or using other transportation.
Meal preparation: Ability to plan and prepare daily meals.
Home maintenance: Ability to keep one’s home clean, including dishes and laundry.
Financial management: Ability to pay bills and maintain bank accounts or other financial assets.
Communication: Ability to contact others when needed, including using the telephone and managing mail.
Getting around town: Ability to drive a car or request, travel by and pay for public transportation, such as a taxi, if needed.
Managing medications: Ability to obtain and refill prescriptions and to take medication as directed, without supervision.
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Why ADLs matter
Someone who can’t perform ADLs or IADLs is typically unable to meet all of their basic needs, which can lead to issues such as inadequate hygiene, malnutrition and medical problems. The person is also at a higher risk of falling and being admitted to a hospital or nursing home. With support from caregivers and medical professionals, someone with decreased ADL skills can have a better quality of life.
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How to measure ADLs
Several methods can determine whether a person can or cannot perform an ADL. The most common assessment tools are the Katz Index of Independence in Activities of Daily Living and the Lawton Instrumental Activities of Daily Living (IADL) Scale, but the test that a provider uses depends on thepatient's situation.
Assessments vary in how many ADLs or IADLs they measure, the levels of independence they consider and how they assess a patient’s progress.
Depending on which assessment method a provider uses to assess ADLs, the provider may observe a patient doing particular activities or allow the patient (or someone close to them) to self-report their abilities.
Financial assistance for ADLs
The following options offer assistance for people who have lower ADL and IADLs skills. However, because programs vary in features and eligibility, not all of them apply to everyone.
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The Social Security Administration (SSA) requires you to provide information about your ADLs on a Function Report when you apply for Social Security Disability Insurance (SSDI) benefits. The SSA typically asks about your daily routine, your ability to drive and perform household tasks, your ability to perform basic ADLs and how your condition affects your sleep and ability to work.
Medicaid covers custodial care for low-income patients who struggle with ADLs. All state Medicaid programs must cover costs associated with nursing homes for people who are over 21 and qualify for coverage, and some states’ programs cover the cost of assisted living and home-based services. Medicaid might require an assessment of an applicant’s ADL skills if they are seeking nursing home and long-term services at the state level, but eligibility criteria varies by state.
Long-term care insurance can be a helpful alternative if you don’t qualify for Medicaid. With most policies, you typically become eligible for benefits once you can’t perform at least two of the six basic ADLs. Beneficiaries are often reimbursed for daily services they need to compensate for deficient ADL skills. Policies may limit how long they will cover someone or a limit on how much they reimburse, and someone who is already receiving long-term care might not be eligible for long-term care insurance.
Veterans Affairs (VA) provides Aid and Attendance or Housebound benefits to qualifying veterans or their survivors who have certain disabilities. If you need assistance with ADLs and are a veteran or survivor, you might qualify for benefits.
Medicare does not cover nursing homes or assisted living. Seniors in a nursing home may still receive medical care covered by Medicare, but the cost of the nursing home itself is not covered. Medicare, on the other hand, does cover some costs associated with ADL deficiencies, such as temporary stays at a skilled nursing facility following a hospitalization and medical supplies to assist with some ADLs.
Paying for ADL support
Paying for professional assistance with ADLs for a loved one can be expensive. In 2021, the average cost of an in-home health aide was $5,148 per month, according to Genworth, a company that provides long-term care insurance. The average cost of a nursing home with a semi-private room was $7,908 per month.
Unfortunately, not everyone will qualify for these programs. Here are a few tips to afford proper care if you have to pay for long-term care on your own.
You may be able to deduct a portion of long-term care insurance premiums on your federal tax return.
Look at long-term care insurance early on. Getting long-term care insurance can be difficult if you are already struggling with ADLs, so plan ahead. If you think you or a loved one might have issues with ADLs in the future, consider learning about long-term care insurance options ahead of time so you buy a policy before you need to use it.
Check your private insurance coverage. Some private health insurance policies cover services related to ADL assistance. If you’re unsure of your coverage, call your health insurance provider to see what’s covered.
Open a health savings account. Some employers offer high-deductible health insurance plans, which may allow you to contribute to a health savings account. If you have an HSA, you might be able to use those funds to pay for some long-term care costs such as nursing services if you meet the requirements.
Look into a reverse mortgage. This option lets you borrow against your home’s equity. But only people 62 and older are eligible, and there are risks with taking out a reverse mortgage.
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