What ADLs Are and Why They Matter

If you’ve spent any time researching senior care, accompanying a senior loved one to the doctor, or helping your loved one with their insurance paperwork, you may have encountered the acronym ADL. It’s a term that’s commonly used and important for seniors and their loved ones to understand.

What are ADLs?

ADL stands for activities of daily living. ADLs are the basic self-care tasks that are usually learned in early childhood and can help determine what type of care an elderly loved one may need.

These activities include:

• Feeding yourself
• Going to the bathroom
• Brushing your teeth and hair
• Getting dressed
• Bathing
• Walking
• Everyday mobility tasks like getting in and out of bed, into a wheelchair on your own, or stepping into the bath or shower

These activities are all things we tend to take for granted when we’re healthy. For most of your life, you probably didn’t think twice about getting out of bed or brushing your hair each morning. Due to a variety of health issues and the general effects of aging though, many of these tasks start to become difficult for seniors to complete on their own.

One of the main ways families know that a loved one can no longer live alone is when they begin to have trouble with ADLs.

What are IADLs?

While the medical community talks more often about ADLs, there’s another important category for families to be aware of as well: the instrumental activities of daily living or IADLs.

IADLs are tasks that are still important to living independently, but don’t require the same level of care to complete as ADLs. They aren’t a requirement for basic health and survival, but they do make a big difference in quality of life and long-term well being.

The main IADLs to be aware of are:

• Managing finances
• Handling transportation – whether that means driving or being able to navigate public transportation and getting rides
• Shopping
• Preparing meals
• Using communication devices
• Managing medications
• Housework and basic home maintenance
• Pet care (if applicable)

Not being able to handle these on your own doesn’t mean you need full-time care, but it does point toward a need for general help. And if a senior is having a hard time with a number of these, it could mean they’re no longer fit to live on their own safely.

Why ADLs Matter

Knowing the list of ADLs can give you the language to better analyze and talk about your loved one’s care needs. The term and the associated list are commonly used in medical and senior care conversations for two main reasons.

ADLs help you determine the right level of care.

When you’re trying to determine what type of care is best for your loved one, it helps to sit down and really define the specific needs they have. ADLs help you to do that. If your loved one needs help with any of the activities on the ADLs list, then someone – whether it’s their spouse, you, or someone you hire – needs to be around each day to help with them.

It’s worth noting that some of the ADLs require less constant care than others. Once your loved one reaches of the point of needing help to perform multiple ADLs, or once they have difficulty performing those that must occur with some frequency, like going to the bathroom on their own, you need to figure out how to ensure they receive full-time care.

Considering whether to move a loved one to assisted living, a nursing home, or into your own home is a big decision that requires some serious thought. One factor that can help you make the decision that’s best for both you and your loved one, is thinking about the specific ADLs your loved one needs help with.

ADLs play a role in determining your coverage.

One of the biggest reasons ADLs matter is in their ability to help families make the right decision for their loved one, but another crucial role they play is in providing a standard that Medicare, Medicaid, and many insurance companies use to figure out the level of coverage to provide.

Under these programs, the number of ADLs a senior needs help with is often the defining factor in whether or not they qualify for assistance in paying for an assisted living home, a nursing home, or in-home care. For many long-term care insurance policies, the inability to perform two ADLs or more is the point where the insurance provider decides it’s time to start paying on the policy.

For families that need senior care, figuring out how to pay for it is a big part of the equation. Defining the ADLs your loved one needs help with is therefore important in paying for the type of care they need, as well as determining what that is.

How to Talk To Your Loved One About ADLs

Many seniors have a hard time discussing their limitations. This is often due to pride, fear of losing access to their home and independence, or embarrassment. Whatever the cause, it makes the the first step to understanding what ADLs your loved one needs help with – talking to them about their needs – challenging.

Look for Signs of Difficulty Performing ADLs First

If you suspect your loved one may be hesitant to discuss their issues performing ADLs openly, start first by spending enough time with them to see for yourself what they’re having a hard time with. Look for signs that they’re having difficulties with basic tasks, like clothes that don’t match or aren’t buttoned right if they used to be particular about fashion, or weight loss that could be due to difficulty shopping and cooking.

Ask direct questions like what they ate today or when they last bathed (that last one may seem rude, but is worth checking on). And offer to help with things like cooking and running errands together, both to help and to have a chance to see whether they’re having trouble with them.

You an also tell a lot by paying attention to a loved one’s home environment. If they used to be pretty clean and are now letting dust build up and dishes pile in the sink, that’s a sign that they’re having trouble with basic around-the-house chores. And keep an eye out for bruises that might suggest they’re experiencing falls or running into things more frequently.

Have the Conversation

If you’ve identified enough signs that they’re having trouble with ADLs, then sit down with them and have the hard talk. If they’re doubtful it’s a problem or deny it, point to the evidence you’ve seen. Make sure you don’t frame the conversation as being about you being right – make it about concern for their well being and how important it is to you that they be safe and comfortable. Living at home past the point where it’s safe could lead to a long stays in the hospital after a fall, difficulty making and maintaining social connections, and senior depression.

Having that conversation will open the door to discussing what level of care they need and what you need to do to make sure it’s met. There are things you and other family members and friends can help with, but you should also consider if things have reached the point where you need to turn to professional senior care options.

Finding Care Based on Your Loved One’s Needs

You have several options when it comes to choosing professional senior care, but not all of them provide the same level of care. Understanding what each type of senior care offers is important to figuring out which makes the most sense for your loved one.

Home Care

In-home care is attractive to many seniors because it allows them to begin getting the help they need while staying in their own home. It’s also frequently more affordable than other types of senior care. For in-home care to be an option, your loved one should be able to still perform most of the activities on the ADL list and some of the activities on the IADL list, particularly those that are fundamental to their well being and continued good health. Hiring an in-home caregiver can help them fill in the gaps, so to speak.

Assisted Living

Assisted living offers a combination of residential housing, meals, and personalized support services, but it does not provide skilled nursing care. Assisted living is designed for adults needing assistance with IADLs such as housecleaning and medication reminders, as well as some ADLs like getting dressed and getting around. Meals are usually provided, and often there are transportation services and social interaction programs.

Continuing Care Residential Communities (CCRCs)

CCRCs combine the services of a nursing home with an assisted living center. Continuum of care goes beyond the traditional retirement home approach because seniors can maintain their independence and still receive the care they need. As the individual’s needs become more complex, a continuing care facility can provide those services. In addition, certain CCRC services might only be required for a limited time, such as if someone has surgery and requires additional help during the healing process.

Nursing Homes

These facilities offer higher levels of care that support individual skills and interests in an environment designed to minimize confusion and agitation. Similar to assisted living communities, nursing home facilities provide assistance with dressing, grooming, bathing and other IADLs. Meals, laundry and housekeeping are provided, along with skilled nursing.

Figuring out the right senior care for a loved one is a necessary and difficult process. Clarifying the level of need they have with ADLs won’t make the decision easy, but it can help you make the right decision and may make the difference in your ability to pay for care.

Our comprehensive senior care directory is a great free resource you can use to identify facilities that offer services based on your loved ones ADLs and IADLs evaluation. You can see how amenities compare and read reviews from seniors and their loved ones with direct experience at the different facilities in your area.

Your loved one may not be thrilled at the idea of moving from their home to a facility, but if you’re confident it’s the right move for them, finding the right home for them and their needs can make a big difference to how difficult the transition is.

SeniorAdvisor.com Staff

Senior Advisor's knowledgeable writers blog about senior care services, trends and more.