Activities of Daily Living: Taking the Mystery out of ADLs

If you are researching adult foster care you may have come across the term Activities of Daily Living or ADLs. In order to qualify for adult foster care in Massachusetts, the care recipient must have a physical, cognitive, or behavioral impairment that makes them need assistance with at least one activity of daily living.

According to WebMD, “ADLs essentially indicate your ability to care for yourself without assistance.” A National Health Interview Survey found that more than 20 percent of adults older than 85 need help with ADLs. But what are ADLs? And what do you need to know about them as a caregiver or care recipient in adult foster care? This article answers the following questions:

• What are the activities of daily living (ADLs)?
• What are the independent activities of daily living  (IADLs)?
• How are ADLs assessed?
• When would someone assess your ADLs?

What are the activities of daily living (ADLs)?

In general, ADLs fall into two main groups, explains the Cleveland Clinic:

• Basic activities of daily living.
• Instrumental activities of daily living.

The acronym ADL usually refers to basic activities of daily living (unless specified as IADLs).

The U.S. Centers for Medicare & Medicaid Services defines activities of daily living as “activities related to personal care…If a sample person has difficulty performing an activity by himself/herself and without special equipment, or does not perform the activity at all because of health problems, the person is deemed to have a limitation in that activity.” 

The basic activities of daily living (ADLs) include these five categories:

1. Ambulating: the ability to walk, sit, stand, lie down and get up, and climb up and down stairs, both inside and outside your home.
2. Grooming: all activities necessary to maintain personal hygiene, like brushing your teeth, bathing, shaving, and hair and nail care.
3. Toileting: the ability to control your bladder and bowels (continence), use the toilet safely, and clean yourself after use.
4. Dressing:  the ability to dress yourself properly, including using buttons and zippers.
5. Eating: the ability to use cutlery and feed yourself.

So in order to receive care through the adult foster care program, in Massachusetts, the care recipient must be unable to do one of those five activities on their own. 

What are the independent activities of daily living  (IADLs)?

IADLs include more complex activities that are essential to live independently. These are important activities that you don’t need to do every day, unlike ADLs. 

The American Occupational Therapy Association lists 12 essential IADLs:  

1. Personal finances: paying your bills, using bank facilities, and planning your expenses
2. Health and medical care: attending regular doctor visits and following medical prescriptions correctly
3. Shopping: buying groceries, toiletries, clothing, and other necessities
4. Meal preparation: planning, prepping and cooking your own meals
5. Transportation: driving vehicles, taking cabs, and using public transport
6. Communication: using the telephone, post, email, and other communication devices
7. Household chores: maintaining the home through regular tasks like cleaning, gardening, and laundry
8. Pet care: feeding and caring for pets
9. Child care: caring for children in the household
10. Looking after others: including supervising caregivers
11. Recreation: maintaining religious practices, hobbies, or other interests
12. Emergency preparedness: knowing safety procedures and emergency contacts and responses

How are ADLs assessed?

While there are no universal assessments, WebMD outlines six of the most commonly used ADL assessment tools:

Katz Index: This is a simple checklist that’s mainly used for older adults to assess whether they can perform ADLs independently. 

Lawton-Brody Scale: This scale assesses eight categories of IADLs. 

Klein-Bell Scale: This scale has a 170-item list that assesses six ADL categories

Cleveland Scale: This 47-item checklist is used to assess the independence levels of people with dementia or Alzheimer’s. 

Bristol Scale: This 20-item questionnaire assesses ADLs and IADLs in people with dementia. 

Barthel Index: This 100-point scale assesses 10 activities in people who have had a stroke. 

When would someone assess your ADLs?

Health care professionals use functional assessments of ADLs and IADLs to determine an individual’s ability to live independently without harming themselves. According to the Cleveland Clinic, nurses and occupational therapists may assess how well you can perform ADLs when you:

• Are staying in a hospital (hospitalized).
• Return home from a hospital stay.
• Are recovering from surgery, physical injury, traumatic brain injury or stroke.
• Have a neurodegenerative disorder, like Alzheimer’s disease or Parkinson’s disease.
• Have an intellectual disability.
• Have a mental health disorder.

Do you have questions about adult foster care, or MassHealth? Check out the resource center at Mass Care Link for more articles and guides for caregivers.