The Importance of Activities of Daily Living (ADLs)

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When it becomes obvious that a loved one can’t get through a day without assistance, the logical next step is to begin looking into resources that can provide the support they need. One of the first things a long-term care insurance company, home care company, adult day care center or assisted living facility will ask about is the senior’s ability to perform activities of daily living (ADLs). But what exactly are ADLs, and why are ADLs important?

What Are Activities of Daily Living?

Every field has its jargon and the long-term care industry is no exception. In the business of providing care, the phrase “activities of daily living” is used often and for good reason. Activities of daily living refer to the basic skills needed to properly care for oneself and meet one’s physical needs in six areas: eating, dressing, bathing, toileting, continence and mobility.

Read: Activities of Daily Living Defined

What Do ADLs Measure?

ADLs are used as indicators of a person’s functional status. Of course, a senior’s functional abilities aren’t necessarily identical across all six areas. A person may be totally independent, require minimal or moderate assistance, or be completely dependent on another person in each area. These finer details are used to determine the level of care a senior requires and what supportive services their care plan should include.

How Do Age and Health Conditions Affect the Ability to Perform ADLs?

“A decline in the ability to perform ADLs is often due to a medical condition or general weakness that has increased with age,” explains Carmel Froemke, CMC, an Aging Life Care Professional (also known as a geriatric care manager). “Most family members pick up on a loved one’s decline through secondary signs of a problem, such as changes in their routines or appearance. These red flags typically indicate there is a more serious underlying issue that is interfering with their ability to perform self-care.”

Read: Signs a Senior Needs Help at Home

Advancing age can naturally cause a decline or impairment in physical functions in otherwise healthy individuals. Health conditions that affect musculoskeletal, neurological, circulatory or sensory systems can also affect a senior’s ability to perform ADLs. Other more subtle factors, such as social isolation, medication side effects and certain aspects of a senior’s home may make self-care increasingly difficult and unsafe as well.

For instance, if a senior is wearing the same outfit each time you see them, it may be because they have lost the flexibility or dexterity needed to put on and fasten other clothing items they own. Simply switching from conventional clothing to adaptive clothing might allow for more independent dressing. Solutions could include bottoms with elastic waistbands, shoes with Velcro fasteners instead of laces or buckles, or shirts with magnetic front closures instead of pullovers and button-downs. In other cases, these symptoms may indicate changes in balance, coordination, energy levels and/or cognitive function and a need for assistance with dressing.

Another common example is significant changes in personal hygiene practices. If a fear of falling in the shower or bath is the driving force behind a senior bathing infrequently, the solution could be as simple as implementing appropriate home safety measures, such as grab bars, non-slip floor mats or a shower chair. If durable medical equipment and home modifications for aging in place still do not solve the problem, then hands-on care from a family member or bath visits from a home health aide may be in order.

Most seniors want to maintain their independence for as long as possible, so they are often reluctant to tell someone they are having increased difficulties. They may fear having to move away from their home and comfort zone. However, Froemke points out that an honest evaluation of an elder’s ability to perform ADLs will allow for the development of a customized plan of care that will enable them to continue living as safely and independently as possible and ensure their needs are still met.


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Why Are ADLs Important?

Functional status and the ability to care for oneself have a significant impact on a senior’s quality of life. While changes in ADLs can be caused by underlying medical conditions, failing to recognize these growing needs can also contribute to a cycle of physical and mental health problems. Unmet needs for help with activities of daily living can lead to malnutrition, poor personal hygiene, isolation, illnesses like urinary tract infections (UTIs), and falls. In fact, studies have shown that ADL disabilities are associated with an increased risk for mortality. Ensuring a senior has the daily care they need can help prevent new and worsening health issues, keep overall costs down, and delay or eliminate the need for institutional care. Therefore, a senior’s functional abilities are often factored into important care decisions along with their medical needs.

The ability to perform ADLs is often used to determine what types of care and senior living settings are suitable for an elder. For example, independent living facilities do not provide any assistance with ADLs. This type of unskilled care is usually referred to as personal care or custodial care. If a resident requires help, he or she will have to get it from a family caregiver, hire in-home care or move to a higher level of care where ADL support is provided (e.g. an assisted living facility, a memory care unit, a nursing home).

ADLs are also used as eligibility criteria for many elder care services, benefit programs and even insurance coverage. For example, a senior must have a documented need for a “nursing home level of care,” which often includes an inability to perform a certain number of ADLs among other requirements, to qualify for long-term care Medicaid programs. Needing help with ADLs is also one of the eligibility criteria for the VA Aid and Attendance pension, and applicants for Social Security disability benefits must submit an ADL questionnaire demonstrating how their condition affects their daily life. Having a firm understanding of a loved one’s functional abilities and limitations makes it easier to find care options that match their needs and supportive services they qualify for.

How to Get an Activities of Daily Living Assessment

Official ADL assessments can be made by a variety of elder care experts and medical professionals, but most programs that provide or cover long-term care services have their own assessment processes, assessors, rules and guidelines, and they may vary greatly from one program to another. For instance, long-term care insurance agencies typically employ or hire private assessors to make eligibility determinations for policyholders who wish to begin using their long-term care benefits.

“It is best to have a complete ADL assessment conducted by a specialist, such as a geriatric care manager, a nurse, an occupational therapist or a social worker, to fully identify all problems, their root causes and potential solutions” Froemke explains. “However, if modifications are put in place and there is still a need for support, it may be time for outside help.”

Read: When Is it Time to Hire In-Home Care?

One of the best resources for beginning the assessment and application process is your local Area Agency on Aging (AAA). AAAs can provide referrals to providers and, in some cases, may actually be able to conduct functional assessments. These offices can also recommend support programs and benefits that an aging loved one may qualify for and assist with applications.

Do-It-Yourself ADL Assessment Checklist

If you are noticing changes in a loved one’s functional abilities that are affecting their independence, you can also use our ADL Worksheet as a starting point for determining how much assistance they require.

Printable: ADL Assessment Checklist

Sources: StatPearls: Activities of Daily Living (ADLs) (https://www.ncbi.nlm.nih.gov/books/NBK470404/); Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841172/); Medicaid Nursing Facilities (https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/nursing-facilities/index.html); VA Aid and Attendance benefits and Housebound allowance (https://www.va.gov/pension/aid-attendance-housebound/); Function Report-Adult Form SSA-3373-BK (https://www.ssa.gov/forms/ssa-3373-bk.pdf)

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