Unlike basic activities of daily living (ADLs) that relate to personal care and are central to day-to-day function, IADLs are more complex tasks that are necessary for truly independent living.
There are eight instrumental activities of daily living (IADLs) used to assess a senior’s ability to be self-sufficient and determine what supportive services they need to help them continue living independently. Because of their complex nature, IADLs tend to weaken first in the earlier stages of illness or cognitive decline, while ADLs often weaken in the middle and later stages of impairment.
What Are Instrumental Activities of Daily Living?
Instrumental activities of daily living are categories of skill that require certain levels of both physical and cognitive ability. Skill levels in these categories range from independent proficiency to requiring outside assistance for completion. Assessing a senior’s level of functioning in the following eight areas provides an effective measure of how different impairments affect their ability to live alone.
- Cooking: Is the individual able to plan, prepare and serve adequate meals?
- Managing Medications: Is the individual capable of taking correct doses of medications at the right times? Is the individual capable of the above if their medications are organized in separate dosages in advance?
- Shopping: Is the individual able to independently shop for all their needs, including clothing, personal care items and groceries?
- Communicating Via Telephone: Is the individual able to operate a telephone and look up and dial phone numbers?
- Managing Money and Finances: Is the individual able to independently make and follow a budget, write checks, pay bills, make trips to the bank, and monitor their income and expenses?
- Performing Housework: Is the individual able to maintain an acceptable level of cleanliness throughout their home?
- Driving or Using Public Transportation: Is the individual able to drive, use public transportation or arrange for a taxi service?
- Laundering Clothing: Is the individual able to wash and dry their personal laundry?
How Are IADLs Supported?
It is possible for a senior to need assistance with only a few IADLs and still be capable of handling their own self-care. A geriatric care manager, primary care physician or occupational therapist can conduct a functional assessment to determine the amount and type of help a senior requires as well as what their care plan should entail. A comprehensive geriatric assessment is often conducted to assess proficiency in both ADLs and IADLs, lifestyle factors and physical and mental health to get a complete picture of a senior’s circumstances and needs.
If a senior does not require assistance with personal care (ADLs), both family caregivers and formal caregivers hired through an in-home care company can easily support IADLs. In addition to providing valuable assistance with identified needs, seniors also benefit from companionship and meaningful social interaction with professional caregivers. In the home care industry, when an elder receives assistance with IADLs, it is often referred to as “homemaker services” or “companion care.”
Because assistance with IADLs is not considered “skilled care,” this kind of home care service is paid for out of pocket. In some cases, limited IADL assistance may be covered by Medicare if a senior also requires short-term help with ADLs and medically necessary skilled nursing care provided in the home.
Sources: Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living (https://academic.oup.com/gerontologist/article-abstract/9/3_Part_1/179/552574); Geriatric Assessment: An Office-Based Approach (https://www.aafp.org/afp/2018/0615/p776.html); Medicare & Home Health Care (https://www.medicare.gov/sites/default/files/2018-07/10969-medicare-and-home-health-care.pdf)