Understanding Activities of Daily Living (ADLs)
Sidney Katz, MD, first formulated an index of basic activities that are necessary for a senior to live independently in 1963. The Katz Index of Activities of Daily Living is still used by healthcare professionals to assess functional abilities and evaluate long-term care needs in older adults.
The use of indexes to measure daily functioning is important in the overall assessment of a senior's wellbeing because appropriate levels of assistance with ADLs can improve an elder’s independence, health outcomes and quality of life. An official assessment of the ability to complete the six activities of daily living (ADLs) contributes to the determination of a senior’s eligibility for both supportive services and financial assistance such as Medicaid long-term care, VA benefits, and the payment of long-term care insurance claims.
What Are the Six Activities of Daily Living (ADLs)?
Activities of daily living fall into six categories of basic skills needed to properly care for oneself. Due to varying levels of physical and/or cognitive decline, a senior may be able to complete ADLs safely and independently in some categories but not have the skills necessary to complete others. Levels of assistance also vary; seniors may need help ranging from prompting or supervision to total support in order to ensure these basic physical needs are met.
When evaluating daily functioning, evaluators will assess these 6 basic areas of functioning:
Is the individual able to move food and drink successfully from the table to their mouth?
Bathing and Personal Hygiene
Is the individual able to get in and out of the shower or bath without assistance? Are they able to wash their face, body and hair? Are they able to groom themselves, maintain oral hygiene and care for their nails?
Is the individual able to choose appropriate clothing? Are they able to put on and take off these items, including fastening and unfastening them properly.
Can the individual maintain control over their bladder and bowel function?
Is the individual able to transfer on and off the toilet, clean themselves, and resecure their clothing?
Walking and Transferring
Is the individual able to walk independently? Are they able to move to and from a chair and bed without the assistance of another person? Note that the use of assistive devices or mobility aids such as canes or walkers is an acceptable source of support in walking and transferring independently.
Creating a Care Plan based on ADLs
The amount of assistance a senior requires to complete each of these ADLs is used to determine the level of care they require and create a personalized plan for support, called a care plan. For this reason, most state and federal assistance programs, home care companies, adult day care programs and senior housing facilities require an ADL assessment as the starting point for establishing a person’s suitability or eligibility for services and/or coverage.
When navigating elder care options, benefits and supportive services, ADL assistance can be referred to as personal, companion or custodial care. This non-medical or “unskilled” care is commonly provided by family caregivers, personal companions and home health aides in a senior’s own home, in many adult day care settings, and in assisted living communities. Of course, assistance with ADLs is also provided in long-term care settings that offer higher levels of skilled care, such as memory care units and nursing homes.
If you are noticing a change in functional abilities that is impacting your loved one’s ability to live independently, use our ADL Worksheet as a tool to determine how much assistance they require.
Printable: ADL Assessment Checklist
A professional assessment is often the gateway to eligibility for additional services. Functional assessments that identify ADL difficulties can be made by physicians, nurses, case managers, and occupational therapists. Furthermore, long-term care insurance companies typically employ assessors to make eligibility determinations for policyholders who wish to begin using their long-term care benefits. One of the best resources for beginning the formal assessment and care planning process is your local Area Agency on Aging. AAAs can let you know where to have a needs assessment performed and, in some cases, may actually be able to conduct assessments themselves.
For more information regarding the importance of this measure and the role of activities of daily living (ADLs) in planning for a senior's long term care, explore our articles, assessments and Q&A from other caregivers in the Caregiver Forum.
Activities of Daily Living Articles
The Importance of Activities of Daily Living (ADLs)
Activities of daily living are used to measure a senior’s functional status. An ADL assessment will help determine the level of care an aging loved one requires and what support programs and benefits they may be eligible for.2 Comments
Instrumental Activities of Daily Living Defined
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.1 Comment
Should Your Elderly Parent Continue Living at Home?
Evaluate your elderly parent's ability to age in place by conducting a thorough assessment to determine if they are physically and mentally able to continue living in their own home.42 Comments
Needs Assessment: The First Step When Moving to Senior Housing
Senior living communities conduct a needs assessment that measures potential residents’ physical and cognitive abilities to ensure that a senior’s needs match the services the community is able to provide.0 Comments
How to Make a Care Plan for the Elderly
An elder care plan can be a scheduling tool, an informal agreement with an aging loved one, or a formal contract used to coordinate payment for care services. Learn how to create a plan of care that will help you stay focused and organized.0 Comments
Activities of Daily Living Questions
Best calendar for those with dementia?21 Answers
My mother lives alone and has a home aide come weekdays. We need to find service that will provide weekend visits covered by Medicaid. Any tips on where to start?5 Answers
How can I be sure that my LO flosses and brushes all of her teeth?15 Answers
How can I help my father to find a purpose to go on living?27 Answers
Activities of Daily Living Discussions
Washed a pad by accident.6 Comments
Introvert in an ALF5 Comments
Banking use to be so easy.19 Comments
Make sure your loved one's teeth are getting brushed in a nursing home.3 Comments