What Are Activities of Daily Living?

When exploring senior living options, one of the most important questions you’ll face is: How much care is actually needed?

The answer depends on many factors, but one of the most important has to do with activities of daily living, or ADLs. Understanding ADLs can help families make more informed decisions about what senior living options are best suited for their circumstances.

What are activities of daily living (ADLs)?

ADLs are the everyday self-care tasks that people typically do themselves. As a person’s ability to perform these activities for themselves changes, they may need additional support from family members, in-home caregivers or assisted living staff. How much assistance an older adult needs with ADLs can play a significant factor in determining the level – and cost – of care they require.

Healthcare professionals and senior care providers commonly consider six basic categories of ADLs (also known as the Katz Scale) when evaluating an individual’s ability to live independently. The categories are:

• Bathing – Getting in and out of the shower or bathtub and washing oneself safely
• Getting dressed – Selecting appropriate clothing and putting it on and taking it off
• Toileting – Getting to and from the toilet, using it appropriately and managing personal hygiene afterward
• Transferring – Moving safely between positions or surfaces, such as getting out of bed or moving from a chair to a wheelchair
• Eating – Feeding oneself, including the ability to bring food or beverages to the mouth
• Continence – Managing bladder and bowel functions

A person able to perform all of these tasks independently is often considered independent and may still be capable of living on their own or with minimal support. Conversely, difficulty with one or more ADL can be a sign that a person would benefit from daily support.

Instrumental activities of daily living

In addition to the six basic ADLs, there are also instrumental activities of daily living (IADLs), which are more complex tasks involved with daily life and independent living. These include:

• Preparing meals
• Shopping
• Managing medications
• Handling finances
• Using a telephone or computer
• Doing household tasks like laundry or dishwashing

IADLs help provide a broader picture of someone’s ability to live independently. Whether or not someone is comfortable driving to the store, preparing healthy meals or keeping up with housework can have a direct impact on their quality of life and is an important consideration when looking at senior care options.

How do ADLs affect senior care?

ADLs become particularly relevant when families are considering assisted living because a person’s functional abilities help determine the level of care they need.

For example, an older adult who can bathe, dress, eat and move around without help would be able to maintain a high degree of independence in senior living and would require minimal support from community staff. Someone who needs assistance with bathing, getting dressed and transferring would require more hands-on, comprehensive care.

Most assisted living communities perform professional assessments of new residents to determine which ADLs they can or can’t perform without assistance. These initial assessments help communities devise an appropriate personalized care plan that provides support and assistance when needed while preserving as much independence as possible.

Care needs can change over time

A person’s ability to perform ADLs is not fixed. Changes in mobility, strength, cognition and overall health can make certain activities more challenging over time. Conversely, rehabilitation and other interventions may help a person regain some ability to perform ADLs they used to struggle with.

Once a resident has moved into a senior living community, reassessments are performed on a regular basis so that the level of support with ADLs can be adjusted as needed. Reassessments may also be conducted when there’s a sudden change in health or following an injury or fall.

A proactive approach to assessing ADLs helps ensure that a resident’s care plan continues to reflect their needs.

How do ADLs impact the cost of senior living?

Providing additional support for residents requires more staff time and resources, so the amount of assistance a person needs usually has a direct impact on the overall cost of senior living care. However, the way that cost is calculated varies from community to community.

Different communities often have different assessment tools, pricing models and levels of care. Some may include a certain amount of ADL assistance in the base monthly fee and charge additional fees for higher levels of care. Others may use an à la carte model or tiered pricing structure.

When researching assisted living options, families should ask each community how they assess care needs, which services are included in the base cost and what circumstances could cause the cost to change. Detailed answers to these questions can give families a clearer understanding of what they can expect to pay for care services.

Insurance and ADLs

Insurance can sometimes help offset the ADL-related costs of assisted living, but coverage varies significantly depending on the type of insurance and a person’s individual policy.

Medicare generally does not cover ongoing custodial care, including the assistance with ADLs that many people receive in assisted living. However, it may cover certain eligible medical procedures and short-term skilled care for specific procedures.

Long-term care insurance may provide benefits for assisted living, depending on the policy. Many long-term care policies use an individual’s inability to perform a specified number of ADLs as one factor in determining when benefits become available.

Medicaid may also cover certain long-term expenses for people who meet eligibility requirements, including ADL-related costs, although coverage and eligibility vary by state.

Because insurance and government benefits can be complicated, families may want to consult their insurance provider, benefits administrator or a qualified financial professional when planning for senior care expenses.

Finding the right level of care

Ultimately the goal of a senior living community is to provide older adults with the right amount of support at the right time.

For some residents, this may mean maintaining an independent lifestyle while enjoying services like housekeeping and prepared meals. For others, assisted living can provide the personalized assistance they need with everyday tasks while giving them opportunities to remain socially connected and engaged. Often, communities offer multiple levels of care, so residents who don’t need care today have peace of mind should their needs change.

Understanding how ADLs relate to care needs and costs allows families to approach decisions about assisted living with greater clarity and confidence.