ADL (Activities of Daily Living)
What Are ADLs and IADLs?
Daily living tasks fall into two main categories: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs are essential self-care actions needed every day to live independently. IADLs are supportive tasks that enable independent living but are not always required daily. Generally, IADL abilities decline before ADLs as we age.
How Do ADLs and IADLs Compare?
| Activities of Daily Living (ADLs) | Instrumental Activities of Daily Living (IADLs) |
|---|---|
| Mobility (walking, stairs, transfers) | Shopping for groceries, medications, clothing |
| Dressing (selecting and putting on clothes) | Meal preparation (planning, cooking, cleanup) |
| Eating (using utensils, self-feeding) | Housework (cleaning, laundry) |
| Personal hygiene (bathing, grooming, oral care) | Money management (paying bills, budgeting) |
| Toileting (continence, cleaning after use) | Transportation (driving or arranging rides) |
| Medication management | |
| Communication (phone, computer, mail) |
Why Is It Important to Measure ADL and IADL Abilities?
Assessing daily living capabilities reveals current care needs, potential safety risks, and appropriate living arrangements. It also helps determine the right level of support, from in-home help to assisted living or nursing care.
Can You See Examples of ADL/IADL Assessments in Action?
- Joan: Early Alzheimer’s—needs weekly help with meals, cleaning, and laundry but can live alone.
- Fred: Post-stroke—requires daily supervision and assistance during caregiver’s work hours; adult day care recommended.
- Tonya: In assisted living—assessment suggests nursing home care may be better suited.
How Do ADLs and IADLs Affect Medicaid Eligibility?
For long-term care Medicaid (nursing home, HCBS waivers, ABD Medicaid), applicants must show a functional need. This is often based on the inability to perform a set number of ADLs/IADLs. Nursing Home Medicaid and HCBS waivers generally require a Nursing Facility Level of Care (NFLOC), while ABD Medicaid often has lower thresholds.
The VA also uses ADL/IADL limitations to determine eligibility for certain benefits like the Aid & Attendance Pension.
What Types of ADL/IADL Assessments Are Commonly Used?
Different programs and states use various tools to measure daily living abilities. Even within the same state, the tool may vary by Medicaid program.
Katz Index of Independence in ADLs
Measures independence in six ADLs (bathing, dressing, toileting, transferring, continence, feeding). Scores: 6 = independent, 0 = dependent.
Lawton-Brody IADL Scale
Rates ability in eight IADLs (telephone, shopping, food prep, housekeeping, laundry, transport, medications, finances). Total score up to 8; higher = more independent.
Klein-Bell ADL Scale
170 items across six ADL categories (mobility, communication, dressing, elimination, bathing/hygiene, eating). Scores reflect level of independence.
Cleveland Scale for ADLs
Designed for dementia—47 items rated 0 (independent) to 3 (always dependent).
Bristol ADL Scale (BADLS)
20 items mixing ADLs/IADLs, scored 0 (independent) to 60 (dependent).
Barthel Index
Assesses 10 ADLs, with scores from 0 to 100. Commonly used post-stroke; higher scores indicate greater independence.
