Activities of Daily Living (ADLs and IADLs)
When states decide whether someone needs the level of care that Long-Term Care Medicaid pays for, the most important measure is usually how much help the person needs with activities of daily living (ADLs). A second group, instrumental activities of daily living (IADLs), also matters for some programs. This guide explains what these terms mean, how they are measured and how to describe a person’s needs accurately.
Figures change periodically. Double-check current amounts before relying on them.
What ADLs are
ADLs are the basic tasks of personal care that most adults do for themselves every day. The list used by most states includes:
| ADL | What it covers |
|---|---|
| Bathing | Getting into and out of the tub or shower, washing the body |
| Dressing | Choosing clothes, putting them on and taking them off, including fasteners and shoes |
| Eating | Getting food from plate to mouth (not cooking) |
| Toileting | Getting to and from the toilet, using it and cleaning oneself |
| Transferring | Moving from bed to chair, or chair to standing |
| Continence | Controlling bladder and bowel, or managing incontinence supplies |
| Mobility / walking | Moving around inside the home, with or without a device |
Some states also count personal hygiene (grooming, shaving, oral care) or medication administration as ADLs.
What IADLs are
IADLs are the more complex tasks needed to live independently:
- managing money and paying bills;
- shopping;
- preparing meals;
- housework and laundry;
- using the telephone;
- managing medications;
- getting to appointments (transportation).
IADLs alone usually do not meet nursing home level of care, but they can count for lower-level home care programs and help show cognitive impairment. Trouble with IADLs is often the first sign that someone can no longer live alone safely.
Levels of help
Assessors look at how much help is needed, not just whether help is given. Typical categories:
| Level | What it means |
|---|---|
| Independent | Does the task safely without help |
| Supervision / cueing | Needs reminders, coaching or someone watching for safety |
| Limited assistance | Needs some hands-on help, such as guiding a limb |
| Extensive assistance | Needs significant hands-on help with much of the task |
| Total dependence | Someone else does the task |
Many states count supervision and cueing, which matters greatly for people with dementia who can physically do a task but not safely or in the right order.
How many ADLs are needed?
It depends on the state and program. As a general pattern:
- nursing home level of care often requires help with two or three ADLs, or a combination of ADL needs and cognitive impairment or skilled needs;
- lower-level home care programs may require help with one or two ADLs, or with IADLs;
- some states use a point score that combines ADLs, cognition, behavior and medical needs.
Each state guide gives what is known about the state’s criteria.
Describing ADL needs accurately
People often underreport their needs. Pride, fear of losing independence, and simply not noticing how much help a family member gives all play a part. Some tips:
- Think about the whole task. Bathing includes getting in and out of the tub safely. Dressing includes buttons, zippers and shoes. Toileting includes cleaning up.
- Count supervision. If someone must stand by during a shower because of fall risk, that is help with bathing.
- Consider frequency. If help is needed some days but not others, describe both. Assessors may ask about the past week or month.
- Mention equipment. A walker, shower chair or raised toilet seat shows a need, but if help is still required, say so.
- Think about nights. Help with toileting or wandering at night counts.
A worked example
Henry, 82, has had two strokes. Here is how his daughter describes his ADLs to the assessor:
| ADL | Henry’s need | Level |
|---|---|---|
| Bathing | Needs someone to help him into the shower and wash his back and feet | Extensive assistance |
| Dressing | Can put on a shirt, needs help with pants, socks and shoes | Limited assistance |
| Eating | Feeds himself once food is cut up | Independent with setup |
| Toileting | Uses a raised seat; needs standby help at night | Supervision |
| Transferring | Needs a hand to get up from a chair | Limited assistance |
| Continence | Occasional accidents | Limited assistance |
| Mobility | Uses a walker; unsteady | Supervision |
Henry needs help with several ADLs. In most states, this would meet nursing home level of care.
ADLs and long-term care insurance
ADLs matter outside Medicaid too. Most long-term care insurance policies, and the federal tax rules for “qualified” policies, pay benefits when a person cannot perform at least two of six ADLs (bathing, continence, dressing, eating, toileting and transferring) without substantial help for a period expected to last at least 90 days, or needs substantial supervision because of severe cognitive impairment. If a person has such a policy, the same documentation can support both a claim and a Medicaid application.
Keeping a care log
A simple log helps the assessor, the doctor and any appeal. For one to two weeks, write down:
- each time help is given with an ADL, and what kind;
- falls or near-falls;
- episodes of confusion, wandering or unsafe behavior;
- incontinence episodes;
- missed or doubled medications.
Bring the log to the assessment and give a copy to the doctor.
Common questions
Does using a walker count as needing help with mobility? Using a device alone may count as independent in some states. If the person also needs someone nearby for safety, that usually counts as supervision.
My mother can do everything but forgets to. That is often counted as needing cueing or supervision, especially with a dementia diagnosis.
Does help from family count, or only paid help? The question is what help the person needs, not who provides it.
What if needs change after the assessment? Ask for a reassessment. Needs often increase after a fall, hospital stay or illness.
Are IADLs ever enough by themselves? For nursing home level of care, rarely. For some lower-level home care programs, they can be.
Where to go next
If a parent or spouse is starting to need help with ADLs, it is a good time to learn the financial rules as well. A Certified Medicaid Planner (CMP) can explain how the medical and financial tests fit together and what steps to take before care needs increase.
ADLs in different settings
At home. In a home care program, the number of hours of help approved often depends on the ADL assessment. A person who needs help with bathing and dressing every morning, and toileting at night, will usually be approved for more hours than someone who needs help only with bathing a few times a week. Describing the timing of help, not just the tasks, helps the assessor plan hours.
In assisted living. Facilities assess ADLs at move-in and charge more as needs grow. If a waiver pays for care services in assisted living, the waiver’s own assessment decides eligibility, separate from the facility’s.
In a nursing home. Nursing homes assess ADLs regularly with a federal tool called the Minimum Data Set (MDS). Those records can support a Medicaid level of care decision.
ADLs and dementia: a closer look
Dementia changes how ADLs are measured. A person may be strong enough to dress but put a sweater on over a coat, or not change clothes for a week. They may be able to eat but forget to. Assessors are trained to ask about these situations, but they rely on what they are told. Families should explain:
- which tasks need reminders or step-by-step coaching;
- whether the person resists help;
- whether the person can recognize danger, such as a hot stove or a cold night outdoors;
- whether the person wanders or has gotten lost.
These details often make the difference between meeting and not meeting the state’s criteria.
Who can assess ADLs?
For Medicaid, the official assessment is done by the state or its contractor. But doctors, nurses, occupational and physical therapists, and home care agencies also assess ADLs. Their notes can be submitted as supporting evidence. An occupational therapy evaluation, in particular, gives a detailed picture of what a person can and cannot do safely.
A short checklist before an assessment
- Write down which ADLs need help, and how often.
- Note any falls in the past six months.
- List equipment used, such as a walker or shower chair.
- Bring the care log and medication list.
Related guides
- Nursing home level of care
- What counts as long-term care?
- Who qualifies for in-home care?
- Eligibility overview
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.