In Part I of this series, we talked about the concept and the approach, using our ability to perform Activities of Daily Living (ADLs) and Instrumental ADLs to determine whether we need assistance and, if so, how much assistance in order to live safely at home. We also provided a link to the Advance Living Directive tool.
In this article, we will talk about what the Activities of Daily Living actually are and why we focus on them (and IADLs) as a benchmark for assessment.
Most scales list either six or seven ADLs. Our scale uses seven. Our Advance Living Directive tool uses four status points, relative to our ability to perform this and all ADLs. Ratings for Instrumental ADLs is a bit different, and we will talk about that in Part III.
- Personal Hygiene: involves bathing, including sponge / bed bath, tub bath or shower
- Dressing and Undressing: gets and replaces clothing and applies / removes them, with the possible exception of tying shoes
- Eating: involves feeding oneself, with the possible exception of activities such as cutting meat or buttering bread
- Transferring: moves from bed to chair or to standing; may use a cane or walker or grab bar or pole
- Continence: control of urine and bowel function
- Toileting: ability to use restroom, separate from continence
- Ambulation / Mobility: separate from transferring; ability to walk, including with use of a cane or walker
The use of our ability to perform Activities of Daily Living to determine need for home care is very common. In fact, almost every Long-Term Care Insurance (LTCI) company uses this to determine whether benefits will be paid to their clients. Within the scope of ADLs, the four points on the scale indicate that the individual is,
- Independent – requires no assistance from a caregiver
- Needs Help – needs some assistance but can participate in the activity with a caregiver
- Dependent – cannot participate in the ADL; must rely completely on a caregiver
- Does Not Do / Perform – even with a caregiver’s assistance, the activity cannot be performed
As you can see, each of these ADLs is critical to our ability to live independently. The more our ability is compromised in one or multiple activities, the more likely we are to need a professional Home Care Aide in order to successfully age in place at home.
In Part III of the series, we will explore Instrumental ADLs. In our view, they are just as important as “basic” ADLs in determining the level of assistance needed.
Best wishes, Bert