Advance Living Directive™ In Depth: Part III


In this article, we will discuss what are called Instrumental Activities of Daily Living (IADLs).  As we will see, at Support For Home, we consider as important as ADLs, in terms of establishing the need for home care.

The distinction from “basic” Activities of Daily Living is subtle, in our view, and there is a tendency in the insurance and medical communities to underestimate their importance, frankly.  When Long-Term Care Insurance companies perform an assessment as to whether their clients are eligible for benefits to begin, the insurance companies require that assistance is needed for at least two of the basic ADLs that we discussed in Part II:

  • 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

Instrumental ADLs (IADLs) are seen as supporting that basic set.  In many ways, IADLs are more nuanced than the “basic” ADLs.  We are able to more clearly articulate the levels of ability to perform them than with basic ADLs.  In some ways, that actually makes them easier to use as a benchmark or planning tool set than the basic ADLs.  We will talk about the levels of ability to perform IADLs in Part IV of this series.

The IADL set includes:

  • Ability to use a telephone
  • Shopping for food and other necessities
  • Food preparation
  • Housekeeping and organization
  • Doing laundry
  • Meeting needs for transportation
  • Managing medication
  • Handling finances

In Part IV, we will “grade” ability to perform IADLs and tie them back to specific ADLs, fleshing out the tool set.

Best wishes, Bert

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One response to “Advance Living Directive™ In Depth: Part III

  1. Pingback: Advance Living Directive™ In Depth: Part IV | Support For Home In-Home Care

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