Advance Living Directive™ In Depth: Part IV


In Part III of the series, we introduced the Instrumental ADLs.  As discussed there, in our view, the IADLs are as important as the basic ADLs, even if Long-Term Care Insurance companies don’t want to pay benefits to support them. 

In this posting, we will discuss why we believe that.  we will also talk about the levels of ability to perform them as a very good tool for assessing the need for and level of home care for ourselves or others.  We will cover one-half of the IADLs in this posting and complete the IADLs in Part V.

To refresh, the IADLs include:

  • 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

For the first IADL, ability to use a telephone, there are four levels of ability:

  • Operates telephone on own initiative; looks up and dials numbers, etc. (4 Points)
  • Dials a few well-known numbers (3 Points)
  • Answers telephone but does not dial (2 Points)
  • Does not use telephone at all (1 Point)

For each of the IADLs there is a score, which becomes part of the total score for IADLs.  However, for each IADL, we believe there is a threshold below which we feel home care is appropriate.  For this IADL, even at the two point level, communication by phone is still and emergency communication, via a pendant or bracelet alarm system is still possible.

The next IADL, shopping for food and other necessities, also has four levels. 

  • Takes care of all shopping needs independently (4 Points)
  • Shops independently for small purchases (3 Points)
  • Needs to be accompanied on any shopping trip (2 Points)
  • Completely unable to shop (1 Point)

For shopping, we believe that the two point level requires home care.  The need to be accompanied may be from physical limitations or dementia.  As is the case with several other IADLs, the need involved in performing the IADL is critical to an underlying ADL.  For example, I may be able to satisfy the Eating ADL — I can feed myself.  However, if I cannot shop or take care of the next IADL, food preparation, I still definitely need help.

For food preparation, there are, again, four levels:

  • Plans, prepares and serves adequate meals independently (4 Points)
  • Prepares adequate meals if supplied with ingredients (3 Points)
  • Heats, serves and prepares meals or prepares meals but does not maintain adequate diet (2 Points)
  • Needs to have meals prepared and served (1 Point)

As for the prior IADL, we believe that being at the two point level for food preparation does mean home care is needed.  There are wonderful programs such as Meals On Wheels that help with food preparation.  However, they do not substitute for a balanced, adequate diet.

Housekeeping has five levels of ability associated with it:

  • Maintains house alone or with occasional assistance (5 Points)
  • Performs light daily tasks such as dishwashing, bed making (4 Points)
  • Performs light daily tasks but cannot maintain acceptable level of cleanliness (3 Points)
  • Needs help with all home maintenance tasks (2 Points)
  • Does not participate in any housekeeping tasks (1 Point)

At the three level point, there is still the opportunity to use maid services rather than true caregivers.  It may be marginal and, combined with other lower scores for IADLs, even a three on Housekeeping may point very clearly to the need for home care.

In Part V of the series, we will conclude the discussion of IADLs.  In the meantime,

Best wishes, Bert

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