What Are Activities of Daily Living?

When you begin researching long-term care options for yourself or a loved one, you will quickly come across the term activities of daily living, sometimes abbreviated as ADL.

This is more than just a general list of things most people do every day. It is a specific group of “fundamental skills required to independently care for oneself,” according to the National Institutes of Health.

The type of care you need – including whether that care is limited to assistance with activities of daily living – can impact what type of care is most appropriate and how that care is paid for.

The Centers for Medicare & Medicaid Services (CMS) defines long-term care as “a range of services and support for your personal care needs. Most long-term care isn't medical care.” Rather, most long-term care is help with these activities of daily living, such as bathing, dressing and using the bathroom, which Medicare does not cover.

What Activities Are Considered Activities of Daily Living?

The NIH says that activities of daily living are “essential and routine tasks that most young, healthy individuals can perform without assistance.” Those who are unable to accomplish these essential activities may be unsafe and suffer a poor quality of life.

Individual assessments are often used to determine a person’s functional status. They can help predict whether the person needs alternative living arrangements, hospitalization, use of paid home care or admission to a skilled nursing facility or nursing home.

Activities of daily living assessments also help determine treatment programs and their potential outcomes.

What Are the Two Types of Activities of Daily Living?

There are two classifications of activities of daily living:

• Basic Activities of Daily Living (BADL)
• Instrumental Activities of Daily Living (IADL)

Both of these classifications are commonly grouped together and simply referred to as activities of daily living.

The NIH says that basic ADL include the following categories:

• Ambulating: The individual’s ability to move from one position to another and walk independently.
  
  
• Feeding: The ability to feed oneself.
  
  
• Dressing: The ability to select appropriate clothes and to independently put the clothes on.
  
  
• Personal hygiene: The ability to bathe and groom and maintain dental hygiene, nail and hair care.
  
  
• Continence: The ability to control bladder and bowel function.
  
  
• Toileting: The ability to get to and from the toilet, use it appropriately and clean oneself.

Instrumental ADLs, which require more complex thinking, cognitive and organizational skills, include:

• Managing transportation: The ability to get around, either by driving or by organizing other forms of transportation.
  
  
• Managing finances: This includes the ability to pay bills and manage financial assets.
  
  
• Shopping and meal preparation: This includes everything required to shop and cook It also covers shopping for clothing and other items required for daily life.
  
  
• Housecleaning and home maintenance: The ability to clean kitchens after eating, maintain reasonably clean and tidy living spaces and to keep up with home maintenance.
  
  
• Managing communication with others: The ability to manage telephone, mail and electronic communications.
  
  
• Managing medications: The ability to obtain medications and take them as directed.

ADL Limitations and Declines

There are many causes and reasons why someone’s ability to perform activities of daily living declines.

The NIH lists the following:

• Aging: The natural aging process is a common cause of the loss of functional status.
  
  
• Health conditions: Musculoskeletal, neurological, circulatory or sensory conditions can lead to decreased physical function and impairment in ADLs.
  
  
• Cognitive or mental decline: Severe cognitive issues among those with dementia are a significant cause of impairment in activities of daily living and quality of life.
  
  
• Social isolation: Lack of connection with others can cause impairment in instrumental activities of daily living. 
  
  
• Hospitalization and acute illnesses: These have been directly linked to a decline in ADL.
  
  
• Other factors: Side effects of medications, an unsafe home environment and other factors also can influence the ability to perform ADLs.

ADL Assessment and Measurement

It’s important to assess the extent of loss someone has suffered in their ability to care for themselves before creating an appropriate care and support plan. The NIH says that there are several checklists used by healthcare professionals to measure an individual’s ability to care for themselves.

An ADL assessment also helps determine if the patient needs rehabilitation services or assistance at home, or if he or she needs full-time care at a skilled nursing or long-term care facility.

For example, if the patient is struggling with just some of the basic ADLs, a home health aide may be enough to provide part-time assistance for shopping, paying bills and cooking. However, if the patient is unable to ambulate safely, there is an increased risk of falls, which are associated with an increased risk of death, and may need to be moved to a long-term care facility.

Can I Get Help Paying for Long-Term Care?

The NIH points out that occupational therapists often assess ADLs to determine benefits for disability insurance and long-term care (LTC) insurance policies. The costs of care – whether it’s in the home or at a skilled care facility, assisted living community or nursing home facility – can be very high, and coverage is not provided by Medicare or most private insurance. Some long-term care insurance policies can help cover these care costs when Medicare or other private insurance doesn’t.

Medicaid can also cover long-term care, but patients must meet certain income and asset restrictions to qualify for coverage.

Depending on your situation, you may also be able to get help paying for long-term care by working with home- and community-based service providers, subsidized senior housing and other options.