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Activities of Daily Living (ADLs)
Assisted living serves those that need assistance with ADLs.

What are activities of daily living?

Activities of daily living (ADLs) refer to the common, everyday tasks people learn to do to become self-sufficient. The simple term for daily activities include bathing, eating and dressing. Every person must learn them to remain independent and healthy. As people age or become ill, the body and mind loses dexterity, balance, motor skills and the brain's keen awareness of the body's signals. For this reason, as people age, they need help from other human beings to accomplish them.

Examples of Activities of Daily Living

  • Bathing - Taking a bath or a shower for personal hygiene.
  • Getting dressed - Selecting clothes to wear and undressing at the end of the day.
  • Eating - Feeding ourselves (including chewing and swallowing food).
  • Toileting- Going to the bathroom and being able to control bowel and bladder.
  • Oral Hygiene - Brushing teeth or dentures as needed.
  • Grooming - Washing our hair and shaving as needed.
  • Walking - Moving around from place to place as needed.
Eating is an ADL
Eating is an ADL

As people age, or if they live with a physical or mental challenge that prevents mobility or understanding, they require assistance in the basic self-care activities. Assessing a person's ability to perform one or several skills will determine their physical limitations and the care they need. Ongoing assessments of one's needs measure the progress or deterioration of their health.

For example, brushing teeth requires eye-hand coordination and fine motor skills. And using the toilet requires fine motor skills, balance, and the brain's awareness of the body signals. Age or an accident can play havoc with activities of everyday living.

What are Instrumental Activities of Daily Living?

Telephone Use is an IADL
Telephone Use is an IADL

Instrumental Activities of Daily Living (IDLs) are those actions that are not necessary for functional living, but the actions that allow a person to perform complex skills. The term instrumental activity is a traditional term in the assisted living service definitions and descriptions. By assessing an individual's ability to perform them will give a clear picture of their physical and mental condition.

Examples of Instrumental Activities of Daily Living

  • Managing Finances - Managing money and paying bills.
  • Housework - Basic cleaning and maintaining of home.
  • Shopping - Grocery shopping and clothes shopping.
  • Telephone Use - Using a phone or other forms of communication.
  • Technology Use - Using a computer, TV remote, etc.
  • Medication Management - Administering medication at proper times and dosage.
  • Community Mobility - Moving around from place to place in a given area.
  • Meal Preparation and Cleanup - Preparing meals and cleaning up afterward.

In many instances, a person might be able to perform several activities on their own, but may need some help with a few. The amount of support needed depends on the level of performance. By observing and assessing, one can decide whether or not a residential care home is best.

Activities of Daily Living by the Numbers

The following statistics show the activities that residents need the most help with when living in a residential care home.The data from The 2010 National Survey of Residential Care Facilities helps families understand why a loved one may need to move to an assisted living community.

It's common for older adults to need more care and help with everyday living tasks. In 2011, The Administration on Aging reported 35% men and 38% women at age 65+ had some disability that cause them to require assistance to meet essential personal needs. It also found that 92% of institutionalized (assisted living and nursing home) Medicare beneficiaries had difficulties with one or more ADLs and 76% of them had difficulty with three or more ADLs.

The limitations in activities rise with age due to chronic conditions. If you or a relative lives with a chronic disease, be on the look out for their increased need for personal care.

Assistance With Activities Of Daily Living

Over two-thirds of the residents in the study were receiving assistance with some ADLs

Responses of refusal (< 1%), and don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Resident Responses)

Let's take a look at the types of activities that residents require the most help in performing. The CDC survey discovered that 60% of them need help going outside. As a family member, before choosing a residential care facility, find out the ratio of staff to residents. Knowing that 60% of the residents need help with mobility, you need to know how responsive the staff will be to a loved one. You gain peace of mind knowing your relative or friend will receive help when needed. You may decide that living at home with a caregiver is a safer option.

What percentage of residents need help moving around?

Approximately 10% of residents are confined to a chair. Those residents are not included in these responses.

The data in this chart has been rounded and simplified.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Resident Responses)

There are exceptions to every rule, but the following graph illustrates that a person's growing need of support in daily activities tends to follow a pattern. The first ADL that needs support is bathing. After this, a person will need help in dressing; next comes toileting, transferring and eating respectively. So where do your needs (or loved one's) match up on the escalating chart? If your dad needs some help with taking a bath, it prepares you for the next stage of aging. His subsequent requirements will be for help with dressing and using the bathroom. Are you prepared for the upcoming stages? Information like this is golden and gives you clear indications on what's next. It's meant to help you and the rest of the family to prepare better.

In 2001, NCAL, the National Center for Assisted Living discovered that residents in larger facilities (greater than ten beds) needed help with 2.0 ADLs. And residents in small facilities (10 or fewer beds) needed help with 2.5 ADLs. Overall, the data collapse accordingly, 20% needed help with only one ADL, 18% needed help with two, and 15% needed help with three. 19% needed no help, and 27% needed help with four or five ADLs.

In summary, do your research before selecting a facility. The needier the resident population of the facility, the more staff they should provide.

What percentage of residents need assistance with ADLs?
The data in this chart has been rounded and simplified.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Resident Responses)

This pattern shows the trend of needed support for Instrumental activities of daily living. For example, more than half need help with most of the activities. The ones with highest demands are doing laundry, managing money, taking medications, shopping, and housework. Knowing the most common instrumental living needs that older adults have, family members can better evaluate whether a loved one is capable of living at home. If you're determined to keep mom at home and by knowing the kinds of help most people in her age bracket require, will give you a shopping list of the type of support that suits her best.

Here's a tip, the next time you visit your mom, do you notice any of these signs? The ones that point to her need for more care like; her hair is dirty, she's lost weight, her grooming is unkempt, and the bills have piled up. She may need more help and maybe she needs to move to a facility. Don't rush into conclusions, she may do just fine with a personal caregiver helping out at home.

Of those that perform instrumental ADLs, what percentage need assistance?
The data in this chart has been rounded and simplified.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Resident Responses)

This pattern shows the percentage of residents that do not perform any Instrumental activity of daily living; with or without support. If a parent lives in an assisted living, assess whether he's receiving all the help he requires to manage properly. Don't assume that since a parent lives in a facility that he receives help with these tasks. Not all residential homes deliver personal care services routinely. Some charge for each service separately. If your dad needs help taking medications, ask the facility if they deliver that particular service. And if they do, how much do they charge?

What percentage of residents do NOT perform instrumental ADLs, even with assistance?
The data in this chart has been rounded and simplified.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Resident Responses)

Daily Living Aids To Make Activities Easier

There are daily living aids that make the activities of daily living easier for those with challenges. This varies from person to person, so while this information is useful, it is important to assess each situation and determine what will help and what might hinder. Keep in mind the needs of the individual, as well as what their personal levels of comfort are.

Examples of Daily Living Aids to Assist

Long-handled shoehorn: for those with mobility difficulties, long-handled shoehorn gives independence and comfort.

  • Long-handled sponges: reaching during bathing is a challenge, which is why long-handled sponges are excellent gadgets. These are particularly useful for those individuals not ready to ask.
  • Splints: these splints help stabilize wrists and ankles.
  • Dinnerware: items like non-skid bowls, soft grip utensils, and plate guards aid during dining and spill prevention. In addition to aiding in independence, these items also provide comfort during meals.
  • Bed ladders: created to aid individuals with getting into and out of their beds, this gadget should only be used when the person is not a fall risk because of its looped construction. There are some bed ladders created to prevent falls, however, but these come with a higher price tag. Inquire with your health care plan to know what's covered.
  • Dressing sticks: when individuals need help getting dressed, but are not ready to ask an advocate, dressing sticks help get pants on without the need for bending over.

Home modifications can assist people living with a disability. Prepare the home for an individual who needs help with common everyday tasks. You can install ramps and railings to accommodate a wheelchair, walker or scooter. Add bathroom grab bars or a shower seat for safer bathing. Close to 41% of people with ADL limitations have made these modifications.

Gadgets and home modifications like these are just a few number of tools that assist persons with a disability. Speaking with health care providers, primary care physicians and medical supply stores about the individual needs and concerns is the next step for finding the right gadget.

Family Caregivers Help with Activity Limitations

Family caregivers help with activities of daily living

Since family members deliver 72% of the paid and unpaid caregiving for the older adults with activity limitations, they are at risk for physical, mental and emotional illnesses themselves. The most common coping mechanism used by family caregivers is prayer and talking with friends and relatives.

Over half of the family members give care every day. Chronic diseases affect your older relative's independence. If your loved one lives with CHF, congestive heart failure or lung disease, they lack the physical endurance to clean, cook, and wash clothes on their own. Individuals with arthritis cannot do the short, precise movements of the hands, like opening medication bottles. Vision and hearing problems make self-care difficult. For example, taking medications incorrectly may link to reading the instructions, or the failure to get out of a chair and walk over to the sink for a glass of water.

Aging relatives count on you for help with small and large ADLs and IDLs. Other activities they need help with:

  • Help with putting shoes on
  • Zipping or fastening a shirt or dress
  • Tying shoelaces
  • Cutting foods or holding a glass
  • Difficulty swallowing
  • Bringing a spoon up to one's mouth

Help for Family Caregivers

There are several resources in the community who can help. The local Area Agency on Aging is an excellent one to help you locate professionals in your area. An agency caseworker can visit your relative at home and assess their needs. After the evaluation, the caseworker will direct you to local providers and professionals who can help. Helping an older relative requires a team of people so don't try to it all yourself. Ask for support from friends and family.

When you contact the local Area Agency on Aging, give them a precise explanation of your loved one's problems with activities of daily living. Chances are high that they have a waiting list for evaluations. They will need your relative's insurance cards and financial information so have it handy. Be prepared - it will speed up the assessment process.

The designed the Caregiver How To for Guidance.

A great checklist for family caregivers to use when assessing IADLs.

Use this form to assess your loved one's ADL limitations.

Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.