Understanding ADLs and IADLs: The Basics of Caregiving Assessments

If you’ve started the process of applying for Medicaid Home and Community Based Services Waivers or any other long-term care services, you’ve likely heard the terms ADLs and IADLs. These aren't just clinical jargon; they are the "measuring sticks" that state assessors use to determine exactly how much help a person needs to remain safely at home.

Understanding these two categories is the first step in knowing whether you or your loved one might qualify for state-funded support for long-term care.

1. Activities of Daily Living (ADLs) – The "Basics"

Activities of Daily Living (ADLs) refer to the fundamental, basic routine tasks that most healthy individuals can perform without assistance. Typically, these are the basic skills necessary for individuals to independently care for themselves, such as eating, bathing, and mobility. They are markers of physical independence. If an individual struggles with these, it is often a sign that they need a higher level of hands-on care. These are also the first skills that a case manager, waiver coordinator, or nurse will assess to make a determination on the care needs of an individual.

Basic Activities of Daily Living include the following:

• Personal Hygiene: The ability to bathe and groom oneself and maintain dental hygiene, nail, and hair care.
• Dressing: The ability to select clothing and put it on without assistance.
• Feeding: The ability to feed oneself (not including meal preparation).
• Toileting: The ability to get to and from the toilet and clean oneself.
• Continence: The ability to control bladder and bowel functions.
• Mobility/Transferring: The ability to move safely from one position to another (e.g., getting from a bed to a chair) or walk around the home.

Assessing ADLs is one way state programs determine if an individual needs daily help and would require ongoing long-term care.

2. Instrumental Activities of Daily Living (IADLs) – The "Life Management" Tasks

Instrumental Activities of Daily Living (IADLs) are more complex. They require higher-level thinking, organizational skills, and problem-solving. While these tasks aren’t strictly physical daily tasks, they are essential for living independently in a home and community. These tasks typically occur intermittently and are usually the first tasks that an individual needs help with before requiring help with ADLs.

• Meal Preparation: The ability to plan, cook, and serve balanced meals while safely operating cooking devices and maintaining safe food storage.
• Medication Management: The ability to keep track of dosages and ensuring medications are taken on time.
• Managing Finances: The ability to manage finances, pay bills, managing a budget, and handling money.
• Housekeeping: The ability to perform light and heavy cleaning (laundry, dusting, vacuuming) and other general home maintenance tasks.
• Shopping: The ability to go grocery shopping and managing household supplies, maintaining an awareness of what items are needed for sustenance and procuring them.
• Transportation: The ability to plan for and use transportation like using public transit or driving to get to appointments and errands.
• Managing Communication: The ability to manage telephone and email.

Why Do These Terms Matter to You?

When an Area Agency on Aging representative comes to the home for a waiver assessment, they are specifically looking to see if your loved one has "functional deficits" in these areas.

• Eligibility for Care: Most Medicaid programs require that an individual show a "level of care" deficit. This means if a person can no longer perform a certain number of ADLs or IADLs safely, they become "eligible" for programs like Structured Family Caregiving (SFC).
• Care Planning: Knowing exactly which tasks are a struggle helps us build a better care plan. For example, if someone is great at ADLs but struggles with IADLs (like medication management and meal prep), they may need a "homemaker" style of support rather than full-time medical assistance. Similarly if an individual requires help with ADLs, they may need "personal care" services in addition to homemaker.

When Should You Seek Help?

You don’t need to wait for a total loss of independence to start looking for support. If you notice your loved one skipping meals because cooking is too tiring, or if you’re seeing bills pile up because they are confused by the mail, these are "IADL red flags."

If you're already doing all of this for them, you are likely eligible for support under Ohio’s waiver programs.

Not sure if your loved one meets the "Level of Care" requirements? Navigating the assessment process can be intimidating, but you don't have to do it alone. We help Ohio families understand their eligibility and connect with the right care resources.

Related Resources

• NIH Guidelines on ADLs and IADLs

• Cleveland Clinic's Definitions of ADLs and IADLs

• CareOasis Guide to Getting Paid as a Caregiver