Activities of Daily Living: Why This Measure Matters

Every field has its jargon, and the long-term care industry is no exception. In the business of providing care, the phrase “activities of daily living” is used often, and there’s a good reason for this. Activities of daily living are basic self-care skills needed to properly care for oneself in the areas of eating, dressing, bathing, toileting, continence, and mobility. ADLs are one of the most important measurements used to determine the level of care an individual requires and what their care plan should entail.

To help us understand ADLs, I asked Aging Life Care Professional, Carmel Froemke, for some clarification. Carmel has spent 25 years providing direct care and program management for individuals with disabilities, specializing in mental health rehabilitation. Below, Carmel answers our questions regarding activities of daily living.

How Are ADLs Affected By Age and Health Conditions?

A decline in the ability to perform ADLs is often due to a medical condition or general weakness that has increased with age. Most family members pick up on a loved one’s decline through secondary signs of a problem, such as changes in their routines or appearance. These red flags typically indicate there is a more serious underlying issue that is interfering with their ability to perform self-care.

For instance, if the senior is wearing the same outfit each time you see them, it may be because they have lost the flexibility or dexterity needed to fasten zippers and buttons on other clothing items they own. Simply changing their clothing style to elastic waist pants, Velcro-closure shoes or front-closing shirts may solve the problem and allow for more independent dressing and increased clothing options.

Another common example is a significant change in personal hygiene practices. If a fear of falling in the shower or bath is the driving force behind their infrequent bathing, the solution could be as simple as implementing appropriate safety measures, such as grab bars, non-slip floor mats or a shower chair.

How Are ADLs Assessed?

Most seniors want to maintain their independence for as long as possible, so they are afraid to tell someone they are having increased difficulties. They may fear having to move away from their home and comfort zone. However, an honest evaluation of the ability to perform ADLs will allow for the development of a customized plan of care that will enable them to continue living as independently as possible and ensure their needs are still met.

It is best to have a complete needs assessment conducted by a specialist (geriatric care manager, nurse, occupational therapist or social worker) to fully identify all problems, their root causes and potential solutions. However, if modifications are put in place and there is still a need for support, it may be time for outside help.

Who Conducts Official Functional Assessments?

Assessments can be made by a family doctor or an occupational therapist, but most programs that provide or cover long-term care services have their own assessment process, assessors, rules and guidelines, and they may vary greatly from one program to another. For example, long-term care insurance agencies typically employ or hire private assessors to make eligibility determinations.

One of the best resources for beginning the assessment and application process is your local Area Agency on Aging. AAAs can let you know where you need to have an assessment done, and, in some cases, may actually be able to provide the assessment.