What Are the Activities of Daily Living (ADLs)? A Complete Checklist

When you begin researching care options for an aging parent or a loved one with a disability, you will quickly encounter a barrage of medical acronyms. Perhaps the most important acronym you need to understand is ADLs, which stands for Activities of Daily Living.

ADLs are not just medical jargon. They are the specific, standardized metrics that doctors, social workers, and insurance companies use to measure a person's ability to live independently.

More importantly, your loved one's ability to perform ADLs dictates what type of care they need, and whether insurance (like Medicaid or Long-Term Care Insurance) will pay for it.

In this guide, we will break down the six basic ADLs, explain the difference between ADLs and IADLs, and show you how to assess your loved one's needs.

In This Guide

• The 6 Basic Activities of Daily Living (ADLs)
• What Are Instrumental Activities of Daily Living (IADLs)?
• Why ADLs Matter for Insurance and Funding
• How to Assess Your Loved One (The Katz Index)
• Finding Help When ADLs Become Too Difficult

The 6 Basic Activities of Daily Living (ADLs)

Basic ADLs are the fundamental skills required to care for oneself and survive on a daily basis. While different medical organizations may use slightly different terminology, the healthcare industry universally recognizes these six core activities:

1. Ambulating (Walking/Mobility): The physical ability to move from one position to another and walk independently. This includes getting in and out of a bed or a chair (often called "transferring").
2. Feeding: The ability to feed oneself. Note: This refers to the physical act of getting food from a plate into the mouth and chewing/swallowing safely. It does not include cooking or preparing the meal.
3. Dressing: The ability to select appropriate clothes and physically put them on and take them off without struggling.
4. Personal Hygiene (Bathing/Grooming): The ability to safely wash one's face and body in the bath or shower, as well as maintaining dental hygiene, hair care, and nail care.
5. Continence: The physical and mental ability to control bowel and bladder functions.
6. Toileting: The ability to get to and from the toilet, use it appropriately, and clean oneself afterward.

If a person cannot perform one or more of these tasks without physical assistance or verbal cueing (reminders), they are considered to have an "ADL deficit."

What Are Instrumental Activities of Daily Living (IADLs)?

While basic ADLs are required for basic survival, Instrumental Activities of Daily Living (IADLs) are the more complex skills required to live independently in a community.

People often lose the ability to perform IADLs before they lose the ability to perform basic ADLs. For example, a person in the early stages of dementia may still be able to bathe and dress themselves (ADLs), but they may no longer be able to safely manage their finances or drive a car (IADLs).

Common IADLs include:

• Managing Finances: Paying bills, writing checks, and managing bank accounts.
• Managing Medications: Taking the correct dosage of the right medication at the right time.
• Transportation: Driving safely or navigating public transit.
• Meal Preparation: Planning a meal, safely using the stove/oven, and cooking.
• Shopping: Buying groceries, clothing, and other necessities.
• Housework: Doing laundry, washing dishes, and maintaining a clean home.
• Communication: Using a telephone, smartphone, or computer to communicate with others.

🔍 Find Post-Acute Care Providers Near You Search our directory of 77,900+ providers to find home health, hospice, SNF, and rehab services in your area. Search Providers →

Why ADLs Matter for Insurance and Funding

Understanding your loved one's ADL deficits is the key to unlocking financial assistance for their care. Here is how the three major funding sources view ADLs:

1. Long-Term Care (LTC) Insurance

If your loved one has a Long-Term Care Insurance policy, the policy will not pay out simply because they are getting older. Almost all LTC policies use the "2 out of 6" rule. This means the insurance company will only trigger benefits and start paying for care if a doctor certifies that the policyholder requires substantial assistance with at least two of the six basic ADLs.

2. Medicaid and HCBS Waivers

Medicaid is the largest payer for long-term custodial care in the United States. To qualify for Medicaid to pay for a nursing home, the patient must require a "Nursing Facility Level of Care" (NFLOC). States determine this by assessing the patient's ADLs.

Furthermore, if you want Medicaid to pay for a caregiver to come to your home (through a Home and Community-Based Services Waiver), the state will send an assessor to your home to evaluate your loved one's ADLs. If they do not meet the state's minimum ADL deficit requirements, they will be denied funding.

3. Medicare

It is critical to understand that Original Medicare does not pay for care if you only need help with ADLs.

Assistance with ADLs is considered non-medical "custodial care." Medicare only pays for skilled nursing care or therapy. (Note: If you are already receiving skilled nursing care at home under the Medicare Home Health benefit, Medicare may temporarily pay for a home health aide to help with bathing and dressing, but only as a supplemental service to the skilled care).

How to Assess Your Loved One (The Katz Index)

If you are unsure how to evaluate your loved one, medical professionals often use a tool called the Katz Index of Independence in Activities of Daily Living.

You can perform a basic version of this assessment at home. For each of the 6 basic ADLs, score your loved one as:

• Independent (1 Point): They can perform the task entirely on their own, safely, without any supervision or physical help.
• Dependent (0 Points): They require physical assistance, supervision, or verbal reminders to complete the task safely.

A score of 6 indicates full independence. A score of 4 indicates moderate impairment. A score of 2 or less indicates severe functional impairment.

Note: If your loved one is struggling with IADLs (like forgetting to take medications or leaving the stove on), but still scores a 6 on basic ADLs, it is still time to intervene. Unmanaged IADL deficits quickly lead to safety crises.

📋 Understanding Your Care Options? Read: What Happens After the Hospital: A Step-by-Step Guide to Post-Acute Care

🔍 Compare Providers in Your Area Browse verified providers, compare services, and find contact information. Search All Providers →

Finding Help When ADLs Become Too Difficult

If your loved one is struggling with ADLs or IADLs, it is no longer safe for them to live completely independently. They require custodial care.

Depending on their medical needs and financial resources, this care can be provided in an Assisted Living Facility, a nursing home, or right in their own home by hiring a home care agency.

The National Directory of Post-Acute Providers (NDPAP) can help you find verified, trustworthy agencies in your area that specialize in assisting with Activities of Daily Living.

• Search Home Health & Home Care Agencies in Your City

(Are you a home care provider that assists with ADLs? Make sure families can find you. Claim your NDPAP directory listing here.)