This article about activities of daily living by attorney Nicole Wipp at the Family & Aging Law Center in Michigan is not legal advice. It is for informational purposes only. For legal advice on your situation in Michigan, contact us at (248)178-1511 today.

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As we age, we may face various challenges affecting our ability to live independently. A decline in the ability to perform ADLs is often part of the natural process of aging, and it is important to distinguish between changes due to normal aging and those caused by illness or injury.

Everyday tasks may become difficult, and some may require more assistance than others. This is where the Activities of Daily Living (ADLs) come in. Activities of Daily Living (ADLs) is a term used to describe the everyday tasks we perform to take care of ourselves, while Instrumental Activities of Daily Living (IADLs) tasks are necessary for an individual to live independently in their community, but they are not essential to immediate functioning. Both ADLs and IADLs are key measures of day to day functioning for older adults, and changes in physical function can significantly impact a person's ability to perform these activities.

In Michigan, older adults, their caregivers, and loved ones must understand both ADLs and IADLs and how they impact quality of life.

In this blog, we will discuss the different activities of daily living, provide examples, explore how many activities an individual needs help with to trigger qualification for long-term care, and consider the legal issues that may arise when ADLs and IADLs become an issue.

Getting Legal Issues Handled Before ADLs and IADLs Are Out Of Your Control

Acknowledging the inevitable shifts in functional ability is a fundamental aspect of aging gracefully. As time advances, individuals often confront legal challenges stemming from these changes in their daily living capabilities.

Ponder over this: are you prepared to address the legal implications of planning for long-term care, orchestrating your finances, ensuring your estate is in order with up-to-date wills and trusts, and making informed healthcare decisions?

The foresight to tackle these matters early on is critical to safeguarding your rights and solidifying your intentions. Consider the peace of mind that comes with having these affairs expertly managed, allowing you to focus on living life to its fullest. Ultimately, the support of an elder law attorney can prove essential in navigating these complexities.

What Are The Activities Of Daily Living (ADLs)?

Activities of Daily Living (ADLs) refer to essential day-to-day activities that we perform independently, unassisted, or with minimal assistance. ADLs are necessary to maintain a healthy and fulfilling life as we age.

They are a fundamental part of daily activities and include six main categories: bathing, dressing, feeding, transferring, toileting, and continence (which includes control over both bladder and bowel function). Assessment tools like the Katz scale or Katz ADL scale are commonly used to evaluate a person's ability to perform these activities and determine their level of functional independence. An individual’s ability to perform activities in these categories measures his or her functional status. Assessing a person's ability to perform essential ADLs helps determine the level of support needed and guides care planning. The level of independence, severity of impairment, and support required for each individual vary.

What Are The Instrumental Activities Of Daily Living (IADLs)?

Instrumental Activities of Daily Living (IADLs) are necessary for an individual to live independently in their community, but they are not essential to immediate functioning.

Some examples of IADLs include managing finances, meal preparation and food preparation, doing laundry, shopping, paying bills, managing medications, using technology, and transportation. These instrumental ADLs require a diverse set of skills required for independent living. Unlike ADLs, IADLs are not related to physical abilities, but rather cognitive and functional abilities.

IADLs are a set of activities related to independent living and functioning in daily life. These activities are more complex than the Activities of Daily Living (ADLs). IADLs cover everything from managing medication to doing laundry to preparing meals and running errands. Daily living IADL assessments help determine the level of support needed and are critical for evaluating functional independence and planning care interventions.

As caregivers, we must know the types of support our loved ones need in performing these activities.

Understanding the Difference Between Personal Hygiene ADLs and Instrumental Activities

To ensure that our loved ones receive the best care possible, it's important to understand the difference.

Personal Hygiene ADLs

ADLs refer to the basic tasks necessary for daily living. These include activities such as bathing, grooming, dressing, and toileting, which are essential for maintaining good hygiene and overall health.

As we age, performing these tasks independently may become challenging. This is why many long-term care facilities, including nursing homes, have trained caregivers and nursing staff to assist with ADLs, ensuring that residents can maintain their dignity and independence. Nursing staff play a vital role in helping residents with these daily activities, providing support and monitoring to ensure safety and quality care. Supporting personal hygiene ADLs not only promotes health but also helps preserve self esteem, allowing individuals to feel respected and confident in their daily lives.

Instrumental Activities

Instrumental activities refer to the more complex tasks that are necessary for independent living. These include activities such as cooking, cleaning, managing finances, and using public transportation. While these tasks may not seem as important as ADLs, they are crucial for maintaining a sense of independence and quality of life.

As people age, performing these tasks can become more difficult. Long term care facilities and home care services can provide support with instrumental activities, helping individuals remain safe and comfortable. In addition, assistive devices can be used to help maintain independence with these tasks, promoting autonomy and dignity. Long-term care facilities can offer support through trained staff or external resources such as meal delivery services, home maintenance, or transportation assistance.

How Much Assistance Do They Need?

Understanding the difference allows us to assess better the level of care our loved ones need so that we can develop a care plan. The ability to perform ADLs and IADLs is an important factor in determining the appropriate level of support. While some may only require assistance with ADLs, others may also need support with cognitive activities. By understanding this distinction, we can ensure that our loved ones receive the appropriate care plan for their individual needs. Early and accurate evaluation provides benefits such as improved care planning, better decision-making, and enhanced quality of care.

Furthermore, by supporting all these activities, we can help our loved ones maintain their independence and quality of life as they age.

What are ADLs and IADLs in Elderly Care?

As people age, it’s common for them to experience physical and cognitive decline, and frail older adults are particularly at risk for difficulties with activities of daily living (ADLs). This can make it challenging for them to perform daily activities that were once easy. Cognitive decline, such as that caused by Alzheimer's disease, can further impact a person's ability to manage both basic and instrumental activities of daily living. Maintaining functional mobility is crucial to support independence and help prevent falls as individuals face these challenges.

Learn more about Elderly Care. 

What are Some Specific Examples of ADLs?

ADLs refer to basic self-care tasks that individuals typically do daily. They include activities such as:

• Bathing

• Dressing

• Eating

• Toileting

• Transferring (moving from one position to another)

These activities are essential for maintaining hygiene and staying nourished and independent. People may experience difficulties performing these tasks due to physical limitations or health conditions as they age.

What are IADLs?

IADLs refer to more complex activities that are necessary for a person's well-being and quality of life. These activities require a combination of physical and cognitive abilities and complex thinking skills such as:

• Managing medication

• Shopping

• Cooking

• Managing finances

• Using transportation

IADLs are crucial for older adults to maintain their independence and live a fulfilling life. However, as they age, they may face challenges completing these tasks due to mobility or cognitive issues. Home health services can provide support for individuals struggling with these activities, offering assistance and assessments in the home environment. Interventions often include treatment plans designed to help individuals regain or maintain their ability to perform IADLs, supporting independence and quality of life.

The Importance of ADLs and IADLs in Elderly Care

The ability to perform ADLs and IADLs is a key factor in determining an older adult’s level of independence and overall quality of life. These are essential tasks that support daily functioning, and for many, completing them independently is crucial for maintaining a sense of dignity and self-worth.

Moreover, difficulties with ADLs and IADLs can also impact an individual's safety. For example, being unable to bathe or dress independently can increase the risk of falls and injuries.

The Role of Caregivers

In many cases, older adults may require assistance managing communication along with ADLs and IADLs. This is where caregivers play a crucial role. Caregivers provide support and assistance to help older adults maintain their independence and quality of life.

In addition to caregivers, allied health professionals such as occupational therapists are key members of the healthcare team who assess and support daily living activities. Occupational therapists evaluate an individual's ability to perform ADLs, develop intervention plans, and help restore or maintain functional independence, especially in rehabilitation and disability management scenarios.

Caregivers can also advocate for older adults, ensuring that their needs are met and they receive the necessary help and resources to perform ADLs and IADLs.

The Vital Support of Skilled Care Facilities

Skilled care facilities play a pivotal role in bridging the gap when aging individuals face complexities in performing ADLs and IADLs. Have you ever wondered who steps in when the intricacies of medication management become too cumbersome or when the simple act of preparing a meal becomes a hurdle too high for family caregivers of an older loved one to clear? The answer lies within the compassionate walls of skilled care facilities.

These facilities provide a structured environment where professionals are adept at addressing the unique needs associated with ADLs and IADLs. Skilled care facilities also support hospitalized patients who require assistance with ADLs during recovery and transition, ensuring their functional status is closely monitored and any decline is promptly addressed. Staffed by a team of trained healthcare providers, they ensure that every aspect of care is tailored to enhance the individual’s autonomy while providing the necessary aid. It’s not just about meeting basic needs—it’s about enriching lives through specialized care plans that dignify and respect the aging process.

Picture the relief on a daughter's face when she knows her father is not missing his critical heart medication, or the joy in a son's heart seeing his mother engaging in social activities despite her mobility limitations. These moments are the testimonials of a skilled care facility's impact.

Supporting an elder’s ability to perform these daily tasks is more than a service—it's a commitment to preserving their independence and dignity. It acts as a beacon of assurance for family members, knowing their loved ones are in capable, caring hands.

How Many ADLs Does It Take To Trigger Qualification for Skilled Nursing Care?

The number of ADLs required for long-term care varies in each state. In Michigan, two ADLs trigger eligibility for long-term care assistance. The Centers for Medicare and Medicaid Services (CMS) define LTC as care needed for 90 days or more. To qualify for LTC, you must meet certain ADL criteria. To trigger LTC, you must require assistance with at least two ADLs or have a cognitive impairment.

For example, if someone has trouble bathing and toileting without assistance, they may need long-term care.

This is where the Activities of Daily Living Assessments come in.

The ADL assessments are designed to help individuals and caregivers assess their ability to perform ADLs, identifying any needs or concerns. This assessment is often conducted by a healthcare professional, family member, or nursing home and is a crucial step in developing a long-term care plan.

The assessments may include questions about the individual's ability to perform ADLs, such as "Can the person dress themselves independently?" "Can they get in and out of bed without assistance?" "Can they clean themselves and feed themselves without any help?" These questions are designed to help determine the level of assistance required.

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Signs That It's Time To Assess ADLs And IADLs

What are the signs that it's time to assess ADLs and IADLs? If you observe that your loved one is struggling with managing everyday tasks or has become forgetful, it may be time to assess their ADLs and IADLs. No two individuals are the same, so every senior's abilities and needs will be different.

As a family caregiver, it is important to monitor subtle changes rather than focus on significant issues. If you notice any changes or difficulties with IADLs, consider scheduling an assessment with a healthcare professional. It's crucial to quickly report any problem with IADLs and ADLs, as it can lead to an earlier diagnosis and intervention of potential problems in any of these areas.

Many seniors may not realize or be willing to admit that they're struggling with an ADL or and IADL. In our experience, this is common. That's why loved ones need to stay involved and help as quickly as possible.

Here are some common signs that it may be time to assess both ADLs and IADLs:

- Struggling to manage daily tasks due to physical or mental limitations

- Unexplained weight loss or changes in eating habits, possibly due to an inability to feed oneself or recognize hunger

- Difficulty with mobility or balance, increased risk of falls

- Forgetfulness, missed appointments, or unusual prescription drug usage

- Changes in personal hygiene, appearance, or grooming habits

- Struggling to walk independently

- Difficulty in paying bills

The 3 Types Of ADL Assessments Health Care Professionals Use

Different types of assessments are available to evaluate the level of support needed by people in performing IADLs and ADLs.

The full ADL assessment and IADL assessments have various parallels, but they are different. The IADL assessments are more complex than ADLs, adding community function, instrumental communication, and knowledge and skills to the list. These evaluations have the potential to identify any impairments as early as possible and provide the required support or solutions to the problem identified.

1. The Katz Index of Activities of Daily Living

This assessment includes the six most basic activities, or ADLs, mentioned earlier and evaluates the senior's ability to perform them with or without assistance.

2. The Lawton Instrumental Activities of Daily Living Scale

This assessment evaluates a senior's competence in the seven IADLs mentioned earlier. It is used to determine how much assistance a senior requires.

3. The Mini-Mental State Examination

This examination assesses cognitive functions and organizational skills such as memory, attention, and language. It evaluates basic skills and the senior's ability to problem-solve and make appropriate decisions.

It's worth noting that while these assessments are useful, they don't always provide a complete picture of an individual's functional abilities. They may also fail to consider the unique circumstances, environment, and cultural factors that may impact an individual's ability to perform ADLs and IADLs.

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If Your Loved One Needs Skilled Care, Contact Us (248)278-1511)

Recognizing changes to an individual's functional status is essential to aging.

As we get older, a variety of legal issues can arise as part of that loss of function related to daily living. These may include planning for long-term care, managing finances and assets, creating wills and trusts, and navigating healthcare decisions. It's important to address these issues before they become urgent to ensure your wishes are carried out, and your rights are protected.

How We Can Help

As an elder law attorney, I specialize in the legal needs of older adults and their families. For that reason, I deeply understand the unique challenges that come with aging and can provide valuable assistance in navigating these complex legal matters.

Some ways our office can help include:

• Providing guidance on long-term care options and helping to develop a plan for future care

• Assisting with financial planning, including creating a will or trust and managing assets to ensure they are protected

• Advocating for your rights and ensuring you have access to the resources and support you need

• Helping with healthcare decisions, such as creating advance directives and navigating insurance coverage