Activities of Daily Living (ADL’s)
Written by Carol Bradley Bursack
Originally posted on Agingcare.com
Edited by SSM
ADLs, or activities of daily living, are the fundamental self-care skills we need to properly care for ourselves. ADLs are one of the most important measurements used to determine if people qualify for certain services or if they need an increased level of care. Essentially, these tasks help to determine what an individual’s care plan should entail.
To help us understand ADLs, I asked 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. Carmel answers our questions regarding activities of daily living:
How many ADL’s are there?
There are six basic ADLs that involve the ability to independently care for oneself:
- Eat and obtain adequate nutrition
- Wash oneself by bath, shower or sponge bath and maintain personal hygiene practices such as brushing one’s teeth and shaving
- Dress oneself—both putting on and taking off clothing, including managing fasteners, putting on shoes and other assistive devices (braces, artificial limbs, etc.)
- Use the toilet
- Maintain control of one’s bladder and bowels and hygiene associated with this, or effectively manage incontinence
- Walk and maintain mobility (or execute transfers), such as moving from the bed to a chair or up and down stairs
Which ADLs tend to weaken first as people age?
Bathing is typically the first to weaken. This is followed by dressing, toileting, transfer/mobility and eating, according to the National Center for Assisted Living’s Assisted Living Sourcebook, 2001.
If you’ve noticed the senior has had changes in hygiene (does not look neat and tidy or has a body odor), you will want to determine the cause. If a fear of falling in the shower or bath is the issue, the solution could be as simple as providing appropriate safety measures such as grab bars, non-slip floor mats or a shower chair. If general weakness has prevented them from doing their laundry or bathing, you will want to provide this service or hire someone to do it for them. It is also wise to encourage an exercise regimen to strengthen their muscles and help build endurance.
How do you know when you or your loved one needs help?
Some common warning signs are: weight loss, skipping meals, spoiled food in the refrigerator, difficulty remembering to take medications or attend appointments or confusion regarding these everyday activities. Also, getting lost, difficulty managing finances and paying bills, increased isolation or changes in their typical routine can be causes for concern
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. Seniors often wait until a crisis happens before seeking help. If they are willing to plan ahead, such as working with a care manager or confide in a family member, a crisis can often be averted.
When offering help, think about starting small and proceed slowly for those who may be resistant to change. An example might be adding a chore service to take care of laundry, yard work, heavy cleaning, or transportation to appointments. Once the senior is accepting of some outside help, additional services can be more easily introduced. If you can frame the assistance in a way that the senior believes they are helping you with a problem, he/she is more likely to collaborate with you on finding a solution.
Who makes an official assessment to determine if an individual qualifies for certain care/coverage?
Medicaid, long-term care insurance providers, Social Security disability benefits and other providers require the need for a certain amount of help with ADLs before they will provide service.
Most programs that provide medical coverage have their own assessment process, assessors, rules and guidelines, and they may vary greatly from one program to another and one state to another.
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. Assessments can also be made by a family doctor or an occupational therapist. However, long-term care insurance agencies typically employ or sometimes hire private assessors to make eligibility determinations.
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