Activities of Daily Living (ADLs)
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.
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 ability to 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 that your loved one has had changes in hygiene (i.e., decrease in bathing, brushing hair/teeth), you will want to determine the cause. If a fear of falling while bathing 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 bathing or taking care of themself or their home, you can hire someone to do it for them. An exercise regimen is also encouraged to help maintain and strengthen their muscles and help build endurance.
How do you know when your loved one needs help?
Some common warning signs are: significant weight loss, spoiled food in the refrigerator, difficulty remembering to take medications or attend appointments, increase in car accidents or confusion regarding everyday activities such as banking or grocery shopping. Getting lost, difficulty managing finances and paying bills, increased isolation or changes in their typical routine can be causes for concern and are often a major red flag. Those with dementia often self isolate for a variety of reasons including fear of others finding out and uncomfortableness maintaining conversations that may now be difficult to follow.
Most older adults want to maintain their independence for as long as possible, so they can be afraid to tell someone if they are having increased difficulties. They may fear losing their independence. Older adults often wait until a crisis happens before seeking help. Those significant events typically fall into major accidents of falling, car accidents or getting scammed out of thousands of dollars. If your loved one is willing to talk to you, a crisis can often be averted. As my brother often says “safety first!”
When offering help, start small and proceed slowly for those who may be resistant to change. An example might be hiring a service to take care of laundry, yard work or heavy cleaning. The next step may be offering to take your loved one to medical appointments as “an extra set of ears.” Gradually, additional services can be more easily introduced. If you can frame the assistance in a way that your loved one believes they are helping you with a problem, they may be more likely to collaborate with you on finding a solution. For example, offering to attend doctor’s visits because you don’t understand what your loved one said and this way you can take notes to ask the doctor your own questions and moreover, if issues are hereditary, you have a right to know as well!
Who makes an official assessment to determine if an individual qualifies for certain care/coverage?
Long term care facilities, medicaid, linsurance providers, Social Security disability benefits and other providers require that the individual have a certain level of need with ADLs before they will provide or cover certain services. 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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Photo by Brooke Cagle (US) @brookecagle
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