Activities of Daily Living: Measurements to Qualify for Benefits and Care

Published In Assisted Living

April 23rd, 2015

As you begin to take a serious look at assisted living options for seniors, you will find that a great deal of emphasis is placed on helping seniors perform the activities of daily living. Limitations in those abilities are the key to a senior’s suitability for an assisted living facility and eligibility for financial benefits.

What are Activities of Daily Living?

The term “activities of daily living” (or ADL) is frequently defined as “the basic tasks of everyday life.” Those tasks include:

  • eating,
  • dressing,
  • bathing,
  • using the toilet, and
  • moving from one place to another.

While disabilities can hinder the performance of those tasks in persons of any age, seniors are the group most likely to need help performing those tasks.

A related term you may encounter as you research assisted living is “instrumental activities of daily living” (IADL). Those are the daily tasks required to maintain a normal life that rely on dexterity, memory, and cognitive ability. Counting and sorting medications is an example of an IADL. Other examples include shopping, housekeeping, preparing meals, making telephone calls, and driving or taking public transportation.

A decline in the ability to cope with ADLs and IADLs is the most common reason for seniors to seek the help that assisted living facilities provide. The direct care aides employed by an assisted living facility help seniors perform all ADLs with which they need assistance. They also help with IADLs, such as housekeeping, laundry, and meal preparation. Help with some IADLs, including financial management, is usually provided by children or a financial guardian rather than an assisted living facility.

Why is an ADL Assessment needed?

It is important to assess a senior’s ability to cope with ADLs and IADLs before deciding upon the care option that best meets the senior’s needs. When combined with the senior’s own preferences, an assessment can help you decide whether a nursing home, an assisted living facility, a different kind of facility (such as a memory care facility), or some form of home care is the best match for a senior who needs help with his or her ADLs. Some states require an assessment as part of admission process to an assisted living facility.

An ADL assessment is also necessary to determine benefits that may be available to a senior who is need of assistance. Some disability insurance and long-term care insurance policies, for example, provide coverage for services to seniors whose ability to perform ADLs is substantially limited. Eligibility for state Medicaid Home and Community-Based Services (HCBS) programs also depends upon an evaluation of a senior’s ability to perform ADLs and IADLs.

The results of an ADL assessment are used not only to determine whether government or insurance benefits are available, but also the dollar amount of those benefits. The greater the senior’s overall need for assistance, the higher the benefit payment is likely to be. Assessment results also guide the preparation of service plans by assisted living facilities.

How is an ADL Assessment conducted?

Several assessment tools are used to evaluate an individual’s performance of ADLs and IADLs. Insurance companies, healthcare providers, and benefit providers choose the assessment instrument they believe is most appropriate.

An ADL assessment examines the degree to which a senior requires assistance in the performance of each ADL and selected IADLs. Most assessment methods depend upon a direct observation of the senior rather than relying on the senior’s opinion of his or her ability to perform a task. Results are graded on a scale that typically follows this range:

  • No help needed.
  • Supervision required.
  • Limited assistance required.
  • Moderate assistance required.
  • Extensive assistance required.
  • Total dependence upon another.

Assessments may be updated periodically as residents grow older. A new assessment may also be ordered if staff members notice a sudden change or deterioration in a senior’s ADL performance.

What are Service Plans?

If the assessment results suggest that an assisted living facility would best meet a senior’s needs, staff members at the facility you choose will use the assessment results to prepare an individualized Service Plan. The Service Plan is a comprehensive program designed to meet the senior’s need for help while maximizing the senior’s ability to live and function independently.

A Service Plan usually uses the assessment results as a starting point. Building upon those results, facility staff will explore the senior’s lifestyle, habits, and preferences to create a plan that promotes the senior’s welfare, safety, comfort, and happiness. The plan considers a resident’s emotional as well as physical needs.

Service Plans create a schedule for staff members to provide assistance for each ADL task that a resident cannot perform independently. The plan may also include exercise or recreational programs and other activities that would enhance a resident’s health and lifestyle.

Choosing an Assisted Living Facility

Different assisted living facilities offer different levels of assistance. Some seniors need more help than others. It is important to select a facility that is capable of meeting a senior’s needs as identified by an ADL assessment.

If medication management is an important concern, you need to find a facility that is capable of providing the level of assistance that is required. In some states, only a licensed nurse is allowed to dispense medications. Aides in those states are only permitted to remind a resident to take medication, but cannot help the senior take it. If you live in one of those states, you need to determine whether the senior should be in a facility that makes a nursing staff available.

Nearly all assisted living facilities help residents with every ADL. The degree to which they help with IADLs varies. Not all facilities provide the same degree of assistance arranging for shopping trips or off-campus transportation. You may need to compare several facilities in order to find the one most suited to a senior in need of assistance.

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