What are activities of daily living?
The checklist doctors, insurers and care planners use to decide how much help your loved one needs.
Activities of daily living (ADLs) are the basic self-care tasks a person needs to manage independently: walking and transferring, eating, dressing, bathing and grooming, toileting and continence. Instrumental ADLs (IADLs) are more complex tasks like managing money, medicines, cooking, shopping and transportation. In dementia, IADLs usually slip first.
How ADL changes show up day to day
The early signs are usually IADLs.
Bills go unpaid, the fridge holds three of the same item and no milk, pill organizers are half full on Friday, or a familiar drive suddenly takes two hours. Later, basic ADLs follow: wearing the same clothes for days, skipping showers, needing reminders to eat, or accidents on the way to the bathroom.
Basic ADLs
Moving and transferring, feeding, dressing, personal hygiene, continence, toileting.
Instrumental ADLs
Transportation, managing finances, shopping, meal preparation, housekeeping, phone and mail, managing medications.
Why dementia affects them in this order
A review in StatPearls (NCBI) explains that IADLs demand more complex organization and planning, so people typically need help with them before basic self-care. The term “ADL” traces back to Sidney Katz in 1950, and the Katz Index is still used to rate basic ADLs. The same review notes that self-reported ability is often inaccurate in dementia, so observation by family matters.
What helps at home
- Simplify instead of taking over: lay out one outfit, set the shower temperature, put the toothbrush ready.
- Break tasks into single steps and give one instruction at a time.
- Protect dignity. Offer help as teamwork (“let’s get ready together”) rather than correction.
- Track what has changed. A simple care log makes doctor visits and care planning much easier.
How activities of daily living are measured
Doctors, nurses and care managers use a few standard tools. Knowing the names helps you read a discharge summary or an insurance assessment.
| Tool | What it covers |
|---|---|
| Katz Index | Basic ADLs only, such as bathing, dressing, toileting and feeding |
| Lawton IADL Scale | 8 areas, from phone use and shopping to medicines and money, scored 0 to 8 |
| Kohlman Evaluation of Living Skills | Watches the person do tasks, so it suits people with cognitive decline |
The StatPearls review notes the Lawton scale relies on self-report, which can over- or underestimate ability. That is another reason your own observations count.
Why a hospital stay can change ADLs
The same review explains that acute illness and hospitalization can reduce ADL function, and some patients go home below their usual baseline. ADL status also predicts nursing home admission, hospital stays and the need for paid home care. If your loved one comes home weaker, ask about physical or occupational therapy before assuming the loss is permanent; our after-discharge guide covers the first weeks.
When to call the doctor
Call if your loved one loses an ADL suddenly (for example, cannot stand or feed themselves within a few days), which can point to illness, a fall, a stroke or delirium. Also ask for an assessment when ADL needs grow, since many benefits are tied to them.
Why ADLs matter for paying for care
Long-term care insurance policies commonly use ADL needs, or cognitive impairment, as benefit triggers, so check your policy wording; see our long-term care insurance guide. Medicare’s home health benefit, by contrast, does not cover help with bathing or dressing when that is the only care someone needs.
ADLs vs. IADLs
People often use “ADLs” for both lists. The difference matters: a person who needs help only with IADLs, such as meals, errands and medication reminders, may do well with a companion. Someone who needs hands-on help with bathing or toileting needs a personal care aide or a home health aide, because Florida law says companions and homemakers may not give hands-on personal care. Our companions cover the IADL side along with companionship; for hands-on help with bathing, dressing or toileting, families add a licensed home health agency or aide, and our companion can work alongside them.
A quick ADL checklist for families
- Can your loved one get in and out of bed and a chair safely?
- Do they eat a full meal without reminders?
- Do they choose weather-appropriate clothes?
- Do they bathe and brush their teeth without prompting?
- Do they reach the toilet in time, day and night?
- Are pills, bills and groceries handled correctly?
A “no” to any of these is a reason to talk with the doctor and adjust the care plan. In Florida, the Elder Helpline (1-800-963-5337) connects you to your Aging and Disability Resource Center, which screens for state programs such as Alzheimer’s Disease Initiative respite for adults with a dementia diagnosis whose impairments affect daily living.
Where our companions fit
Our in-home support covers IADL help such as meal prep, light housekeeping, errands, appointment escort and medication reminders, alongside companionship. When basic ADLs like bathing, toileting or getting in and out of a chair need hands-on help, families add a licensed home health agency or aide, and our companion can work alongside them. We do not give medications or provide nursing care. For a sense of total costs as needs grow, see the cost of dementia care in Florida.
Related terms
Help with the everyday tasks that are slipping
Meals, errands, reminders and good company. 3-5 matched profiles in 48 hours, $35/hour for 40+ hours a week.
Frequently asked questions
Still have questions?
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- Florida ADRD training before the first visit
What are the 6 basic activities of daily living?
Commonly listed basic ADLs are moving or transferring, eating, dressing, bathing and grooming, toileting, and continence.
What is the difference between ADLs and IADLs?
ADLs are basic self-care. IADLs are more complex tasks such as managing money, medicines, cooking, shopping and transportation, which usually need help first in dementia.
Can a companion help with ADLs?
Companions can help with many IADLs such as meals, errands and reminders. Under Florida law, companions and homemakers may not provide hands-on personal care like bathing. For those hands-on ADLs, families add a licensed home health agency or aide, and our companion can work alongside them.
Why does my loved one say they can do everything themselves?
Self-reported ability is often inaccurate in dementia, sometimes because of anosognosia. Family observation gives a truer picture.
How are activities of daily living assessed?
Doctors, nurses and care managers use a few standard tools. The Katz Index rates basic ADLs such as bathing, dressing, toileting and feeding, and the Lawton IADL Scale covers 8 areas, from phone use and shopping to medicines and money, scored 0 to 8. The Kohlman Evaluation of Living Skills watches the person do tasks, so it suits people with cognitive decline. Self-reported ability is often inaccurate in dementia, so your own observations count, and a printable dementia care log helps you keep track.
Don't see your question? Call (689) 333-6079 or send us a message.
Sources
- StatPearls (NCBI Bookshelf), Activities of Daily Living
- Medicare.gov, Home health services coverage
- Florida Statutes s. 400.462, Definitions (home health agencies, companions, homemakers)
- Florida Department of Elder Affairs, Aging and Disability Resource Centers
- Florida Department of Elder Affairs, Alzheimer's Disease Initiative