Activities of Daily Living: Why This Measure Matters

When it becomes obvious to us that our loved one can’t get through a day without assistance, we start looking into resources. Soon after we reach the first agency that we call, we are asked about their ADLs. Their what?

Every field has its jargon, and many of the terms are acronyms for frequently used phrases. In the business of providing care, the phrase “activities of daily living” is used often, and there’s a good reason for this. 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. She’s now very close to obtaining her credentials as a Geriatric Care Manager. Below, Carmel answers our questions regarding activities of daily living:

ADLs: What are they?

ADLs, or activities of daily living, are the fundamental self-care skills we need to properly care for ourselves. There are six basic ADLs that involve the ability to independently:

• 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 get weak first as people age?

Bathing is the most commonly supported ADL. This is followed by dressing, toileting, transfer/mobility and eating, according to the National Center for Assisted Living’s Assisted Living Sourcebook, 2001.

The loss of skills in ADLs is often due to a medical condition(s) or general weakness. Loved ones and supports should first determine the cause of the problem and then take steps necessary to remedy it.

It is best to have a complete assessment by a specialist (Care Manager, Nurse or Social Worker) to best identify the problems, causes and potential solutions. Family members can be very helpful by sharing information from their unique perspective. For instance, the senior may have a loss of flexibility or dexterity to fasten zippers, buttons or tie shoes. Changing their clothing style to elastic waist pants, Velcro-closure shoes or front-closing blouses or shirts may solve the problem.

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 to develop a customized plan of care, a crisis can often be averted. In turn, this can reduce costs by avoiding hospitalization, skilled care or rehabilitative services.

The intervention of a family member or friend may be necessary to encourage a senior to seek assistance. Remember to start 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. Also, “little white lies” may be appropriate, such as “I’m going that way anyway, I’ll drive you,” or “I’ll pick up your groceries for you.” 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.

PACE (Program of All-Inclusive Care for the Elderly), 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. Who makes an official assessment to determine if an individual qualifies for certain care/coverage?

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.

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.

Fidelity Home Health Care is a full-service health care agency that is owned and managed by a Registered Nurse with 18 years of extensive clinical experience in direct patient care in hospital settings. We provide home care services to the residents of Philadelphia, Northeast Philadelphia, Doylestown, Warrington, Warwick, Warminster, Northampton, Upper Southampton, Lower Southampton, Richboro, Churchville, Newtown, Feasterville, Langhorne, Penndel, Hulmeville areas. Please contact us online or call 215-710-0515 today to learn more about us and give us an opportunity to help you.