Activities of Daily Living (ADLs):
Why They Matter for Care, Medi-Cal, IHSS & Long-Term Care
Activities of Daily Living, often called ADLs, are the basic personal care tasks used to evaluate whether someone needs help at home, in assisted living, in a nursing home, or when filing a long-term care insurance claim. ADLs are also important when families are trying to understand Medi-Cal, IHSS, caregiving needs, skilled nursing, and long-term care planning.
Quick answer: ADLs usually include bathing, dressing, eating, toileting, transferring, continence, and sometimes walking or mobility. Different programs and insurance contracts may use slightly different lists, so always check the specific rule, policy, or benefit explanation.
The Common Activities of Daily Living
| ADL | What It Usually Means |
|---|---|
| Bathing | Washing oneself, getting in or out of the shower or tub, and maintaining basic hygiene. |
| Dressing | Putting on, taking off, and managing clothing, shoes, braces, or fasteners. |
| Eating | Feeding oneself after food is prepared and made available. |
| Toileting | Getting to and from the toilet, using it, and cleaning oneself afterward. |
| Transferring | Moving in and out of a bed, chair, wheelchair, or standing position. |
| Continence | Controlling bladder and bowel function, or managing incontinence care. |
| Walking / Mobility | Moving safely from place to place. Some lists treat this separately from transferring. |
| Scroll down for much more detail – Lawton and Katz Scales | |
Why ADLs Matter
ADLs are more than a medical phrase. They are often the practical test of whether a person can live independently or needs help. A person may still be able to talk, make decisions, and appear “okay,” but if they cannot bathe, dress, transfer, toilet, or eat safely without help, that can change the care plan dramatically.
Long-term care insurance: Many policies look at whether the insured person needs substantial assistance with a certain number of ADLs, often two or more, or whether there is severe cognitive impairment. The exact trigger depends on the policy language.
Medi-Cal nursing home planning: ADL limitations may help show why someone needs a higher level of care, but Medi-Cal eligibility also involves income, assets, medical necessity, and California rules. See my related page on how to qualify for Medi-Cal nursing home benefits.
IHSS: In-Home Supportive Services may look at the help a person needs with daily tasks in the home. ADLs and related personal care needs may be part of the discussion. See my related page on IHSS and In-Home Supportive Services.
Medicare vs. long-term care: Medicare is generally not designed to pay for long-term custodial care just because someone needs help with ADLs. Medicare may cover skilled nursing or home health under specific rules, but that is different from ongoing custodial care. See my related page on long-term care vs. Medicare.
Important: Needing help with ADLs does not automatically mean one specific program will pay. The ADL list is a starting point. The real answer depends on the person’s medical condition, income, assets, insurance policy, care setting, and the specific program rules.
ADLs vs. IADLs
ADLs are basic personal care tasks. IADLs, or Instrumental Activities of Daily Living, are more complex daily activities such as shopping, cooking, transportation, managing medications, handling money, using the phone, and housekeeping. A person may need help with IADLs before they need hands-on help with ADLs.
Common Questions
How many ADLs are usually needed for a long-term care insurance claim?
Many long-term care insurance policies use the need for help with at least two ADLs as a benefit trigger, but every policy must be read carefully. Some policies also include cognitive impairment as a separate trigger.
Does dementia count if the person can still walk or eat?
It may. Cognitive impairment can create a need for supervision, cueing, or protection from unsafe decisions. Insurance policies and care programs may treat cognitive impairment differently from physical ADL limitations.
Is cooking an ADL?
Usually no. Cooking is generally considered an IADL, not a basic ADL. Eating is an ADL, but preparing the meal is usually a separate category.
Does needing help with ADLs mean someone qualifies for Medi-Cal nursing home care?
Not by itself. ADL limitations may support the need for care, but Medi-Cal nursing home eligibility also depends on medical necessity and financial eligibility.
Can ADLs matter for IHSS?
Yes. IHSS looks at the help a person needs to remain safely at home. Personal care, household tasks, and supervision issues may all matter depending on the case.
Related Pages
Bottom Line
ADLs are often the first practical sign that someone may need more help than family expected. They can affect long-term care insurance claims, home care decisions, IHSS, Medi-Cal nursing home planning, assisted living discussions, and Medicare confusion. The key is not just knowing the list of ADLs — it is knowing which program or insurance policy is being asked to pay.
“7 Seven #Activities of daily living” ADL’s –
nursing Long Term Care which include
- (1) Eating, which shall mean reaching for, picking up, and grasping a utensil and cup; getting food on a utensil, and bringing food, utensil, and cup to mouth; manipulating food on plate; and cleaning face and hands as necessary following meals.
- (2) Bathing, which shall mean cleaning the body using a tub, shower, or sponge bath, including getting a basin of water, managing faucets, getting in and out of tub or shower, and reaching head and body parts for soaping, rinsing, and drying.
- (3) Dressing, which shall mean putting on, taking off, fastening, and unfastening garments and undergarments and special devices such as back or leg braces, corsets, elastic stockings or garments, and artificial limbs or splints.
- (4) Toileting, which shall mean getting on and off a toilet or commode and emptying a commode, managing clothing and wiping and cleaning the body after toileting, and using and emptying a bedpan and urinal.
- (5) Transferring, which shall mean moving from one sitting or lying position to another sitting or lying position; for example, from bed to or from a wheelchair or sofa, coming to a standing position, or repositioning to promote circulation and prevent skin breakdown.
- (6) Continence, which shall mean the ability to control bowel and bladder as well as use ostomy or catheter receptacles, and apply diapers and disposable barrier pads.
- (7) Ambulating, which shall mean walking or moving around inside or outside the home regardless of the use of a cane, crutches, or braces. CA Insurance Code 10232.8 *
Learn More
- wikipedia.org ADL’s
- Katz ADL scale
- Lawton IADL scale 3- point check list & scale..
- California Insurance Code
- Assessment Domains (8 items): Ability to use telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for own medications, and ability to handle finances.
- Scoring: Usually scored 0 (low function/dependent) or 1 (high function/independent) for each item, with a total score ranging from 0 to 8.
- Target Population: Primarily used to evaluate older adults, often in clinical or community settings.
- Interpretation: A lower score indicates a higher level of dependency. It is often used to detect functional decline early, as IADLs are typically lost before ADLs (like bathing or dressing). [1, 2, 3, 4, 6]
.
