What are activities of daily living and why are they used for determination of needs for long term services and support (LTSS)?

According to the Centers for Disease Control and Prevention, roughly one in five adults aged 65 and older have difficulty with one or more essential daily tasks. This highlights the critical importance of understanding what are activities of daily living and why are they used for determination of needs for long term services and support (LTSS).

Quick Summary

Activities of daily living (ADLs) are fundamental self-care tasks like bathing and dressing, used as a standardized metric by healthcare providers and insurers to measure an individual's functional abilities; this assessment helps determine the appropriate level of care and eligibility for Long-Term Services and Support (LTSS).

Key Points

• Definition: Activities of daily living (ADLs) are the basic self-care tasks required for personal health and survival, such as bathing, eating, and dressing [1, 2].

• Two Types: ADLs are split into basic (B-ADLs), which are core physical tasks, and instrumental (I-ADLs), which are more complex tasks related to living independently [1].

• LTSS Eligibility: Healthcare providers, insurers, and government programs use ADL assessments as a standardized measure to determine eligibility for Long-Term Services and Support (LTSS) [2, 4].

• Matches Care to Needs: Assessment of ADL limitations helps match the level and type of care needed, such as in-home assistance, assisted living, or nursing home care [2].

• Proactive Planning: Declines in ADLs, particularly I-ADLs, can act as early indicators of health issues, enabling families to plan proactively for future care [2].

• Preserves Independence: By identifying specific areas where support is needed, ADL assessments help maintain an individual's independence and quality of life for as long as possible [2].

Defining Activities of Daily Living (ADLs)

Activities of Daily Living (ADLs) are basic, essential tasks that most people perform independently [1, 2]. They are used as indicators of a person's functional status and capacity for independent living. Difficulty with ADLs suggests a need for assistance, which may be temporary or ongoing [1].

The Two Types of ADLs

ADLs are typically divided into Basic ADLs (B-ADLs) and Instrumental ADLs (I-ADLs) [1].

Basic ADLs

B-ADLs are fundamental self-care tasks related to physical needs and are often impacted first by health issues or aging [1]. Standard basic ADLs include [1]:

• Bathing and Grooming
• Dressing
• Eating
• Toileting and Continence
• Transferring: Moving between positions, like bed to chair [1].
• Ambulating: Walking or moving around [1].

Instrumental ADLs

I-ADLs are more complex skills needed for independent living in a community. Difficulties with I-ADLs can appear earlier than issues with basic ADLs [1]. Examples include [1]:

• Managing Finances
• Medication Management
• Meal Preparation
• Housekeeping
• Shopping
• Using Transportation
• Communication: Using devices like a telephone [1].

Why ADLs Determine LTSS Needs

ADLs are used to determine the need for Long-Term Services and Support (LTSS) because they provide an objective measure of functional impairment [2, 4]. This standardized approach helps assess an individual's need for assistance consistently [2, 4].

Standardizing Eligibility

Before standardized ADL assessments, eligibility for services was often subjective [2]. Tools like the Katz Index and the Lawton I-ADL Scale provide a common language for professionals, helping to determine eligibility for programs like Medicaid and long-term care insurance benefits [2, 4].

Matching Care to Needs

ADL assessments identify specific areas where an individual needs help, allowing for personalized care planning. The assessment helps match services to a person's functional status, from in-home assistance to care in a facility [2].

Predicting Future Needs

Assessing current ADL and I-ADL status can offer insights into potential future needs, enabling proactive care planning and potentially preventing health issues [2].

How ADL Assessment Works

ADL assessments are usually conducted by healthcare professionals. Methods may include [2]:

• Direct Observation: Observing the individual performing tasks [2].
• Caregiver Reports: Information from caregivers is valuable, especially for those with cognitive issues [2].
• Self-Report: The individual reports their own abilities [2].

LTSS and ADLs: Services Triggered

ADL assessments can lead to various LTSS, including [2]:

1. Home Health Care: Personal care assistance with basic ADLs [2].
2. Assisted Living: Residential care with support for ADLs and I-ADLs [2].
3. Nursing Home Care: 24/7 skilled care for significant limitations [2].
4. Adult Day Programs: Daytime supervision and activities [2].
5. Rehabilitation Services: Therapy to improve ADL performance [2].

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Basic vs. Instrumental Activities of Daily Living

Feature	Basic Activities of Daily Living (B-ADLs)	Instrumental Activities of Daily Living (I-ADLs)
Focus	Fundamental self-care tasks essential for survival.	Complex, higher-level skills for independent living.
Examples	Bathing, dressing, eating, toileting, transferring, ambulating [1].	Cooking, shopping, managing finances, using transportation, housekeeping, managing medications [1].
Timing of Decline	Often affected later in the course of a disease or aging [2].	Typically decline earlier than B-ADLs, indicating potential issues [2].
Significance	Indicates immediate need for physical assistance with daily care [2].	Reflects ability to live independently within the community [2].
Common Assessment	Katz Index of Independence in ADL [2].	Lawton Instrumental Activities of Daily Living Scale [2].

The Broader Impact of ADL Limitations

Limitations in performing ADLs impact quality of life, autonomy, and can lead to social isolation or depression. It also affects family caregivers [2]. ADL assessments help identify support systems to enhance independence [2].

For more information on the scope of long-term services and supports, resources like the KFF offer valuable insights into the programs that use ADL assessment as a foundation for eligibility [3].

Conclusion

Activities of Daily Living (ADLs) are standardized measures used to assess functional ability and determine the need for Long-Term Services and Support (LTSS) [2, 4]. By evaluating basic and instrumental ADLs, assessors can ensure individuals receive appropriate support, helping to maintain their quality of life, independence, and safety [2].

Frequently Asked Questions

What are the six basic ADLs?

The six basic activities of daily living are bathing, dressing, eating, transferring (moving from one place to another), toileting, and continence (bladder and bowel control) [1].

How are Instrumental ADLs different from Basic ADLs?

Basic ADLs are fundamental self-care tasks essential for survival, while Instrumental ADLs are more complex tasks that enable independent living within a community, such as managing finances, cooking, and shopping [1].

What happens during an ADL assessment for LTSS?

During an ADL assessment, a healthcare professional evaluates an individual's ability to perform daily tasks through observation, self-reporting, or reports from caregivers [2]. The assessment helps determine the specific types of assistance an individual may need [2].

Can I qualify for LTSS if I only need help with I-ADLs?

Yes, many LTSS programs and long-term care insurance policies recognize the need for support with Instrumental ADLs. Difficulties with I-ADLs often signal a need for support to maintain safety and independence at home [2].

Does Medicare or Medicaid cover services related to ADL needs?

Medicare typically only covers medically necessary, short-term home health services. Medicaid, however, is a primary payer for Long-Term Services and Support (LTSS) for those who meet financial and functional eligibility criteria, which is determined by ADL assessments [3, 4].

What is the Katz Index of Independence in ADL?

The Katz Index is a widely used tool that assesses a person's ability to perform basic ADLs [2]. It provides a score that helps healthcare providers track a person's functional status and decline over time, informing care plans [2].

How do ADL limitations impact long-term care insurance claims?

Many long-term care insurance policies are triggered when a policyholder demonstrates an inability to perform a specific number of ADLs (often two or more) without substantial assistance [2]. The ADL assessment provides the objective evidence needed to start receiving benefits [2].