The first time I heard the phrase “Activities of Daily Living,” my mind went to an idyllic lazy summer: waking up late, eating cold pizza, and avoiding as much work as possible. But “ADLs” are really helpful guideposts for caregiving needs and the basis for “concrete” caregiving tasks.
Kudos to Dr. Sidney Katz, a pioneer in rehab medicine and geriatrics. His group developed a list and scale of functions that one needs to live independently; these days there are many sophisticated checklists used by Occupational Therapists, Physical Therapists and Social Workers. They help assess a person’s needs in detail, and can help a caregiver plan.
On the other hand, the insurance industry has created a simplified version that is very practical, lumping ADLs into six categories:
“Activities of daily living (ADLs) are activities related to personal care. They include bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating.”
“Instrumental activities of daily living (IADLs) means activities related to living independently in the community, including but not limited to, meal planning and preparation, managing finances, shopping for food, clothing, and other essential items, performing essential household chores, communicating by phone or other media, and traveling around and participating in the community.” [definitions from Investopedia and Wikipedia]
And don’t quote me on this, but my understanding is that Medicare calls ADL personal needs “custodial care,”, not medical care, so generally Medicare doesn’t cover their cost. And don’t ask me about tax issues, either! Anyway we caregiving old guys have a reason to exist.
EVERYONE is an INDIVIDUAL, but these lists and scales help set up a practical framework of needs and helps planning for caregiving. Since Alzheimer’s seems to follow a progressive (or regressive?) pattern, the most useful to me are the detailed versions of the Reisberg Functional Assessment Staging Tool (FAST, see below).
[If you’re reading this and your situation does not include Alzheimer’s, there is probably a specific functional ADL scale out there; I’ve seen them for other neurological conditions like ALS, FTD, Multiple Sclerosis, stroke, and several for dementia.]
Stage 1: No difficulty, either subjectively or objectively [uh..NORMAL ?!? as in “oh, this is just a temporary Stage 1 phase the caregiving old guy is going through”]
Stage 2: Complains of forgetting location of objects; subjective work difficulties [uh…NORMAL CURMUDGEON STUFF ??!? as in ” I bet that caregiving old guy so and so is forgetting to do his “quality” makework on purpose!!”]
Stage 3: Decrease job functioning evident to coworkers; difficulty in traveling to new locations
Stage 4: Decreased ability to perform complex tasks (e.g., planning dinner for guests, handling finances)
Stage 5: Requires assistance in choosing proper clothing
Stage 6: Decreased ability to dress, bathe and toilet independently
Sub Stage 6a: Difficulty putting clothing on properly
Sub Stage 6b: Unable to bathe properly; may develop fear of bathing
Sub Stage 6c: Inability to handle mechanics of toileting (i.e., forgets to flush, does not wipe properly)
Sub Stage 6d: Urinary incontinence
Sub Stage 6e: Fecal incontinence
Stage 7: Loss of speech, locomotion and consciousness [substages omitted here, but click for details].