ADLs, IADLs: Understanding Long-Term Services and Supports
To ensure that every person receives the care they need, doctors and governing bodies have created standardized scales and surveys to assess patient health. These measurements can tell healthcare professionals more about your risk of certain diseases and whether you should try certain treatments. They can also reveal which resources may help you. The Katz Index of Independence in Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living (IADL) Scale surveys are 2 of these standardized measurements.1
Both ADLs and IADLs are assessed using questionnaires to measure your health. Your provider may walk through the questions with you during a visit. The information they glean from the survey helps them to understand how you live. They can use it to determine which long-term services and supports (LTSS), specifically for Alzheimer's, may help you.2
What is long-term services and supports?
LTSS is a collection of services funded by the US government for those who are "dually eligible." This means people who can enroll in both Medicare and Medicaid. These services are for those who have functional limitations of some kind. These limitations may be physical or cognitive. Services can include home nursing, adult day care, and assisted living. They can also include respite care for families.2
What are ADLs?
ADLs are fundamental, day-to-day tasks that are necessary to take care of yourself. They are assessed using the Katz Index. It asks about 6 actions:2
- Ambulating: How well can you walk around your home and move from place to place?
- Feeding: Do you need help feeding yourself?
- Dressing: Can you dress yourself? Can you choose appropriate clothing?
- Personal hygiene: Do you need help with bathing or keeping up with your dental health?
- Continence: Do you have any issues that interfere with bladder or bowel control?
- Toileting: Do you need help getting to or using the toilet?
If you struggle with these activities, you may benefit from long-term services and supports. Aging is a natural process that affects both the body and the mind. Healthcare workers do not use the Katz Index out of judgment or to shame anyone. Their goal is to make sure that you are cared for and safe.2
What are IADLs?
IADLs are more complex than ADLs. They are all activities that allow someone to live on their own. They are not necessary for day-to-day living. However, they may improve the quality of life.3 They are assessed using the Lawton IADL Scale. This scale looks at:1
- Transportation and shopping: Are you able to drive? If not, can you organize a way to get around for groceries, appointments, and events?
- Managing finances: Are you able to pay your bills and manage your banking?
- Shopping and meal preparation: Are you able to grocery shop and cook? Are you able to shop for clothing and other necessities?
- Housecleaning and home maintenance: Can you keep your home reasonably clean and tidy?
- Managing communication with others: Can you call and mail others?
- Managing medications: Can you pick up and take your prescriptions as directed?
These tasks require higher-level thinking. There is also a spectrum of how much help you may need. Because of this, your ability to complete each activity is scaled from 0 to 8. ADLs are scored 0 or 1. IADLs also help determine the support you may need from loved ones or from LTSS.1
Long-term services and supports for Alzheimer's
The goal of ADL and IADL assessments is to better understand your needs. This ensures that you can stay safe in your home. They also ensure that if you are dually eligible and need more assistance, you will have access to LTSS. Quality of life is a top priority for both patients and healthcare workers. LTSS programs help those who are dually eligible access resources.1
If you have any questions or concerns about accessing LTSS programs, reach out to your provider or local Agency on Aging. If you are caring for a loved one, both the ADL and IADL assessments are easily accessible online.
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