IADLs and ADLs… What’s the Difference?

My grandmother came to visit us for a week. We always loved spending time with Grandma T., and I had looked forward to this visit since the last one, about a month earlier. The visit began with dinner, games and sweet conversation—not unlike the other times we had spent together—until it was time for bed, and she opened her suitcase. It was completely empty! She was as surprised as we were that she had forgotten to pack but remembered the suitcase.

Was an empty suitcase a threat to my grandmother’s safety? No. Did it suggest that other more serious concerns were possibly looming in her future? Yes. 

Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs)

Like the Activities of Daily Living (ADLs), the Instrumental Activities of Daily Living (IADLs) are a way of helping to identify any special challenges someone with a disability may have. Challenges with either ADLs or IADLs can occur very suddenly, and sometimes seemingly all of them at once (e.g, in the case of someone who experiences a traumatic event). Likewise, challenges with both types of activities can also occur quietly and gradually over a long period, as was the case with my grandmother, who was later diagnosed with dementia.

Although alike in the above ways, ADLs and IADLs are very different, and it’s important to know the difference, for two reasons in particular:

• Difficulty performing IADLs may be precursors to future, more critical needs related to safety in performing ADLs. Many families find that the need for help by a loved one experiencing dementia began with just one or two of the IADLs, such as making irrational decisions about money and forgetting appointments. One caregiver I knew became alarmed when a family member signed up online to receive 24 months’ deliveries of $100 face cream. Piled-up laundry, unexplained dents in the car and spoiled food in the refrigerator fall into the same category.

• ADLs are used by the State of Indiana to determine eligibility for state-funded home and community-based services (HCBS) designed to keep people safe in the community. While IADLs are important, it is the ADLs that are considered critical and thus used for assessment.

Here’s an easy way to sort them:

Activities of Daily Living

ADLs are tasks that, if done without required direct assistance or not at all, are likely to put the care recipient at risk for physical harm. These tasks require that a helper is physically present with the care recipient.

The eight ADLS are:

• Cognition—Is supervision for safety required at all times due to confusion and/or disorientation that is not related to, or a result of, mental illness?
• Medication assistance—Are all physician-ordered medications taken correctly?
• Eating—Is there a choke risk? Can the individual get food from the plate to the mouth, chew and swallow safely?
• Toileting tasks—Is help needed getting on and off the commode, or with any other aspect of toileting?
• Mobility—Has there been a fall? Can the individual safely ambulate in the home with a walker, cane or wheelchair?
• Transferring—Is help needed to move from one chair to another, or from a chair to a bed, etc.?
• Bathing—Is assistance needed when getting into or out of a shower or tub, or for performing a bed bath?  (This includes help with grooming.)
• Dressing—Is assistance needed with dressing both the upper and lower body?

Instrumental Activities of Daily Living

IADLs, on the other hand, are tasks that are important and impact quality of life but do not pose a risk for immediate physical harm. These often can be done or arranged from elsewhere (even from far away) by another person without directly engaging with the care recipient.

Examples include:

• Care/maintenance of the home— vacuuming, washing dishes, repairs, etc.
• Meal preparation—not necessarily cooking, but getting food ready to eat.
• Managing finances— writing and recording checks, paying bills on time.
• Running errands, shopping

Eligibility for Assistance with ADLs in Indiana

It’s also helpful to note that if an individual qualifies for state funding to cover the cost of assistance with ADLs, that same person who comes to help may also be able to assist with the IADLs. The bottom line, however, is that to qualify for Indiana’s Medicaid Aged and Disabled Waiver or CHOICE funding, one must first require help with some ADLs (three for the Waiver, and two for CHOICE) and must meet certain financial criteria. All of these things can be discussed to determine eligibility by calling our Aging & Disability Resource Center at (317) 803-6131—or you can submit an online request form for information and we’ll call you.

We know that most people want to live in their home for as long as they can.  CICOA is here to help!