Activities of daily living

What it means

Activities of daily living, usually abbreviated ADLs, are the standard shorthand for what somebody can still do without help. The list is short and physical.

A separate list, instrumental activities of daily living, covers the harder-to-see things: managing money, taking medication, cooking, using the telephone, arranging transport. Difficulty here usually appears first.

Care levels and eligibility are frequently expressed as a number of ADLs a person needs help with.

Why it matters

It is the vocabulary that decides things. Long-term care insurance benefits, Medicaid eligibility for care, and the level of care a facility will accept are all usually written in terms of ADLs.

It is also a useful way to describe a parent to somebody who has never met them, without arguing about whether they are "managing".

When you are likely to meet it

• When an assessment is arranged for a parent.
• When a long-term care policy is being claimed on.
• When comparing what different care settings provide.

How this varies by state

The list is standard, but the number a person must fail to qualify — for a long-term care policy, or for a state program — is set by the policy or by the state.

Related terms

• Adult day servicesA daytime program providing supervision, activity and often health care outside the home.
• Assisted livingHousing with help for daily tasks and staff on site, but without the licensed clinical care a nursing facility provides.
• Benefit triggerThe condition a long-term care insurance policy requires before it starts paying — usually needing help with a stated number of daily activities, or having cognitive impairment.
• Custodial careHelp with everyday living rather than medical treatment — bathing, dressing, eating, moving about. It is what most long-term care actually is.
• Discharge plannerThe hospital staff member responsible for what happens after a stay ends.
• Elimination periodA waiting period after a long-term care claim is approved, during which the family pays and the policy does not.
• Home and community-based services waiverA Medicaid program paying for care at home instead of in a nursing facility.
• Home careNon-medical help at home — bathing, dressing, meals, housekeeping, company. Medicare does not pay for it.
• Home healthSkilled clinical care delivered at home, ordered by a doctor. Medicare may pay for it while the clinical need lasts.
• Independent livingAge-restricted housing with services and no personal care — the step before assisted living.
• Instrumental activities of daily livingThe harder-to-see tasks — money, medication, cooking, transport, the telephone. Difficulty here usually appears long before difficulty with bathing or dressing.
• Long-term care insuranceA policy that pays toward help with daily living — at home, in assisted living, or in a nursing facility — which health insurance and Medicare do not cover.
• MedicaidA joint federal and state program that pays for health care, including long-term care, for people with limited income and assets.
• Memory careResidential care designed for dementia — secured, higher-staffed, and more expensive than ordinary assisted living.
• Skilled nursing facilityA facility providing nursing and rehabilitation care that has to be delivered by licensed clinical staff — not the same thing as a nursing home in the everyday sense.
• Spend-downUsing up income or assets on care until they fall below the limit at which Medicaid will start paying.

Sahvelo guidance that uses this

• Housing transitions
• Long-term care insurance