What are ADLs and IADLs? A plain guide for families

ADLs and IADLs are the two checklists professionals use to measure how much help an older adult needs to live at home. ADLs, activities of daily living, are the basic tasks of caring for your body: bathing, dressing, eating. IADLs, instrumental activities of daily living, are the tasks of running a household: cooking, shopping, paying bills, taking medicines on time.

Most families first hear the terms from a hospital discharge planner or a home care nurse, and they sound clinical. The idea behind them is simple. When the body tasks start to slip, safety is at stake. When the household tasks start to slip, independence is at stake, and that's usually the earlier warning.

The six ADLs

The standard list comes from the physician Sidney Katz, who published his index in 1963 after studying older patients recovering from hip fractures. The Katz Index is still the one most professionals use. The six activities are:

1. Bathing: washing in the tub or shower, including getting in and out safely.
2. Dressing: choosing clothes and putting them on, including buttons, zippers and shoes.
3. Toileting: getting to and from the toilet, using it and cleaning up.
4. Transferring: moving in and out of a bed or chair.
5. Continence: controlling the bladder and bowels.
6. Eating: getting food from the plate to the mouth. Cooking it is an IADL.

Help with an ADL can mean anything from a reminder or someone standing by to full hands-on help. Bathing is often the first ADL to become hard, because it combines balance, wet floors and stepping over a tub edge. A fall during a transfer, from bed to chair or on and off the toilet, is one of the clearest signs that daily hands-on help has become a safety matter.

The eight IADLs

The psychologist M. Powell Lawton and his colleague Elaine Brody published the standard IADL scale in 1969, reasoning that living independently takes more than self-care. The eight activities are:

1. Using the telephone: answering, dialing and keeping in touch.
2. Shopping: buying groceries and necessities.
3. Preparing meals: planning, cooking and serving food safely.
4. Housekeeping: keeping the home reasonably clean.
5. Laundry: washing clothes and linens.
6. Transportation: driving, or arranging rides and using transit.
7. Managing medicines: taking the right doses at the right times.
8. Handling money: paying bills and managing accounts.

IADLs lean on memory, planning and judgment, so they usually falter before ADLs do, especially in early dementia. Unopened mail, late notices, spoiled food in the refrigerator, a pill organizer that's still full on Friday, or a dent in the car no one can explain are classic first signs. When household tasks are the main gap, the help that covers them (housekeeping, laundry, meals, shopping, errands) is called homemaker services.

ADLs and IADLs side by side

The quickest way to tell them apart: is the task about caring for your body, or about running your life?

	ADLs	IADLs
Covers	Caring for the body	Running a household
Examples	Bathing, dressing, toileting, transferring, continence, eating	Cooking, cleaning, shopping, transportation, medicines, money
Standard scale	Katz Index, 6 items	Lawton scale, 8 items
Depends on	Strength, balance and mobility	Memory, planning and judgment
Usually slips	Later, and signals a safety risk	Earlier, and signals lost independence
Type of help	Personal care	Companion and homemaker care

How families use the two lists

The lists turn a vague worry ("Mom seems to be slipping") into something specific you can plan around. Go through both with your parent, out loud and honestly.

If your father still bathes and dresses himself but the bills are piling up and he's stopped cooking real meals, that's an IADL gap, and a few visits a week may be enough. If your mother is having trouble getting out of the tub or has fallen getting up from a chair, that's an ADL gap, and it usually calls for help every day. Which tasks are slipping, and how many, tells you how many hours of care to plan for and whether staying at home is realistic.

The lists matter for money too. Tax-qualified long-term care insurance policies generally start paying when a licensed health professional certifies that someone needs help with at least two of the six ADLs for at least 90 days, or has a severe cognitive impairment such as advanced dementia. If your parent has a policy, the ADL checklist is the language the insurer speaks.

Discharge planners, doctors and geriatric care managers score these lists as part of their assessments. So do we: we go through them with your family at our free assessment at home, and a registered nurse writes the care plan around the answers.

Matching the lists to home care

Non-medical home care is organized around exactly this split:

• For ADLs, personal care means hands-on help with bathing, dressing, toileting, grooming and moving safely.
• For IADLs, companion care and homemaker services cover meals, light housekeeping, laundry, errands, rides and company.
• When the gaps span both lists and add up to many hours, hourly care or live-in care scales the same help up, and respite care gives a family caregiver a planned break.

One boundary is worth knowing. Help with ADLs and IADLs is non-medical. A caregiver helps with the bath, gives medication reminders from an organizer the family or pharmacist filled, cooks and drives to appointments. Wound care, injections and therapy are skilled services that come from a nurse or a home health agency, and a good home care coordinator will tell you when a need crosses that line. Our guide to home health care and home care explains the difference.

If you're still weighing where care should happen, our guides to home care and assisted living and to what home care costs pick up where this checklist leaves off.

Go through both lists with your parent before the next doctor's visit or hospital discharge. Knowing which tasks have become hard, and which are still easy, is the most useful thing you can bring to that conversation. When you're ready to talk about help at home, call us or request care.