What’s an ADL Assessment?

As you age at home, it’s important to continue living the life you want to live. You deserve to feel like you — even if you’re receiving care.

One way to determine the amount of person-centered care that’s right for you is through a functional and cognitive assessment.  

Don’t let the formal-sounding name scare you: the assessment is a hands-off series of questions administered by a clinician at your home or virtually (whatever you prefer) that looks at how you’re performing your ADLs and IADLs (more on those in a second) and determines what is needed for assistance. 

Below, we’ll walk through the process in a bit more detail so you understand what an assessment may entail.

ADLs (again, short for activities of daily living) are the basic functions we all need to perform to take care of ourselves. As we age, these activities can become more difficult. This can happen for several reasons: an injury, a lingering illness, or chronic conditions.

Whatever the case, if you’re struggling to perform an ADL independently, it’s usually a sign that you may need some help.

The seven primary ADLs:

Showering and bathing: The ability to shower or bathe yourself — safely, without falling.

Dressing: The ability to dress yourself — safely, without falling.

Eating: The ability to feed yourself.

Toileting: The ability to get to the toilet, use the toilet, and perform necessary hygiene. 

Continence: The ability to control your bowel and bladder functions and, if unable, the ability to perform necessary hygiene. 

Mobility: The ability to move about both inside and outside your residence. 

Transferring: The ability to move into or out of a bed, chair, or wheelchair. 

(Curious to learn more? Get the details on ADLs.)  

IADLs (instrumental activities of daily living) are softer-skilled, but equally important functions. They include: 

Driving a Car: The ability to drive a car independently and safely. 

Using Public Transportation: The ability to use public transportation — buses, trains, etc. — independently. 

Shopping for Groceries: The ability to shop for groceries independently. 

Shopping for Small Items: The ability to shop for small items independently.

Preparing Meals: The ability to prepare meals at home independently. 

Heating Food in a Microwave: The ability to safely heat food in a microwave. 

Heating Food on a Stove: The ability to safely heat food on a stovetop. 

Organizing and Scheduling Appointments: The ability to organize and schedule appointments independently. 

Handling Financial Affairs: The ability to handle your long-term financial affairs — wills, insurance — independently. 

Managing Your Day-to-Day Money Matters: The ability to handle smaller, day-to-day money matters independently. 

Participating in Social Activities: The ability to participate in social activities independently. 

Housekeeping: The ability to maintain a clean, clutter-free household. 

Doing Laundry: The ability to keep up with laundry. 

Using a Telephone: The ability to use a telephone. 

Dial 911 in an Emergency: The ability to dial 911 if an emergency arises. 

Use a Medical Alert Button: The ability to use a Medical Alert Button if an emergency arises. 

(Learn more about the IADLs here).

A good rule of thumb is to take a look at the above list of ADLs and IADLs and ask yourself: am I struggling to perform any of these?

If the answer is “yes,” it might be time to request an assessment.

One thing to note: it’s okay, and totally normal, to request an assessment if you’re already receiving some type of care. Say, you already have a caregiver that is scheduled to assist three mornings a week with bathing and dressing, but you now find that you need more care more often. An assessment is only meant to determine what the appropriate level of care is that you need — regardless of whether you are already receiving some care, substantial care, or no care at all.

There are two ways to set up an assessment:

• If you have long-term care insurance, you’ll just need to contact your insurance company and complete a request explaining why you need an assessment.  

• If you don't have long-term care insurance, you'll need to find a company yourself that offers assessments.

The assessment will start with the clinician — usually a nurse, but it could be an occupational therapist, licensed social worker, or other clinical professional — gathering some basic medical information. They’ll ask what type of care you’re currently receiving, what types of medications you’re taking — things like that.

From there, the clinician will walk through each of the ADLs and IADLs and ask you to talk about how you perform them, as well as what difficulties you may be experiencing.

After that, there’s a “demo” portion where the clinician will ask you to run through a series of activities meant to assess your abilities. This usually entails basic movements like standing, taking off and putting on shoes, and getting in and out of a chair.

Finally, there’s a cognitive section containing three parts:

• First, you’ll answer questions to assess orientation, recall, registration, and attention. 

• Next, you or your caregiver will be asked some simple questions about the history of your moods.

• Lastly, your caregiver or primary contact will be asked a few questions about your cognitive history.

You can expect the assessment to take about 90 minutes, either in-person or virtually.

After the assessment is complete, a clinician will review it and write a plan detailing the amount of care that’s recommended. Depending on your situation, this could be anything from “I’d recommend a walker” to “I’d recommend their caregiver provides more care.”

If you have long-term care insurance, the assessment is then sent to your insurance company, who will make the final call about what comes next — and, just as importantly, how much they’ll cover.

Overall, the assessment is just about observation. There’s no passing or failing; it’s just an opportunity for the clinician to learn more about you, watch you in your home environment, and determine if there’s anything else that could help you continue to live the life you want to live at home — in the easiest, least stressful way. Because that’s something we all deserve.