Activities of daily living (ADLs) are the six basic self-care tasks used to measure how much help someone needs: bathing, dressing, toileting, transferring, continence and feeding. Instrumental activities of daily living (IADLs) are the more complex tasks of running a life, like cooking, shopping, medications and money. Assisted living assessments, care-level prices and benefit rules are mostly built on these terms.
Key facts
- On the Katz Index, which scores six basic self-care tasks as independent or not, a score of 6 means full function, 4 means moderate impairment and 2 or less means severe impairment. (Hartford Institute for Geriatric Nursing, n.d.)
- The Lawton scale rates eight instrumental activities of daily living, from using the telephone to handling finances, and gives a summary score from 0 (dependent) to 8 (independent). (Hartford Institute for Geriatric Nursing, n.d.)
- In 2022, 75% of residents in assisted living and similar care communities needed help with bathing, and 62% needed help with three or more ADLs. (CDC/NCHS, 2024)
- Medicare calls help with ADLs custodial or personal care and doesn't pay for it when that is the only care needed. (Medicare.gov, 2026)
- In California, the care assessment before move-in, which the state calls a pre-admission appraisal, must record what the future resident can do, their mental state and social factors. (California Code of Regulations, n.d.)
The first time a nurse or a community director asks “how many ADLs does your mom need help with?” it can feel like a quiz you didn't study for. It's worth learning the vocabulary, because it shapes where your parent can live, what care they get and what it costs.
This post explains each ADL and IADL, why they matter for an assisted living move, how professionals measure them, and how you can observe them at home without turning a visit into a test.
What are the activities of daily living?
A widely used list comes from the Katz Index of Independence in Activities of Daily Living. The Hartford Institute for Geriatric Nursing says it is used widely to spot what older adults can and can't do, in clinics and at home. It covers six basic tasks, listed below with the signs that a parent may be struggling with each.
| ADL | What it covers | Signs your parent may need help |
|---|---|---|
| Bathing | Washing in a tub, shower or sponge bath | Skipped showers, body odor, fear of the tub |
| Dressing | Getting clothes out and putting them on, including fasteners | Same outfit for days, clothes on inside out, slip-ons only |
| Toileting | Getting to the toilet, using it, cleaning up, arranging clothes | Urine smell, avoiding outings, stained furniture |
| Transferring | Moving in and out of bed or a chair | Sleeping in a recliner, pushing hard on armrests, “stuck” in a chair |
| Continence | Control of bladder and bowel | Hidden laundry, pads bought in secret, accidents |
| Feeding | Getting food from plate to mouth | Weight loss despite food in the house, spills, untouched meals |
Other sources list similar tasks with small differences. The National Institute on Aging's list, for example, includes grooming and moving around. The idea behind every version is the same basic care of the body that people do each day without thinking about it, until it gets hard.
What are instrumental activities of daily living?
IADLs are the skills needed to live on your own. The Lawton Instrumental Activities of Daily Living Scale measures eight: using the telephone, shopping, preparing food, housekeeping, doing laundry, getting around (transportation), taking medications, and handling finances. The Hartford Institute describes these as more complex than basic ADLs.
Because IADLs are more complex, trouble with them can show up first. A parent may bathe and dress fine but miss bills, eat the same frozen meal every night, or stop driving to the pharmacy. Those gaps can sometimes be filled with services at home, such as grocery delivery, bill-pay help or rides. When basic ADLs start to slip too, the question of where your parent lives gets sharper. Our post on the signs a parent may need assisted living shows how the two fit together.
Why ADLs matter for an assisted living move
ADLs come up at almost every step:
- Admission. Communities assess function before move-in. In California, for example, the care assessment before move-in (the state calls it a pre-admission appraisal) must record what the future resident can do, their mental state and social factors. See the assisted living assessment for how it works.
- Price. The National Institute on Aging says assisted living usually offers a few levels of care. Residents pay more when they need extra services. How much help your parent needs with ADLs is a big part of that picture. See assisted living levels of care.
- Coverage. Medicare calls help with ADLs “custodial” or “personal” care and doesn't pay for it when that's the only care needed. Long-term care insurance policies and Medicaid programs set their own definitions. If your parent has a policy, see using long-term care insurance for assisted living and ask the insurer which ADLs count.
Some context comes from the CDC's National Center for Health Statistics. In 2022, 75% of residents in assisted living and similar care communities needed help with bathing, 60% with dressing, 57% with transferring and 51% with toileting. And 62% needed help with three or more ADLs.
How professionals measure ADLs
Clinicians use structured tools. In the Katz Index, each of the six functions is scored yes or no for independence. According to the Hartford Institute, a score of 6 means full function, 4 means moderate impairment, and 2 or less means severe impairment. Care teams often use it as a shared language when they plan care or a hospital discharge.
The Lawton IADL scale gives a summary score from 0 (dependent) to 8 (independent) and takes about 10 to 15 minutes. The Hartford Institute notes a limit that matters for families. The scale relies on what the person or a family member reports, and that can make the person seem more or less able than they are.
That limit is why what you see counts. A parent who says “I shower every day” may believe it. What you see over two weeks is better evidence than one answer to one question. These scores are for clinicians to read. Don't use them to diagnose or to argue with your parent.
How to observe ADLs at home, respectfully
A notebook and some patience will do. For two weeks, note each ADL and IADL on a simple four-step scale:
- Does it alone. Manages without help or reminders.
- Needs reminders. Does it once prompted (“Did you take your morning pills?”).
- Needs hands-on help. Someone has to physically help, such as steadying them in the shower.
- Can't do it. Someone else does it entirely.
Tips that make the log more accurate:
- Watch mornings and evenings. Many ADLs happen then, and fatigue shows late in the day.
- Look for workarounds. Sleeping in a recliner may mean getting out of bed is hard. Only wearing pull-on pants may mean buttons are.
- Ask the people who see your parent most, with permission: a neighbor, a housekeeper, a friend from church.
- Write down what you saw, not what you concluded. “Needed help standing from the couch twice” beats “can't get up.”
If you want to raise it gently, try: “Mom, I noticed the shower seems harder lately. Is it the step into the tub, or something else? I'd like to figure out what would make it easier, whether that's a grab bar or some help a few mornings a week.”
Your notes feed straight into the move plan
If the log shows a move is coming, Parent Move Plan turns it into 79 tasks on real dates counted back from move-in day, including the assessment and doctor steps. It comes with 41 tour questions, so you can ask each community exactly how it would help with the ADLs on your list.
Get your first 3 days freeWhat to do with what you find
Bring your two-week log to three places:
- Your parent's doctor. Ask whether anything on the list could be treated or improved, and what level of care the doctor thinks is safe. Our questions for the doctor before assisted living help structure the visit.
- The family. A concrete list ends a lot of arguments about whether “Mom is fine.” Share the log itself and let people reach their own view.
- The assisted living assessment. Communities price care by what they find. An honest list helps avoid a care level that is too low at move-in and a surprise increase later.
The moving a parent to assisted living checklist shows where each of these steps fits in the full process.
Frequently asked questions
What are the 6 activities of daily living?
The six basic activities of daily living measured by the widely used Katz Index are bathing, dressing, toileting, transferring (for example, moving from bed to chair), continence and feeding. A person is scored as independent or not in each one.
What is the difference between ADLs and IADLs?
ADLs are basic self-care tasks like bathing and dressing. Instrumental activities of daily living (IADLs) are the more complex skills needed to live independently, such as using the phone, shopping, cooking, housework, laundry, transportation, managing medications and handling money. Because IADLs are more complex, trouble with them can show up before trouble with basic self-care.
How many ADLs do you need help with to qualify for assisted living?
There is no single national number. Each assisted living community assesses your parent against its own admission criteria and the rules for its license in that state. Long-term care insurance policies and Medicaid programs each set their own definitions, so ask the insurer or your state Medicaid office directly.
Does Medicare pay for help with activities of daily living?
Not when that is the only care needed. Medicare calls this custodial or personal care and doesn't cover it at home or in assisted living. It can cover some home health aide help with bathing or dressing, but only alongside skilled care such as nursing or therapy for an eligible, homebound person.
Is bathing an ADL or an IADL?
Bathing is an ADL. It is one of the six basic self-care tasks on the Katz Index, along with dressing, toileting, transferring, continence and feeding. IADLs are the more complex skills needed to live on your own, such as using the telephone, shopping, preparing food, housekeeping, doing laundry, getting around, taking medications and handling finances. Bathing is not on that list.
What do ADLs mean?
ADLs stands for activities of daily living. They are the six basic self-care tasks used to measure how much help someone needs: bathing, dressing, toileting, transferring, continence and feeding. Assisted living assessments, care-level prices and benefit rules are mostly built on these terms.
Sources
- Hartford Institute for Geriatric Nursing: Katz Index of Independence in Activities of Daily Living (ADL) (accessed Sept 2026)
- Hartford Institute for Geriatric Nursing: The Lawton Instrumental Activities of Daily Living (IADL) Scale (accessed Sept 2026)
- CDC/NCHS: Residential Care Community Resident Characteristics, United States, 2022 (accessed Sept 2026)
- Medicare.gov: Home health services (accessed Sept 2026)
- Medicare.gov: Long-term care (accessed Sept 2026)
- National Institute on Aging: Aging in Place, Growing Older at Home (accessed Sept 2026)
- National Institute on Aging: Long-Term Care Facilities, Assisted Living, Nursing Homes, and Other Residential Care (accessed Sept 2026)
- California Code of Regulations, Title 22, Section 87457: Pre-Admission Appraisal (accessed Sept 2026)