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Making Smart Housing Decisions: ADLs and IADLs

Using ADLs and IADLs when considering senior housing decisions
One of the most important factors when considering what type of long-term housing is appropriate for a senior is to carefully examine what are known as the ADLs and the IADLs.

ADLs, or activities of daily living, refer to the activities we do in daily living for self-care. The good news is the number of abilities seniors retain as they age seems to be increasing over time. For example, in a long-term study, referenced by Douglas E. Crews and Susan Zavotka of the departments of anthropology and consumer sciences at Ohio State University, stated the inability to complete one or more of the ADLs declined from 24.9% in 1982 to 21.3% in 1994.

"The goal of health assessment for older adults is to encourage and promote wellness and independent function." – Foundation for Health in Aging
 
ADL activities include any of the following: bathing, dressing and undressing, eating, transferring to and from furniture, toilet use/bodily function control and walking ability (not bedridden). On the other hand, IADLs, or instrumental activities of daily living, refer to activities that are not necessary for fundamental functioning, but enable the individual to live independently, such as:
     
  • Doing light housework
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  • Preparing and cleaning up from meals
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  • Taking medications
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  • Shopping for groceries or clothes
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  • Using the telephone
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  • Managing money
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  • Taking care of pets
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  • Using communication devices
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  • Getting around the community
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  • Following safety procedures and emergency responses
The Foundation for Health in Aging (FHA), a national nonprofit organization reports, "The goal of health assessment for older adults is to encourage and promote wellness and independent function. One approach that works well is for health care providers to rapidly screen several areas by asking screening questions related to various areas of health and function. Whenever a potential problem is found, it is then evaluated more completely. Answers to screening questions should be based on the older person’s day-to-day activities. Another person who is familiar with the older person being assessed (ideally a caregiver or family member) is often needed to provide (or verify) additional information about the older person’s daily functioning."

Housing considerations using ADLs and IADLs
Although there are several options in housing considerations, there are four in particular that are most prevalent, which include:

In-home care
In-home care should always be considered first. Evidence shows that seniors live healthier, happier lives when they remain in their own homes, and it’s also more economical. The elder should be able to still perform the activities on the ADL list and some of the activities in the IADL list, particularly those that are fundamental to their well-being and continued good health when living alone.

Assisted living
Assisted living offers a combination of residential housing, meals and personalized support services, but it does not provide skilled nursing care. Assisted living is designed for adults who may need help with IADLs such as housecleaning and medication reminders, and who want the security of having assistance available on a 24-hour basis in a residential environment. Meals are usually provided, and often there are transportation services and cultural programs.

Continuum of care
Continuum of care facilities combine the services of a nursing home with an assisted living center or an adult day care center. The senior can live in his or her own home for as long as possible, without having to relocate when additional care is needed. Continuum of care goes beyond the traditional retirement or nursing home approach because seniors maintain their independence and still receive the care they need.

 
Each continuum of care facility is different, but as the individual’s needs become more and more complex as he ages, a continuum of care facility can provide those services. In addition, certain continuum of care services might only be required for a limited time, such as if someone breaks a leg and requires additional help during the healing process (like with dressing). After the injury or illness has passed, the individual’s care needs can then be re-adjusted.

Nursing home
These facilities offer higher levels of care that support individual skills and interests in an environment designed to minimize confusion and agitation. Similar to assisted living communities, nursing home facilities provide assistance with dressing, grooming, bathing and other daily activities. Meals, laundry and housekeeping are usually provided within private and semiprivate rooms in a residential-type setting.

 
A great resource to consider is the Eldercare Locator. There, you can find your local Area Agency on Aging (AAA) information that can help you identify facilities that offer these types of services, as well as tips on helping you decide which housing choice is best. 


     
  • In a long-term study conducted at Ohio State University, self-reported disability declined from 24.9% in 1982 to 21.3% in 1994, suggesting that elders are becoming healthier and less disabled than their previous cohorts.
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  • Continuum of care facilities combine the services of a nursing home with an assisted living center or an adult day care center. The senior can live comfortably in his or her own home for as long as possible. 
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  • Eldercare Locator and the Area Agency on Aging (AAA) can help identify nursing home facilities locally that offer more residential-type settings.