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ADLs: What Are They and Why Are They So Important?

By Maria Basso Lipani, LCSW
© 2008-2011

Summary: One of the best ways to determine how much assistance (if any) a person might require on a daily basis is to assess his or her Activities of Daily Living or ADL.  ADL include: bathing, dressing, grooming and toileting.  The greater the difficulty the person has in performing one or all ADLs the greater the need for daily assistance.  An assessment of ADLs is common upon discharge from a hospital to determine the appropriate level of aftercare.

Dear Maria: My mother is currently in the hospital. When I met with the social worker about her discharge she asked me how my mother does with her “ADLs”.  I didn’t know what the heck she was talking about and she was called away just at that time.  I haven’t seen her again and was just curious – what do “ADLs” mean and what bearing do they have on my mother’s discharge?  Mary Ellen, Chicago, IL

Dear Mary Ellen: The term ADLs refers to Activities of Daily Living.  There are four major ADL categories: bathing; dressing; grooming; and toileting.  The social worker asked about ADLs because she is trying to assess how much daily assistance your mother may require upon discharge.  Generally speaking, if a person is unable to bathe, dress, groom or toilet on his or her own, or can only do so with great difficulty, then he or she usually cannot live alone without assistance.  Simply put, ADLs are a reflection of a person’s physical functioning.  If ADL functioning is poor, and a sufficient amount of home care cannot be put in place to provide the necessary assistance with ADLs, a nursing home may be the most appropriate setting for care post discharge.

However, sometimes a person’s physical functioning is only hampered  temporarily as a result of illness or injury.  If this is the case, a doctor may determine that some short term rehabilitation would improve matters and should be considered as discharge option.  This type of rehabilitation is also known as sub-acute rehabilitation.  Many nursing homes offer sub-acute rehabilitation.

Lastly, you may also here the term “IADL” as this is also part of a standard social work assessment.  The term “IADL” stands for Instrumental Activities of Daily Living such as laundry, grocery shopping, meal preparation and housekeeping.  If a person is unable to perform IADL this too would signal the need for assistance, but not necessarily on a daily basis.