Activities of daily living

Activities of daily living, almost always shortened to ADLs, are the six basic self-care tasks that long-term care uses as its common measuring stick. They are:

• Bathing. Washing the body, getting in and out of a tub or shower.
• Dressing. Choosing clothes and putting them on, including fasteners.
• Toileting. Getting to and from the toilet and managing clothing and hygiene.
• Transferring. Moving between bed, chair, and standing.
• Continence. Controlling bladder and bowel.
• Eating. Getting food from plate to mouth.

The list matters far beyond a checklist, because the number of ADLs a person needs help with drives three separate decisions: whether they qualify for a care setting, how much that setting charges, and whether an insurer or Medicaid will pay.

Why the count decides your bill

Most care homes price on care level, and care level is set by an assessment that counts ADLs and rates how much help each one takes. A resident who needs standby supervision in the shower and nothing else lands at the bottom. A resident who needs two people to transfer and full help with toileting lands near the top, and the difference between those two rates can be a thousand dollars a month or more in the same building.

This is why a home’s advertised starting rate is close to meaningless on its own. Ask for the assessment tool, ask which level your parent would come in at, and ask what specifically would move them up a level.

Reassessment is where surprises come from

Homes reassess periodically and after any significant change. A fall, a hospital stay, or a new incontinence issue can move a resident up a care level mid-year, and the new rate takes effect regardless of where you are in the annual budget.

Ask what notice the contract requires before a level change takes effect, and ask for the last three years of rate history at that specific home.

IADLs are a different list

Instrumental activities of daily living cover the tasks of running a life rather than a body: cooking, managing money, taking medication correctly, using the phone, shopping, housekeeping, and transportation.

IADLs usually fail first. A parent who is still bathing and dressing independently but has stopped paying bills or is doubling up on pills is showing IADL loss, and that is often the earliest honest signal that living alone is no longer working.

Insurance and Medicaid eligibility, though, generally key off ADLs. Many long-term care policies require documented help with two of the six before benefits start. Read the policy definition, because the wording varies.