What Are ADLs? The 6 Activities Care Assessments Measure

ADLs, or activities of daily living, are six basic self-care tasks: bathing, dressing, toileting, transferring, continence, and eating. Needing significant hands-on help with two or more of them is the threshold Medicaid, Medicare-certified assessments, and most long-term care insurance policies use to judge whether someone needs a higher level of care.

The 6 core ADLs

1. Bathing. Washing in a tub or shower, or by sponge bath, including getting in and out safely.
2. Dressing. Putting on and taking off clothing, including any braces or prosthetic limbs.
3. Toileting. Getting to and from the toilet, getting on and off it, and cleaning up afterward.
4. Transferring. Moving in and out of a bed or chair.
5. Continence. Controlling bladder and bowel function, or managing incontinence with tools like a catheter or ostomy.
6. Eating. Feeding oneself from a plate or tray that's already been prepared. Cooking is a different skill, covered below.

Why is "2 or more" the line?

Needing hands-on help with a single ADL is common as people age, and on its own doesn't usually signal a need for nursing-level care. Needing real physical assistance with two or more is the point most assessments, including the ones state Medicaid programs use for nursing home care, treat as a meaningful decline in independence.

ADLs vs. IADLs

ADLs are basic self-care tasks. A separate list, instrumental activities of daily living (IADLs), covers things like managing money, cooking, or driving. Trouble with IADLs often shows up first, but it doesn't carry the same weight in a Medicaid level-of-care decision that ADL struggles do.

How this shows up in an assessment

When a nursing facility submits the comprehensive resident assessment used in a state's Medicaid nursing home review, that's where ADL needs get documented, alongside the physician exam and social services evaluation.

Once you know what level of help your loved one needs, the next step is finding the right facility.