What Are ADLs and IADLs? A Plain-English Guide for Families

Sooner or later, someone asks the question: how many ADLs does your mother need help with? It might come from a hospital discharge planner, a long-term care insurer, a Medicaid caseworker or a home care agency. The terms sound clinical, but the idea behind them is simple — and knowing it makes those conversations a lot less confusing.

Quick answer

ADLs — activities of daily living — are basic self-care: bathing, dressing, using the toilet, getting in and out of a bed or chair, continence, and eating. IADLs — instrumental activities of daily living — are the more complex tasks it takes to live on your own: using the phone, shopping, preparing food, housekeeping, laundry, getting around, managing medications and handling money.

The federal aging-statistics glossary puts it in one line each. ADLs are "basic activities that support survival, including eating, bathing, and toileting." IADLs "measure the ability to perform more complex tasks than the related activities of daily living" (Federal Interagency Forum on Aging-Related Statistics).

The six ADLs

The classic list comes from the Katz Index of Independence in Activities of Daily Living, published in JAMA in 1963. The index "ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence, and feeding" (Hartford Institute for Geriatric Nursing).

• Bathing
• Dressing
• Toileting — getting to the toilet, on and off it, arranging clothes and cleaning up
• Transferring — getting in and out of a bed or chair
• Continence — bladder and bowel control
• Feeding — getting food from the plate to the mouth (someone else may prepare it; cooking counts as an IADL)

Federal tax law uses the same six for tax-qualified long-term care insurance, worded as eating, toileting, transferring, bathing, dressing and continence (26 U.S.C. § 7702B).

The eight IADLs

The standard list is the Lawton-Brody scale, published in The Gerontologist in 1969. There are "8 domains of function measured with the Lawton IADL scale," and these skills are "considered more complex than the basic activities of daily living" (Hartford Institute for Geriatric Nursing):

1. Using the telephone — see choosing a phone your parent will actually use
2. Shopping
3. Preparing food
4. Housekeeping
5. Laundry
6. Getting around — driving or using transportation (see rides to medical appointments)
7. Taking responsibility for their own medications
8. Handling finances

Not every source sorts these the same way. The National Institute on Aging, for example, lists "taking medications" alongside bathing and dressing when it describes home care (National Institute on Aging). When a form or policy asks about ADLs, check which list it uses.

Why the difference matters: IADLs usually change first

Research that follows older adults over many years has found a fairly consistent order. A French study that tracked a group of older adults from 1988 to 2012 "confirmed the earliest losses in IADL (shopping, transporting, finances)," followed by a stretch when IADL and ADL difficulties overlap, "with bathing and dressing being the earliest ADL losses" (Edjolo et al., American Journal of Epidemiology, 2016).

That's an average pattern, not a rule for any one person. But it explains why the first signs that a parent could use help often aren't about personal care at all. They look like an unpaid bill, an empty refrigerator, a prescription that didn't get picked up — the things that are easy to miss from a distance. If you notice changes like that, the next step is a conversation with your parent, and often with their doctor, rather than a diagnosis of your own.

Where you'll run into these terms

Long-term care insurance

For a tax-qualified long-term care policy, federal law defines a "chronically ill individual" as someone certified by a licensed health care practitioner as "unable to perform (without substantial assistance from another individual) at least 2 activities of daily living for a period of at least 90 days due to a loss of functional capacity," as having a similar level of disability under federal regulations, or as needing "substantial supervision to protect such individual from threats to health and safety due to severe cognitive impairment" (26 U.S.C. § 7702B). The policy itself spells out how that works in practice, so read your parent's policy or ask the insurer.

Medicare

"Most nursing home care is custodial care, which helps people with activities of daily living (like bathing, dressing, and eating). Original Medicare doesn't cover custodial care if it's the only care you need" (Medicare.gov). Home health works the same way: Medicare doesn't pay for personal care with daily activities when that's the only care someone needs (Medicare.gov).

Medicaid

Medicaid long-term services come with two tests: financial eligibility, and "state-defined functional eligibility criteria, which are based on physical and cognitive abilities." States set their own bar. A high threshold "might be requiring an individual to be dependent in four or more activities of daily living (ADLs), while a lower threshold might require dependency in only two ADLs" (MACPAC).

VA pension: Aid and Attendance

For people who get a VA pension, one way to qualify for the added Aid and Attendance benefit is this: "You need another person to help you perform daily activities, like bathing, feeding, and dressing" (U.S. Department of Veterans Affairs).

How common is needing help?

At any given moment, most older adults living in the community don't need another person's help with these tasks. A CDC analysis of national survey data — which covers people living in the community, not in nursing homes — found that in 2015, 6.9% of adults 65 and older needed another person's help with ADLs, and 11.7% with IADLs (CDC, MMWR, 2016). Among adults 75 and older living in the community in 2014, the figures were 10.6% and 18.8% (CDC, MMWR, 2016).

Over a lifetime, the odds look different. A projection prepared for the U.S. Department of Health and Human Services, covering people turning 65 between 2020 and 2024, found that "a majority (56 percent) can anticipate having at least some needs" for long-term services and supports — counted as needing help with at least two ADLs for a period expected to last at least 90 days, or supervision because of severe cognitive impairment (ASPE, U.S. Department of Health and Human Services).

Where a daily check-in fits — and where it doesn't

A daily check-in doesn't measure ADLs or IADLs, and it isn't an assessment of any kind. It tells your family one thing: your parent checked in today. For a parent who still manages everything on their own — the "basically fine, but I worry" stage — that daily signal sits comfortably alongside ordinary calls and visits, while the bigger questions above get answered by the right people.

If you're wondering how much contact is enough, how often to check on an elderly parent takes that on, and a daily check-in service vs. home care explains where one ends and the other begins. The paperwork to have in place while a parent lives alone is worth sorting out at the same time.

Where to find help

For local services, including help at home, the Eldercare Locator — a public service of the Administration for Community Living — connects older adults and families with resources in their community. Call or text 1-800-677-1116. Your local Area Agency on Aging is another good starting point; the ACL describes it as an agency "designated by a state to address the needs and concerns of all older persons at the regional and local levels" (Administration for Community Living).

Cozy Check-ins is a wellness check-in tool to help families stay connected. It is not a medical, monitoring, or emergency service and should not be relied on for emergencies. In an emergency, call 911.

This article is general educational information, not medical, legal, financial, or insurance advice. Coverage rules vary by state, program, and policy. For advice about a specific situation, talk with a qualified professional.