Activities of Daily Living (ADLs) Checklist: Basic and Instrumental ADLs Explained

Getting up, washing, dressing, eating and moving around the home: most of us do these without thinking. When illness, injury, disability or ageing makes them harder, they become central to care planning. These everyday tasks are called activities of daily living (ADLs), and they’re at the heart of occupational therapy.

Basic ADLs vs instrumental ADLs

The 6 basic ADLs (Katz Index)

1. Bathing: washing the body in a bath, shower or at the sink
2. Dressing: choosing clothes and putting them on and off, including fastenings
3. Toileting: getting to and using the toilet, cleaning oneself and adjusting clothes
4. Transferring: moving in and out of a bed or chair
5. Continence: controlling bladder and bowel
6. Feeding: getting food from the plate to the mouth

The 8 instrumental ADLs (Lawton Scale)

1. Using the telephone
2. Shopping
3. Preparing food
4. Housekeeping
5. Doing laundry
6. Using transport
7. Managing medication
8. Handling finances

Many modern frameworks, including AOTA’s Practice Framework, also include health management, rest and sleep, childcare, pet care, community mobility and religious or spiritual activities.

Levels of independence

When OTs assess ADLs, they record how much help the person needs.

How occupational therapists assess ADLs

ADLs in Medicare assessments (Section GG)

In the United States, Medicare-certified post-acute care settings record self-care with a standard set of items called Section GG. It appears in the assessment tools used by skilled nursing facilities (MDS), inpatient rehabilitation facilities (IRF-PAI), long-term care hospitals (LTCH CARE) and home health agencies (OASIS). OTs and other clinicians usually score it at admission and again at discharge, which shows how much a person has improved.

The Section GG self-care items are eating, oral hygiene, toileting hygiene, showering or bathing, upper body dressing, lower body dressing, and putting on and taking off footwear. Not every item appears on every tool; the long-term care hospital tool, for example, uses only eating, oral hygiene and toileting hygiene.

Separate codes are used when an activity was not attempted, for example because of a medical condition or safety concern.

ADLs and long-term care insurance

ADLs are not just a clinical idea: in the US they decide when tax-qualified long-term care insurance starts paying. Under federal law (26 U.S.C. § 7702B), a person counts as “chronically ill” when a licensed health care practitioner certifies, within the previous 12 months, that they either:

• cannot perform at least 2 of 6 ADLs without substantial help from another person for at least 90 days because of a loss of functional capacity, or
• need substantial supervision to protect their health and safety because of severe cognitive impairment, such as advanced dementia.

The six ADLs named in the law are eating, toileting, transferring, bathing, dressing and continence, and a qualified policy must look at at least five of them. The exact wording of benefit triggers, waiting periods and daily limits differs between policies, so always read your own policy.

An OT’s ADL assessment is often part of the evidence a family, doctor or care manager uses when planning care at home, choosing assisted living, or making a long-term care insurance claim.

How OT helps when ADLs become hard

• Practising tasks in new ways, such as one-handed dressing after a stroke
• Equipment: shower chairs, grab bars, raised toilet seats, reachers, sock aids, adapted cutlery
• Home modifications: rails, ramps, better lighting, rearranging the kitchen
• Memory and planning supports: checklists, pill organisers, reminders. See OT for dementia.
• Energy conservation for people with heart, lung or chronic conditions
• Carer training in safe, supportive ways to help

ADLs in children

Children’s daily living skills develop with age: feeding, dressing, toileting and hygiene. Pediatric OTs help children with developmental delays, autism or physical disabilities build these skills. See pediatric OT goals and OT goals for autism.

Summary

Activities of daily living are the everyday tasks that keep us independent. Basic ADLs cover self-care; instrumental ADLs cover running a home and life in the community. Occupational therapists assess both, then use practice, equipment, home changes and support to help people stay as independent as possible.

References

• Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–919.
• Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3):179–186.
• Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Maryland State Medical Journal. 1965;14:61–65.
• American Occupational Therapy Association. Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. 2020.
• Cornell Law School Legal Information Institute. 26 U.S. Code § 7702B: Treatment of qualified long-term care insurance. law.cornell.edu
• Shirley Ryan AbilityLab Rehabilitation Measures Database. Section GG: Functional Abilities, Self-Care and Mobility. sralab.org
• American Occupational Therapy Association. Section GG Medicare functional assessment (GG0130 and GG0170). aota.org
• Medicare.gov. Long-term care. medicare.gov

Written by

Deepam Pawar, OT

Deepam Pawar is an occupational therapist and co-founder of Occupational Therapy OT. He focuses on clinical frameworks, assessment, and evidence-based practice.

All articles by Deepam →

This article is for general education and is not a substitute for individualized assessment or treatment by a licensed occupational therapist. Always seek the guidance of a qualified professional for specific concerns.