Activities of daily living: what they are and why they matter

Activities of daily living, often called ADLs, are basic personal care tasks. The IRS lists six of them when it defines long-term care needs:

• Bathing
• Dressing
• Eating
• Toileting
• Transferring, such as getting out of bed and into a chair
• Continence

Instrumental activities of daily living, often called IADLs, are tasks that let a person live on their own. They go beyond basic personal care.

Federal sources list tasks such as:

• Managing money and paying bills
• Taking medicines as prescribed
• Shopping and preparing meals
• Housework and laundry
• Getting around, such as rides to the doctor, and using the phone

For some benefits, a licensed health care practitioner, such as a doctor or nurse, certifies how much help a person needs. Care providers and programs may also do their own review, so ask how they measure need.

It can help to ask:

• Which tasks can the person do alone, with some help, or not at all?
• Does the person need someone nearby to stay safe?
• Has the need lasted a while, or is it short term, such as after surgery?
• Can the person's doctor or a geriatric care manager help build a care plan?

For tax rules on qualified long-term care, the IRS calls a person chronically ill if a licensed practitioner certifies one of two things. One is that the person cannot do at least two of the six ADLs without real help for at least 90 days. The other is needing close supervision because of severe cognitive impairment.

Other programs use their own rules. The VA's Aid and Attendance benefit can apply when a veteran needs another person's help with tasks like bathing, eating and dressing. Medicaid eligibility for long-term care depends on each state's rules, so ask the state Medicaid office how need is measured.