What Are Activities of Daily Living (ADLs)?

Why ADLs Matter

ADLs aren't just a medical checklist. They're the yardstick that insurance companies, Medicaid programs, and the U.S. Department of Veterans Affairs (VA) use to decide who qualifies for care benefits.

  • Medicaid uses an ADL-based Nursing Facility Level of Care (NFLOC) assessment to decide who qualifies for nursing home coverage and Home and Community-Based Services (HCBS) waivers. There is no single federal NFLOC definition, so each state sets its own assessment tool and threshold, some meeting NFLOC with help on as few as two ADLs.
  • VA Aid and Attendance requires a veteran to need help with ADLs (or be housebound, bedridden, or in a nursing home) to qualify. In 2026, the Maximum Annual Pension Rate with Aid and Attendance for a veteran with no dependents is $29,093 a year, an income ceiling rather than the amount paid.,
  • Long-term care insurance. The federal Administration for Community Living (ACL), part of the U.S. Department of Health and Human Services, states that most policies pay benefits when you need help with two or more of the six ADLs, or when you have a cognitive impairment (ACL gives Alzheimer's disease as an example of one). Note the denominator: it is two out of that six-task list, not two of any care task. Your own policy's contract language sets your trigger, so read it.

In practical terms: the number of ADLs your loved one struggles with determines what kind of care they qualify for and who pays for it.

The 6 Activities of Daily Living

Federal long-term care guidance most commonly lists these six ADLs:

ADL What It Means
Bathing Washing the body, including getting in and out of the shower or tub
Dressing Putting on and taking off clothing, including fasteners
Toileting Getting to and from the toilet, managing clothing, cleaning oneself
Transferring Moving between surfaces: bed to chair, chair to standing
Continence Controlling bladder and bowel function, managing incontinence supplies
Eating Feeding oneself (not meal preparation)

ADLs vs IADLs

There's a related set of tasks called Instrumental Activities of Daily Living (IADLs). These are more complex activities that a person needs to live independently:

  • Managing finances (paying bills, handling a bank account)
  • Managing medications (taking the right pills at the right time)
  • Food preparation (cooking meals)
  • Housekeeping (cleaning, tidying)
  • Laundry
  • Transportation (driving or arranging rides)
  • Using the telephone or other communication
  • Shopping (groceries, household needs)

IADL limitations often show up before ADL limitations. If your parent is forgetting to pay bills, can't manage their medications safely, or has stopped cooking meals, those are early warning signs that more support is needed, even if they can still bathe and dress independently.

How ADLs Are Measured

Assessments typically rate each ADL on a scale:

  • Independent: Can perform the task without any help
  • Needs supervision: Can do it but needs someone watching for safety
  • Needs assistance: Requires hands-on help from another person
  • Dependent: Can't perform the task at all without someone doing it for them

For long-term care insurance, ACL states that most policies pay benefits once you need help with two or more of the six ADLs, or once you have a cognitive impairment, and it is the "needs assistance" and "dependent" ratings that generally count toward that two. Medicaid is not held to that same two-of-six bar: there is no single federal threshold, so each state sets its own assessment tool and cutoff.

Not sure if your parent's care needs qualify them for benefits? Chat with Brevy's care navigator for a quick assessment.

Common Misconceptions

"My parent can still do some things, so they won't qualify." Qualifying doesn't mean your parent can't do anything. Needing help with just two of the six ADLs (say, bathing and transferring) is enough for the benefit trigger in most long-term care insurance policies, according to ACL. Medicaid sets its own bar state by state, and some states meet nursing facility level of care on as few as two ADLs.

"ADLs only matter for nursing homes." ADL assessments also determine eligibility for home care, assisted living, VA benefits, and adult day programs. They're used across the entire spectrum of senior care.

Your next step To get a loved one's ADLs formally assessed, contact your Area Agency on Aging through the federal Eldercare Locator (1-800-677-1116) and ask about a care needs (functional) assessment.

Learn More

MedicaidTexas Medicaid Programs for SeniorsTexas Medicaid programs for seniors 65+ include STAR+PLUS, CAS, HCBS waivers, and PACE. Find out what each one covers, who qualifies, and how to enroll. Care TypesHome Care vs Home Health in TexasHome care vs home health in Texas: what each covers, what home care costs, when Medicare and Medicaid pay, and how to find a licensed provider near you. VA BenefitsVA Aid and Attendance in TexasLearn about VA Aid and Attendance benefits in Texas for 2026. Covers eligibility, monthly rates up to $2,874, how to apply, and free help from Texas VSOs. Care TypesAssisted Living in TexasHow to choose an assisted living facility in Texas: check the HHSC inspection record, learn what STAR+PLUS Medicaid covers, and compare 2025 care costs. FinancialHow to Pay for Senior Care in TexasA plain-English guide to paying for senior care in Texas: Medicaid, Medicare, VA benefits, insurance, and private pay options. Costs and eligibility for 2026.

Find personalized help understanding senior care benefits at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.