What Are Activities of Daily Living (ADLs)?

What Are Activities of Daily Living (ADLs)?

Why ADLs Matter

ADLs aren't just a medical checklist. Many public programs decide eligibility for services by a person's need for help with them, and most long-term care insurance policies set their benefit trigger by them.1 Here is how three of them work.

• Medicaid looks at ADLs through a Nursing Facility Level of Care (NFLOC) determination, the clinical finding that a person needs the kind of care a nursing facility provides. Its criteria are set out in state rule. Ohio's is one example: its intermediate level of care has four criteria that must all be met, and one of them is a need for at least one of these: help with at least two ADLs, help with one ADL plus help with medication administration, at least one skilled nursing or skilled rehabilitation service, or twenty-four-hour support to prevent harm from a cognitive impairment diagnosed by a physician or other licensed health professional. Ohio's determination also reaches its nursing facility-based Home and Community-Based Services (HCBS) waivers.2 Those rules are Ohio's own; look up the rule in the state you are applying in.
• VA Aid and Attendance is an added monthly payment for a veteran who already gets a VA pension and meets at least one of four needs: needing another person's help with daily activities like bathing, feeding, and dressing; having to stay in bed, or spend a large part of the day in bed, because of illness; being a nursing home patient due to the loss of mental or physical abilities related to a disability; or limited eyesight (5/200 or less in both eyes even with glasses or contacts, or a visual field narrowed to 5 degrees or less).3 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.3,4
• 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 set their benefit trigger at needing help with two or more of the six ADLs, or at having 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. And meeting the trigger is not the same as being paid. An elimination period runs first, and ACL says most policies let you pick one of 30, 60, or 90 days when you buy.1 Your own policy's contract language sets both, so read it.

In practical terms: how many ADLs your loved one needs help with can decide whether a public program or an insurance policy helps pay for their care.1

The 6 Activities of Daily Living

Federal long-term care guidance most commonly lists these six ADLs:1

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:1

• 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)

If your parent is forgetting to pay bills, can't manage their medications safely, or has stopped cooking meals, take it seriously as a sign that more support may be needed, even if they can still bathe and dress on their own.

How ADLs Are Measured

How a need is measured depends on the program or policy doing the assessing. Ohio's Medicaid rule, for example, counts a person who needs assistance completing an ADL.2 Before any assessment, it helps to write down, for each of the six tasks, whether your parent:

• Manages alone: does the task without any help
• Needs someone nearby: can do it but needs someone watching for safety
• Needs hands-on help: needs another person to help complete it
• Can't do it: someone else has to do the task for them

For long-term care insurance, ACL states that most policies set their benefit trigger at needing help with two or more of the six ADLs, or at having a cognitive impairment.1 Your policy's contract says how it measures that help, so read it.

Hitting the trigger starts a clock rather than the payments. ACL defines the elimination period as the amount of time that must pass after a benefit trigger occurs but before you start receiving payment for services, and says most policies let you choose 30, 60, or 90 days at the time you bought the policy.1 The policy pays nothing for services during those days, so plan how care will be covered for up to 90 days after the trigger is met.

Medicaid's level-of-care criteria are set out in state rule, so the threshold that governs your case is your state's, not the insurance trigger above.2

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) meets the benefit trigger in most long-term care insurance policies, according to ACL, though the elimination period still has to run before the policy pays anything.1 Medicaid's bar is set in state rule; in Ohio, help with two ADLs is one way to meet one of the four level-of-care criteria, and the other three must be met too.2

"ADLs only matter for nursing homes." Many public programs decide eligibility for services by a person's need for help with ADLs, and that reaches past nursing homes.1 VA Aid and Attendance counts needing help with daily activities like bathing, feeding, and dressing,3 and Ohio's level-of-care determination also covers its home and community-based services waivers.2

Related Terms

• Medicaid spend-down: A pathway that lets a person whose countable income is above the Medicaid income standard become eligible by incurring medical expenses equal to the excess6
• Nursing Facility Level of Care (NFLOC): The clinical determination that someone needs the kind of care a nursing facility provides. Its criteria are set out in state rule; in Ohio, help with ADLs is one route to meeting part of the test2
• VA Aid and Attendance: An added monthly VA pension payment for a veteran who needs help with daily activities or meets one of VA's three other tests3

Learn More

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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.