What are ADLs and IADLs?

Introduction:Woman applying make-up

In this module you will learn about ways you can help a resident with everyday activities while supporting his/her independence and helping the resident keep a sense of self-respect. You will be introduced to some of the ways in which you are likely to be needed to provide assistance to residents before and during mealtime.

Why is helping residents with everyday activities so important?

Think about all of the little things you need to do each day. Just to start your day you must get out of bed, take care of your personal hygiene (bathe or shower, shampoo hair, brush teeth, etc.), pick out clothes, get dressed and get something to eat. As the day goes on there are many more activities that are so basic that most of us take them for granted. In completing most of these activities many little steps are involved. For example, getting out of bed requires that you are able to roll to the side of the bed, swing your legs over the edge of the bed, place your feet on the floor and stand.

Now think about what would happen if you couldn’t do these things any longer or had great difficulty in doing them. Like most people, you would find that life was getting more difficult and you might feel frustrated, helpless or vulnerable. For many people, a loss in the ability to do the simple daily things can make them feel badly about themselves and angry with the world around them. If the residents you serve have these kinds of feelings about everyday activities, you can be sure that the quality of their lives will not be as high as it could be. This is important because a major part of what you do as a personal care home direct care staff person is aimed at helping people maintain or improve the quality of their lives.

Which activities are important?

Generally, the kinds of activities that are important to the people in a personal care home are organized into two groups:

  • ADLs – This stands for Activities of Daily Living. These are the most basic activities necessary for daily life. They include the following:
    • Eating & drinking.
    • Ambulating – the ability to move about, such as walking with or without devices like canes, crutches, walkers, etc.
    • Transferring – the ability to get in and out of bed, a chair or on and off a toilet.
    • Taking medications.
    • Personal hygiene – bathing or showering, shampooing hair, brushing teeth.
    • Bladder & bowel management.
    • Positioning and changing positions in a chair or bed.
    • Dressing.
    • Securing health care.
  • IADLs – This stands for Instrumental Activities of Daily Living. These activities are more complex and include:
    • Using the telephone.
    • Shopping.
    • Doing laundry.
    • Obtaining and keeping clean clothing appropriate for the season.
    • Making and keeping appointments.
    • Writing letters or other correspondence.
    • Taking part in social and leisure activities.
    • Using a prosthetic device – a substitute for a missing body part such as a hand or leg.
    • Managing finances.
    • Driving or arranging transportation.

As you can see, many activities are part of everyday life. For some of the people you serve, your help with ADLs and IADLs will have a great impact on their ability to participate in and enjoy life. For others, you will be the only way they are able to complete much of what they need to keep safe and healthy from day to day.

What causes changes in ADLs and IADLs?

Many things can cause a change in a resident’s ability to perform these basic activities. You will learn more about this in later modules. For right now, it is important to know four basic things about changes in ADLs and IADLs: 

  1. Some residents have been unable to perform some activities for quite some time—maybe years. These residents have had a longer time to adjust to their loss. Many also know a great deal about how they like to be helped and have strong preferences. For example, Mr. Smith may like to brush his teeth before combing his hair, or he may like to get dressed by putting on clothes in a particular order, or eat, awake or go to bed at a certain time. Wherever possible, it is important to honor these preferences.

  2. Other residents have experienced a recent loss of ability. This means that they have had less time to adjust to their losses and may still be learning about how they can best receive help. In some cases the resident is also trying to adjust to the fact that they may never recover the ability they’ve lost. Some residents have a high ability to adjust to their loss. Others find it more difficult and may display sadness, anger or frustration. In these cases it is important to know that the angry things a resident may say is probably not directed at you, but is really anger at the loss. To overcome and adjust to loss in ability, it is often helpful that residents have a strong sense that they can still have some control in their everyday lives. For this reason it is important to involve residents in choosing how activities will be completed. It is important to encourage them to do as much as they can do on their own.

  3. It is likely that a number of residents with whom you work will have experienced loss in the ways their brains function and are unable to remember, solve problems or even be fully aware of what is taking place around them. For some of these individuals, each time you interact with them is like the first. So your patience and understanding are critical elements of being a caring worker. You must accept and honor that their experiences are real for them. You can also provide hints and suggestions for these residents. For example: Mr. Jackson forgets to bring a jacket when going outside in cold weather. You can give him a cue by saying, “Mr. Jones, the weatherman says it is cold outside today. I’m going to get my jacket. Would you like me to get yours?”

  4. Finally, some residents will be experiencing a temporary loss in their mental or physical abilities from which they will eventually recover. This loss may be due to a mental illness, an injury or the process of recovering from something like surgery. These residents will not have the same sense of having to make permanent adjustments in how they do things. So, it is not unusual for them to be impatient with the recovery process. Once again, patience and understanding on your part are important tools to use when you interact with these residents. Additionally, they may need encouragement to do as much as possible as part of their recovery. You should always check their support plan to see how you can best assist.

Four general helping rules:

  1. The support plan is the starting place for knowing what kind of help is needed by each resident.

    As you learned in the first module, the support plan is the tool that provides the basic information for how you will care for a resident. Each support plan should give a clear picture of the resident’s needs and preferences. Always make sure you read and understand the support plan for each resident you serve.

  2. When you are unsure about preferences or if help is needed, ask.

    Sometimes you will observe a resident struggling with a task, or even after having read the support plan, you may not be sure of the resident’s needs or preferences. While your immediate impulse might be to simply start helping, it is better to ask first. If you have a resident who cannot understand or respond to your questions, try to find out from family members or others who know about the resident’s preferences and remember to record this information in the support plan so it is available to all staff. (In some personal care homes, the appropriate procedure is to ask your supervisor to record information in the support plan.)

  3. Try to use a “person-centered” approach.

    A “person centered” approach involves respecting and honoring the uniqueness of each person and respecting that person’s right to be involved in all decisions that impact on his/her life. These include the little decisions about how ADLs and IADLs are accomplished with your help.

  4. If you believe the resident is in immediate danger of injury, move to help right away. For example, if a resident has fallen asleep and is about to fall out of a chair, move to help reposition him/her immediately.

Assistance with mealtime:Having dinner with others

Many of the tasks with which you will help residents have been studied and analyzed to find safe, respectful and effective ways for you to assist the resident. In this module you will be introduced to ways to assist someone with eating. The assistance with mealtime can be broken into areas. Each is presented below along with the steps to accomplish it.

1. Preparing the resident to eat with others.

For most people, eating is a social event. That is, it is often done with other people. For some residents it may be one of the more important times of the day when they interact with others. So, it is important to help prepare residents for meals. Here are some ways in which you can help:

  • Ask the resident if he/she would like assistance in brushing his/her hair or putting on make-up.
  • Ask the resident if he/she needs to use the bathroom. Assist the resident according to his/her needs.
  • Assist the resident in washing his/her hands or face if assistance is needed.
  • Ensure that the resident has his/her dentures on if they wear them.
  • Ask the resident where he/she would like to sit in the dining room.

2. Serving meals and providing assistance during meals.

As mentioned above, mealtime is an important social time. This time with others is enhanced when the atmosphere is pleasant, calm and enjoyable. While performing your tasks, keep in mind that your calm, relaxed, friendly, encouraging and helpful behavior will go a long way toward making mealtime special. Here are the kinds of tasks you may perform:

  • Serve the meal to the resident by calmly and quietly placing it within easy reach.
  • Make sure the resident has all the utensils he/she will need.
  • Check the resident frequently to see if he/she needs help.
  • Offer to cut food for a resident who is having difficulty. When cutting food, always make sure the pieces are small to help prevent choking. A resident with arthritis may also need help with things such as opening milk containers.
  • Offer different food if a resident refuses what was offered. Each resident has a right to food that is appealing and nutritionally sound.
  • Allow the resident time to complete one course before starting another.
  • If you see any of the following, tell your supervisor:
    • A change in the amount of assistance a resident needs while eating.
    • A change in general behaviors during mealtime such as playing with food, taking food from others, throwing food or falling asleep.
    • A change in attitude such as withdrawing, showing anger or frustration.
    • Choking while eating or drinking.
    • Eating less or more food than usual.
    • A refusal to eat.
  • Wait for all residents to complete their meal before starting another activity or turning on a dishwasher.
  • If needed, help the resident check their personal appearance before moving away from the table. For example, check to see if there are any food spills or crumbs that need to be cleaned. Help a resident to wipe his/her face, if necessary.

In addition to the basic steps already listed, several other things should be considered. First, it is important that the residents’ cultural preferences and beliefs be considered. For example, you may have a resident who wants to pray before each meal. While you do not have to pray with the resident, it is important that you sit quietly and respectfully while the resident does this. You should also be sensitive to the fact that many people’s food preferences are strongly influenced by their culture, ethnic background and religion. These preferences should be honored when possible.

You may also have responsibilities to help prepare the dining room for meals. You might be involved in removing clutter or hazards, reducing distractions such as loud noise or cleaning the table. You may also encounter residents who don’t eat at times pre-set by the personal care home. For example, you may have a resident who likes to wake up at 10 a.m. and have a light breakfast of fruit and coffee instead of the 8 a.m. breakfast call. Honor preferences by being flexible.

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