What are Activities of Daily Living (ADLs)?

Activities of Daily Living are a term that describes the series of basic activities necessary to care for oneself at home or in the community. In certain cases of illness, individuals may find it challenging to do these tasks for themselves as they lose the ability to perform their own daily self- care.

female caretaker helps the elderly man to solve the puzzle
group of elderly man play golf

What are the Common ADLs?

The common ADLs performed repeatedly on a day to day basis generally involve functional mobility and personal care, like bathing, dressing and toileting. So here is a discussion on the most common ADLs that you are going to assist with your client.

male caretaker do the dishes with elderly woman
female caretaker and elderly woman talking each other

Mobility is helping a client to move his limbs or to perform range of motion, while ambulation is to aid the client in walking- with or without your assistance. One of your roles as a caregiver is to help your client to walk and perform other movements to be able to accomplish their daily tasks. Some older persons may have limitations in movement and it is important to understand this. You may maintain close proximity to your client to assist them while walking.

Be sensitive with their need to use mobility aids like canes or walkers as well. To prevent client falls, use the “Guard Method” which is to maintain an arm near the client’s waist or under their arm and shoulder. Make sure that your client can hear your instructions clearly. Some balance issues are because of aging changes in the inner ear canal. Be aware of balance issues in your client.

This type of assistance is related to the client’s ability to move around his or her personal space into the environment. This may be the assistance you give when you move the client in bed and get out of bed, or to move in and out of a chair.

You must remember not to over exert yourself when moving your client from one place to another. Caregivers can hurt their shoulders, neck and back in the process. Here are tips to prevent this from happening:

Tips on Using the Caregiver Lifting Technique
  1. When preparing to lift, keep your feet apart.
  2. As if in a squatting position, bend at your knees and hips.
  3. Lift using your knees and legs, never your back.
  4. Pivot your feet if you need to turn when listing, so as not to twist your back as you lift.
  5. Do not rush the lift, see to it that both you and the client are ready, count to three before you begin the lift.
  6. Seek help from others if necessary.
One- Person Transfer
  1. Put on sock, slippers or shoes on the client so that they can stand without slippingInitially let the client sit for a moment, comfortably on bed.
  2. Communicate each step that you are going to do to the client to that they can prepare what to expect from you.
  3. If you can, lower the bed to the lowest possible position
  4. Lock the chair into a position close by the bed
  5. Help the client to swing their legs over the side of the bed.
  6. Place your knees directly in front of the client to support them.
  7. Using the caregiver lifting technique, support the client’s shoulders with your hands and count to three.
  8. At the count of “3”rock the client forward to stand to make the transfer.
  9. Remind the client not to hold onto your neck but instead to grasp your shoulder or waist.
  10. Bend your knees slightly forward and turn your feet to swivel your body along with the client’s body.
  11. Lower the client slowly to the chair, being careful to keep your back and shoulders straights.
  12. Assist in placing the client in a comfortable position on the chair.
Two-person Transfer for Clients Who Cannot Stand on Their Own
  1. Request the client to fold his arms in a locked position across his stomach Make sure that the side of the chair is next to the side of the bed
  2. Place the chair at the level of the hips of the client next to the bed
  3. Assign one person to: a. Stand in front of the chair to reach under the client’s thigh and calves. b. Stand behind the chair and reach for the client’s shoulders.
  4. Count to three and lift the client safely and lower him comfortably o the chair using the caregiver lifting technique
Transferring Clients in and Out of a Wheelchair
  1. Assemble the paraphernalia that you are going to use such as the wheelchair and an oprtional gait belt that can help with the lifting process
  2. Ask for help if you think you cannot do this on your own
  3. Communicate with your patient by saying who you are and your companions, if any. Tell the patient the steps in which the wheelchair transfer process will flow. Inquire if the patient can move towards you at the end of the bed.
  4. Wash your hands before touching the patient and wear gloves in case any body fluid comes in contact with you during the transfer process.
  5. Always remember to use what you learned from the caregiver lifting technique.
  6. Ask the patient to cross their arms over their chest, put one of your arm underneath their shoulders and the other arm underneath their knees.
  7. Put your leg into a wide stance
  8. Count to three and communicate to the client what to expect
  9. Lift their back and turn the patients legs at the end of the bed
  10. Allow them to sit up straight for a while and ask them if they feel dizzy
  11. Help the patient to put on their shoes, making sure that both shoes are properly placed and that their feet are flat on the floor.
  12. This is the time to put the gait belt around the waist, if it is available. Place four fingers between the gait belt and the patient, then lock it into place.
  13. If you do not have a gait belt, grasp your hand behind the patients back for support.
  14. Place a locked in wheelchair in a position next to the bed.
  15. Ask the patient to place their feet together while explaining how you will lift them up so that both of you will not get hurt.
  16. Ask the patient to put your hands over your shoulders
  17. Grab by the gait belt with one hand at each side of their waist holding on to the beslt.
  18. Count to three, lift and bend the knees as you turn on to the chair
  19. Lower the patient comfortably onto the wheelchair
  20. Position the light rest and foot pedal for support
  21. Carefully lift the patients foot, one at time, into the pedals
  22. Ask the patient again if they are comfortable and if they need you to do anything for them before you leave.
  23. As the patient is ushered into the wheelchair, ensure that nothing is on their way
  24. Thank the patient for his cooperation/
  25. Dispose of the gloves you used and wash your hands.
Repositioning Clients in Bed
  1. Find out the position most comfortable to your client while sitting or sleeping
  2. Assist the client to a comfortable position in bed or chair. Always honor patient preference.
  3. If your client is bed ridden or has memory loss, please reposition him every two hours. This is important to keep the blood flowing and prevents them from having bed sores.
  4. Staying in a comfortable position at all times gives ease and pleasure to our client.
Turning Clients in Bed
  1. Turing the client is a good opportunity for the caregiver to check the patient’s skin for sores and redness.
  2. Initially explain to the client what to expect with the turning that you are going to do.
  3. Encourage the client to help and cooperate with you.
  4. Stay on the side of the client where they will be turning towards and lower the side rails.
  5. Encourage the client to look towards you as this is the direction to which they will turn
  6. In adjustable beds, raise or lower it to a level that will reduce back strain for you.
  7. Place the bed in flat position and the patient at the center of the bed. This will prevent falls caused by rolling on the bed.
  8. Place bottom arm stretched towards you and their top arm across their chest.
  9. Cross bottom ankle with upper ankle.
  10. Get as close to the client as possible and put one of your hands on the client’s shoulders while the other hand on the clients hip.
  11. Place your one foot in front of the other and as you gently pull the clients shoulder towards you, shift your weight to the front foot.
  12. As you gently pull the clients hip towards you, shift your weight to your back foot.
  13. Adjust the shoulder and hip forward until the client is placed in the best position that is most comfortable for him.
  14. After turning, ensure that the client’s ankles, knees, and elbows are not resting on top of each other.
  15. Place a pillow between the client’s legs if this will make them feel more comfortable.
  16. The client’s head and neck must be in line with their spine, not overstretched backwards, forward or to the side.
  17. Place the height of the bed to a comfortable position and raise side rails up.
  18. Talk to your client. Ask about their comfort or if there is anything else that they need.

Safe Restroom Use

This ADL is related to the assisting with the client’s physical and mental ability to properly use the restroom including getting to the toilet and cleaning oneself afterwards. As a caregiver, it is also important for you to check your client for urinary tract infections during toileting. Even if some clients can use the restroom on their own, many need help to maintain safety. Others struggle with incontinence or the loss of bladder control. In a nursing home setting, clients can be offered a bed pan to enable them do their toileting in their own beds.

toilet for disability person
  1. Develop a frequent, scheduled basis of going to the bathroom for your patient.
  2. Ensure adequate lighting in the bathroom and the hallway
  3. Remove any hazards along the way that may cause an accident to the client
  4. Position raised toilet seats and/or grab bars for client’s ease and support.
  5. In case of an accident, stay calm and use a matter-of-fact approach as accidents are very embarrassing for the client.
  6. If accidents happen frequently, discuss the care plan with your supervisor.
  7. Steer clear of citrus juices, caffeine, alcohol, or other bladder irritants in your clients diet
  8. Note of any medication taken by your client that affects the bladder
  9. Drinking plenty of fluids every day is important to prevent strong urine concentration that may irritate the bladder.
  10. Assist the client in cleaning herself after toileting. Remember to use short sentences when giving instructions. Communicate clearly the next steps that are happening so that the client knows what to expect. Allow plenty of time to accomplish what you ask them to do.

Eating & Drinking

Meal time is an important social event. It is also essential to maintain the physical nourishment of the client. While some clients look forward to eating, others may struggle during this time. It is crucial to use an encouraging tone, remain calm, friendly and not to rush the meals. When feeding clients, take note of their swallowing as well as their ability to finish the food and drinks that you have prepared for them. Aside from that, the following tips may come in handy:

Tips to Assist in Eating
  1. The care plan prepared by your supervisor will make you aware of any restrictions or food allergies that your client may have.
  2. Ascertain that your client is receiving proper nutrition by contemplating to blend in meats and vegetables to meal or giving a rich soup to increase their calories and protein.
  3. Place all utensils and meal within your client’s easy reach.
  4. Suggest to the client that you can cut their food if they have difficulty doing so. If there is a chance that your client might choke on certain foods, you can cut or grind the food for them.
  5. Offer any help needed by the client
  6. Do not rush and give time for the client to finish one module of meal before starting on with the next module.
  7. When moving away from the table, help the client to look at the client’s personal appearance to see that they look presentable after the meal. If they have stained their clothing, offer to remove or change them.
Tips to Assist in Drinking
  1. Ensure that your client drinks at least 8 glasses of water every day. Even if say that they are not thirsty, they may still need water, as many clients may not notice being thirsty as their perception of it decreases with older age.
  2. Make sure that drinking water is readily available at all times
  3. Remember to use a straw or offer your client small sips while assisting them to drink throughout the day.
  4. Provide the client with water rich foods such as soup, fruits and vegetables.
  5. Decrease sugary and alcohol-based fluid intake for your client. You may blend a small amount of water with fresh fruit if the client is not getting enough water throughout the day.
  6. If the weather is hot, the client may need more fluid. Remember to take caution to stay cool when the weather is hot.

Bathing & Grooming

When bathing the client, make sure it accomplishes the basic tasks of cleaning the physical body. Grooming is related to drying the skin, combing the hair and even brushing the teeth. Bathing is an essential step to maintaining good hygiene. It will also make a general feeling of comfort and relaxation. The clients care plan will tell you if bathing once or twice a week is recommended. This routine will help older persons to avoid skin breakdown and infections If applicable, look for infrastructure that could help your client in bathing. Senior friendly facilities have installations of grab bars, tub benches and handheld showerheads make bathing a safe experience. Prepare what is necessary for your clients use and allow them to maintain their privacy whenever possible. Even if bathing is not recommended daily, seniors are encouraged to wash their faces once or twice a day with a gentle cleansing agent.

A caregiver can also help their client maintain skin care by making sure that the skin is kept clean and moist. The client also needs to be properly hydrated to keep their skin healthy, as their skin becomes thinner and more fragile in old age.In grooming, you can trim the nails when it is softer, usually after taking a bath. Remember to trim the nails across and be careful not to cut through the skin. Your manager will write down instructions on how to do grooming for your client. To care for the client’s hair, it is easier for both client and caregiver to use a dry shampoo between baths to preserve the energy of the client with in between activities.

What to Prepare Before Bathing?
  1. Follow a schedule for assisting or bathing the client
  2. Ensure client safety during bathing by adding non-slip bath mats, attachable grips or railings in the bathroom.
  3. Prepare all bathing materials within reach
  4. Arrange a warm towel, robe and fresh clothing for use after the bath.
Tips to Bathing an Older Adult
  1. Foremost is to ensure client safety. The client can slip on a wet surface.
  2. As each client have their own physical and/or cognitive disabilities, check for their mobility and ability to clean themselves.
  3. Check water temperature to be warm
  4. Steer clear of any sudden movements
  5. Give gentle reminders and talk to the client slowly.
  6. Take your time. Do not rush the bathing process.

Dressing & Undressing

The way our client choose their clothes and style themselves have an influence on how they view themselves so it is important to minimize embarrassment and feelings of anxiety in the process of helping them in and out of their clothes. Dressing and undressing require a higher level of gross motor skills to do, which may be challenging for a disabled person. More often than not, this may not be just about putting on clothes but on helping the client choose the right clothes that are appropriate for the weather and one that the client wants to wear.

What to Do When Dressing the Client?
  1. Provide privacy by closing the doors and curtains
  2. Ensure warm environment to prevent client from being cold
  3. Give a helping hand when they ask for it
  4. Let them maintain independence as much as possible and support the client in case they want to do the dressing (& undressing) themselves.
Tips When Dressing & Undressing a Client
  1. Help your client maintain comfort with their personal style.
  2. Choose loose-fitting clothes that have few fastenings. Clothing with large front-fasteners like Velcro and zippers are recommended.
  3. Comfortable options include loose fitting pants with elastic waistbands.
  4. Choose cotton fabric in clothing as it is cool, easy to clean and comfortable to wear.
  5. A comfortable non-slip shoe for foot wear is essential. In addition to ADLs, there are also Instrumental Activities of Daily Living (IADLs) that we need to consider in assisting our clients at home.

What Are Instrumental Activities of Daily Living (IADLs)?

Instrumental Activities of Daily Living (IADLs) are more complex tasks that are important to living independently but are not required every day. These are the following:

  • Medication supervision
  • Preparing or ordering for meals
  • Management of personal finances
  • Using the telephone/ cellular phone
  • Using technology/ Internet/ Social media
  • Housekeeping
  • Grocery shopping/ Going to the market
  • Access to transportation
  • Doing exercises and other physical activities
  • Caring for their pets
senior people in cartoons

What is the Activities of Daily Living (IADLs) Checklist?

The Activities of Daily Living (ADL) Checklist is usually included in a client’s care plan. The checklist outlines the things that your client can do on their own and what they might need help in doing. Remember that you would need to determine the level of care or assistance that your client needs at the start of your partnership. Knowing the clients functioning level as it relates to ADLs and IADLs can help you to make realistic goals and meet them with your care plan.

The ADL checklist makes an inventory of the ADLs & IADLs and your role as caregiver is to check the level of function as each activity relates to your client. You would need to look at the category with which the client should be able to function and check if the client should be able to do this independently, needs help, dependent on you as caregiver or cannot do at all.

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