Feeding, continence, and transferring are in the late loss category, while toileting, dressing and bathing fall in the early loss category of ADLs, or activities of daily living. In a series of recent posts on her blog, Cathy Cress, an MSW and geriatric care manager, explains how ADLs fit in with the functional and psychosocial assessments that often precede a transition to assisted living (and sometimes home care). Interestingly, says Cress, older adults lose these abilities in the same way babies are gaining them in their early development days.
The functional assessment is based on the Katz ADL Index scale (you can read more about this evaluation tool here). The senior who is being evaluated is given a score of 0-6: zero being very dependent on help, and 6 being very independent in terms of the need for help. The basic daily life activities listed above — feeding, continence, transferring, bathing, dressing and toileting — are the 6 components that form the 6-point scale.
Cress suggests that an informal, conversational approach to these assessments is best. Consequently, while a professional may be able to give additional insights to families and individuals making a decision about care, the Katz scale is a simple, straightforward way for any caregiver to determine a senior’s ability to manage on their own, to know when or what kind of help is needed. In assisted living communities, the number of care hours required (and therefore the total cost beyond basic charges) will likely be based on the individual’s Katz score.