What are ADLs? The seven activities of daily living
A doctor says it. A discharge planner says it. An insurance form asks about it. Here is what ADL actually means, and why the answer changes what care costs.
The short answer
ADL stands for activities of daily living. They are the basic self care tasks everyone does every day: bathing, dressing, eating, transferring, toileting, continence and grooming. A related set, IADLs or instrumental activities of daily living, covers the tasks that keep a household running: money, shopping, cooking, housework, transportation and medications.
The terms matter because they are the currency of care. They set the care level at a community, the hours a home care agency books, and whether an insurance policy or a VA benefit pays. Nobody is testing you on the vocabulary. They are asking what your parent can still do without someone standing nearby.
The two lists, side by side
Read down both columns and notice which tasks already need a hand. That, more than any single diagnosis, is what decides between a few hours of help a week and a move.
The 7 ADLs
Basic self care. If someone needs hands on help or supervision here, that is what care providers call a hands on need.
- 1. Bathing and showeringGetting in and out of the tub or shower safely, washing and drying, managing water temperature.
- 2. DressingChoosing clothes for the weather, fastening buttons and zippers, putting on shoes and socks.
- 3. EatingGetting food from the plate to the mouth, using utensils, chewing and swallowing safely.
- 4. TransferringMoving from bed to chair, chair to toilet, or standing up without falling.
- 5. ToiletingGetting to the bathroom in time, cleaning up, using a commode or managing a catheter.
- 6. ContinenceControl of bladder and bowel, plus managing pads, briefs and the laundry that comes with them.
- 7. GroomingBrushing teeth, combing hair, shaving, and basic nail and skin care.
The 6 IADLs
The tasks that keep a household running. These usually slip first, well before a bath or a shower becomes a problem.
- 1. Managing moneyPaying bills, banking, keeping track of statements and spotting scams.
- 2. Shopping and errandsGroceries, prescriptions, household supplies, and getting them home.
- 3. Meal planning and cookingDeciding what to eat, using the stove safely, and cleaning up after.
- 4. Housework and laundryCleaning, dishes, changing sheets, washing and folding clothes.
- 5. TransportationDriving, or arranging rides to appointments, church and the store.
- 6. Medications and appointmentsTaking pills on schedule, refilling prescriptions, using the phone and keeping appointments.
Help can mean hands on, or it can mean a reminder and a set of eyes. A person who showers alone but should not be alone in a slippery bathroom still has a bathing need, and the assessment should say so.
Why everybody keeps asking
Insurance claims
Most long term care policies start paying when someone cannot do a set number of ADLs without help, commonly two of six, or has a cognitive impairment. The assessment decides the claim.
VA benefits
Aid and Attendance asks for evidence that daily activities need help. It is one of the few benefits that pays a surviving spouse as well as the veteran.
Care community pricing
Every community assesses ADLs on move in and prices the care level from that. Two families in identical apartments can pay very different monthly rates.
Hours of home care
An agency builds a schedule around which tasks need help and when. Bathing support in the morning is a different booking from overnight supervision.
How a daily task becomes a monthly bill
In a care community, the assessment sets a care level and the care level sets the add on to the base rate. In the home, the same need turns into hours. Bathing and dressing on weekday mornings is roughly seven and a half hours a week. Morning and evening visits with medication reminders is closer to twenty. Once someone cannot be left alone, you are buying a shift rather than an hour.
That is the crossover families feel without naming it. Santa Barbara home care averages $45 an hour, and our local median assisted living rate is $7,000 a month, which is about 36 hours of care a week bought at home. Under that, home care usually wins. Over it, a community usually does.
Quiet signs worth writing down
None of these is an emergency. Together they are the evidence a doctor, an assessor or a sibling will ask for.
- The same clothes worn several days running, or laundry piling up
- Unopened mail, late bills, or a sudden interest in sweepstakes and callers
- The car with a new scrape, or errands quietly stopped
- Pills that are doubled, skipped or running out early
- Weight loss, or a fridge with little in it
- Standing up more slowly, holding furniture, or a fall nobody mentioned
Questions families ask first
What does ADL stand for?
Activities of daily living. It is the clinical shorthand for the basic self care tasks a person does every day: bathing, dressing, eating, transferring, toileting, continence and grooming. When a doctor, hospital, insurer or community asks how someone is doing with ADLs, this is the list they mean.
What is the difference between ADLs and IADLs?
ADLs are basic self care. IADLs are instrumental activities of daily living, the tasks that keep a household running: money, shopping, cooking, housework, transportation and medications. In real life the IADLs slip first. Someone who bathes independently may still have stopped driving, stopped cooking and be behind on the electric bill.
How many ADLs are there, six or seven?
Both counts are used. The Katz Index, the most common clinical tool, scores six: bathing, dressing, toileting, transferring, continence and feeding. Many modern assessments split out grooming and list seven. The number matters less than which ones need help, and whether that help is hands on or just a reminder.
Why does an insurance company care about ADLs?
Because most long term care policies pay when someone cannot perform a set number of ADLs without help, commonly two of six, or when there is a cognitive impairment such as dementia. VA Aid and Attendance uses a similar standard. Read your policy's exact wording before you assume a claim will be approved or denied.
Who actually assesses ADLs?
Hospital discharge planners, home health nurses, occupational therapists and the care director at each community. Ask for the assessment in writing. Different assessors can reach different conclusions, and that difference is often the gap between what a family expects to pay and what the community quotes.
Do ADL needs change the monthly rate?
Yes. Communities price by care level, so the base rate covers the first tier of help and each step up adds to the bill. Home care agencies work differently: you buy hours, and the hourly rate usually does not change when the tasks get heavier. That is one reason the two options cross over at different points as needs grow.
What if my parent refuses help?
Start with the one IADL that is causing visible trouble, usually driving or medication, rather than with the word care. Framing help as a solution to a specific problem that they already see goes further than a conversation about capabilities. Our Clarity Check walks through the same questions in about five minutes.
Keep reading
In-home care, hourly to live in
What each type of care at home costs in Santa Barbara, and how the hours add up.
Run the numbers
Home care, assisted living, memory care and skilled nursing, side by side with local rates.
What assisted living costs here
Median rates from our September 2026 survey of 48 Santa Barbara communities.
Every way families pay
Savings, insurance, home equity, VA benefits and Medi-Cal in one place.
Not sure which column you are in
Tell us what a normal morning looks like and we will tell you which care options actually fit, including the ones that cost less than you expect.
This page is general guidance, not medical, legal or financial advice. Every assessment is different, and policy wording decides insurance claims. Updated November 2026.