How to Assess a Parent's Care Needs (ADLs and IADLs)

Families often argue about care because each person has a different picture of what is needed. One sibling sees a parent who "manages fine"; another has noticed missed medicines and unopened post. A simple, structured assessment replaces those impressions with a shared description, and that description is what doctors, social workers and care agencies will ask for.

This guide is general information. It does not replace a formal assessment by a health or social care professional.

The two lists professionals use

Most care assessments look at two groups of everyday activities.

• Activities of daily living (ADLs) are basic self-care: bathing, dressing, using the toilet, getting in and out of bed or a chair, continence and eating. Needing help here usually means hands-on support every day.
• Instrumental activities of daily living (IADLs) are the tasks needed to live independently: taking medicines correctly, preparing meals, housework and laundry, shopping, getting to appointments, managing money and using the phone.

Safety matters too: memory problems, falls, being alone at night and being left alone for several hours all shape how much supervision is needed.

Step 1: Observe for a week

Before you rate anything, watch and ask. Visit at different times of day if you can, because many people manage well in the morning and struggle in the evening. Note what your parent does alone, what they need reminding about and what someone else is already quietly doing. A daily care log is useful for this.

Step 2: Rate each activity

For each activity, choose one of three levels: independent, some help (reminders, supervision or help with part of the task) or full help. Our free care needs assessment checklist lists the seventeen activities, lets you add a note to each and adds up the result. Rate what actually happens, not what your parent says they can do; many people understate their difficulties to avoid worrying their family.

Step 3: Read the overall picture

• Mostly independent: help with a few household tasks. Family visits, reminders and a weekly schedule usually cover this.
• Regular support: help with several activities, including some personal care. A shared schedule, a paid carer for some hours and a home safety check are worth arranging.
• Substantial daily support: full help with personal care or safety. Daily hands-on care is likely, and a formal assessment and a discussion of care options should not wait.

Step 4: Share it with the doctor

Changes in mobility, memory or continence sometimes have treatable causes, such as an infection, medicine side effects or poor eyesight. Take the printed summary to the next appointment and ask whether anything could explain the change. An appointment preparation sheet helps you cover everything in a short visit.

Step 5: Ask about formal assessments

In the US, a formal assessment may come from a doctor, a hospital discharge planner, a home health agency, a long-term care insurer or your state's Medicaid program, depending on what help you are applying for. Your local Area Agency on Aging can explain which assessments apply where your parent lives.

Repeat it when things change

Needs change, sometimes suddenly. Repeat the checklist every few months, after a hospital stay or a fall, and whenever something seems different. Keeping the dated printouts shows the trend, which is often more useful to professionals than any single snapshot.