Activities of Daily Living Explained

Activities of Daily Living (ADLs) are the basic activities of day-to-day living that one must complete to live comfortably and healthily. These activities include the following:  

Ambulating: Walking, with or without assistive equipment such as a cane or walker, or operating a wheel chair or motorized scooter.

Transferring: Transitioning one’s body position to ambulate. For example, standing up from a chair or getting from the bed to a wheelchair.

Toileting: Including the entire process of going to the bathroom, from needing reminders to initiate or to complete steps throughout the process, to needing physical assistance with pre or post bowel/bladder movement care. 

Feeding:  Physical capacity to eat meals, not including meal preparation.

Dressing: Including choosing appropriate clothing, and undressing.

Grooming: Including bathing, dental cleaning, and all hygienic self-care.

It is important to know and understand the Activities of Daily Living that your loved one has difficulty performing, and those which they need “cueing” with -- meaning reminders or prompts to complete the activity. 

Many providers and benefit programs use ADLs to evaluate the appropriate care level for your loved one, or to determine benefit eligibility. Medicaid, VA Benefits, and Long Term Care insurance all will require an evaluation of the beneficiary’s ability to perform ADLs. 

Aside from the Basic ADLs listed, there is a subcategory called Instrumental ADLs, which include matters like housework, money management, shopping, preparing food, driving, etc. 

These are important activities when considering quality of life, but are not typically considered when qualifying for benefits. 

They may, however, play a role in determining the appropriate care level when seeking out-of- home care, assisted living, or other care options. So be sure to list the activities that your loved one struggles with and keep this information with the other documents and papers.

Guardianship

A guardianship is a legal right given to a person to be responsible for the food, health care, housing, and other necessities of a person deemed fully or partially incapable of providing these necessities for himself or herself.

Establishing Guardianship is a court process which is a great deal more costly and complicated than establishing a Power of Attorney. A medical evaluation of competency is legally required. The senior must be determined medically incompetent. This process is emotionally draining for the senior and his family. After the incompetency is determined, the person seeking Guardianship must go before a judge to declare the incompetence and petition for Guardianship. The court
date is announced and all family members will be informed and invited to contest, whether or not they have a meaningful relationship with the senior in question. The senior may also contest the proceedings.

It is recommended to avoid Guardianship to the best of your ability. Investing the time and money to consult with an Elder Law Attorney to draft an airtight Power of Attorney document early, and before a crisis hits, ismuch more cost effective and may save a family a significant amount of emotional hardship. When Guardianship cannot be avoided, seeking the advice of an elder law attorney is appropriate.

How to Choose a Power of Attorney

Who should you trust with your POA? It does not necessarily have to be the family member or friend with the most health care knowledge or the most advanced understanding offinances.

It is not wise to name a person as POA just to spare hurt feelings. For example, in a family where there are four adult children, the temptation is often to name all four children as POAs
so that everyone has fair say, but this can complicate decision-making in the future when family dynamics come into play.

The best course, usually, is to choose two loved ones (one as the primary agent and one as an alternate) that you trust to keep your best interests at heart. You may grant both financial and medical powers to the same agent, as medical and financial decisions will overlap frequently. If you choose different individuals as financial and medical POA, be sure to choose individuals who work well together, as frequently they will have to agree mutually on decisions.

While you do not need a financial wizard or a medical pro as your POA, you do want to consider the capabilities and personalities of the people you are designating. Someone who has poor history with money management, or has been unable to keep her own paperwork organized, is probably not the best choice for Financial POA. Someone who may be too emotionally frail to make difficult decisions surrounding death is not necessarily the best choice for Health Care POA. You will also be required to name an alternate for each position, a person that can take over the responsibility ifthe first person refuses, becomes incapacitated, or dies.

If you cannot name family members or close friends, you may name an accountant, attorney, or another professionalto be your financial POA. In this case, there will be a schedule of fees associated with the service. Compensation is decided between the principal and the agent, If you wish, family and friends may also be compensated for their service as your agent.

What if a person becomes incapable of making financial or health care decisions for themselves, but they have no POA agent? What if your agent is deceased and the backup refuses? What if the agent was your spouse, but you since divorced and never updated the document? In any of these scenarios, an agent will have to be granted Guardianship, since cannot establish POA for a person who is cognitively incapacitated.

Click Here to Read More About Guardianship

Understanding Powers of Attorney

When you begin taking on the role of caregiver to an aging adult, your first step in the process should be to consider your loved one’s Power of Attorney (POA). If your loved one does not have a Power of Attorney in place, or if it needs to be updated, you need to establish this vital document.

A POA is a document in which an individual (known as the “principal” or “grantor”) names another person or multiple people (the “agent(s)” or “attorney(s)-in-fact”) as decision-maker(s) on behalf of the principal. This document is essential to handling your loved one’s financial and medical affairs.

Executing a POA does not require that the principal be cognitively incapable of making decisions;
it simply allows another person to act on the principal’s behalf. For example, a principal may be hospitalized for a brief time and need an agent to access bank accounts to pay bills. As long as the principal is capable of making decisions, the agent must follow her directives. A POA can be revoked at any time should the principal become dissatisfied with the agent’s actions.

There are different types of POAs. Some “General” POAs expire when the principal becomes cognitively incapacitated; if the principal can no longer make decisions, the agent’s Power
of Attorney is revoked. When establishing a POA for a senior, a “Durable” POA is recommended. This POA allows the agent tomake health care or financial decisions for the senior if they become incapable of making these decisions for themselves.

In some states, Durable Power of Attorney can be “springing,” meaning that the named agent does not acquire Power of Attorney until the principal becomes incapacitated. The definition of incapacitation can be customized within the document when written by a qualified Elder Law Attorney in the state where the POA will be executed.

Principals may designate different individuals as Financial POA and Health Care POA. Financial POAs empower agents to handle financial transactions, such as managing investments, depositing checks, paying bills, and completing tax returns. Health Care POAs make medical and care decisions, such as treatment decisions and accessing long term care benefits.

In both cases, the agent is the fiduciary of the principal, meaning they are legally obligated to act loyally and with the best interests of the principal in mind, honoring their wishes and preferences whenever these are known.

In the case of a medical power of attorney, it is generally wise for an individual to create a health care advanced directive at the same time, making known their wishes for life-prolonging treatment or end-of-life care in the event that catastrophic illness or injury prevents them from communicating their wishes later. This includes statements regarding resuscitation, life support measures, as well as services for spiritual counsel or prayer. Many states allow a medical power of attorney and a health care advanced directive to be in the same legal document.

There are forms available online that make it possible to create a POA without legal advice or help. Though this could be better than not doing it at all, given the sensitivity and vital importance of the POA content, it is recommended that you consult with an elder law attorney.

Click Here to Read “How to Choose Power of Attorney”

Click Here to Read About Guardianship