ADL and IADL assessment, validated tools, and documenting functional change
Functional assessment — measuring what clients can and cannot do independently — is central to home care practice. It drives care planning, justifies skilled nursing visits to Medicare and other payers, and creates the objective baseline needed to recognize decline. This lesson covers the major assessment frameworks and tools used in home health functional evaluation.
Functional assessment in home care is organized around two tiers of activity.
ADLs are the basic self-care tasks required for personal maintenance: bathing, dressing, toileting, transferring (moving from one surface to another), continence, and feeding. The Katz Index of Independence in ADLs is the most widely used standardized tool for measuring these six domains. Each domain is scored as independent or dependent, yielding a score of 0–6. A lower score indicates greater dependence.
IADLs are higher-order activities needed for independent community living: managing medications, managing finances, shopping, meal preparation, housekeeping, transportation, and using the telephone or other communication devices. The Lawton IADL Scale is the standard instrument. IADL deficits often precede ADL decline, making them valuable early indicators of functional change.
The TUG test measures the time for a client to rise from a standard chair, walk 3 meters, turn, return to the chair, and sit. Completion time greater than 12 seconds indicates elevated fall risk in older adults. The TUG is quick, requires no special equipment, and is validated across multiple client populations.
A 14-item scale that assesses static and dynamic balance across a range of tasks (sitting to standing, standing with eyes closed, reaching forward, picking up an object from the floor). Total score of 56 points; below 45 indicates significant fall risk. Used most often by physical therapists but valuable for any clinician monitoring balance.
Functional documentation must be objective and measurable. Use standardized terminology: independent (no assistance needed), supervision (someone must be present), minimal assist (client does 75%+ of task), moderate assist (client does 50–74%), maximal assist (client does 25–49%), and dependent (client does less than 25% of task).
Avoid vague phrases like "doing well" or "needs some help." These provide no clinical or legal value. Document: which activity, level of assistance, assistive devices used, safety observations, and any change from prior assessment. Any new loss of independence is a clinically significant event requiring documentation and clinical notification.
Complete this 5-question quiz with 80% or higher to earn your CEU credit for this lesson.