(NEW 7/1/07 ML #3088)
Instrumental activities of daily living (IADLs) measures an individual's ability to carry out tasks that may not need to be done daily like ADLs, but which nevertheless are important for living independently. Intervention may be required to help an individual adapt to difficulties experienced in performing IADLs. Performance of IADLs requires mental as well as physical capacity. The IADL scale measures the functional impact of emotional, cognitive, and physical impairments. Only four IADLs are used when determining if an individual is eligible to receive personal care service. If an individual is eligible for personal care services, he/she may receive assistance with IADLs that are not considered when determining the eligibility for personal care services, but have been scored a 1 or 2.
IADLs are scored based on what an individual can do rather than what he/she is doing. IADLs should be scored based on how an individual usually performs a task. Individuals who have occasional difficulty should be coded based on their usual performance, noting the occasional difficulty in the narrative. Not all individuals have the opportunity to perform IADL tasks. For example, an individual who lives with a relative or spouse might not prepare meals simply because another person routinely does this task. Similarly, some individuals do not manage their own money because a spouse does it. However, the IADL scale is designed to measure an individual's ability both physical and cognitive to perform these tasks, regardless of the individual's opportunity to perform them.
In IADL scoring it is essential to look at each task as the sum of its parts. Doing the laundry, for example, includes requirements of the physical ability to carry laundry to the washing machine, the cognitive ability to operate the washing machine including the measuring of soap and setting of controls, the physical ability to move laundry from washer to dryer, the cognitive ability to operate the dryer, the skill to fold and physical ability to carry the clean laundry back from the machine. If one can operate the washer and dryer, but cannot carry the laundry to or from the machines, this individual would rate a 1, “With Help."
Obtain information regarding IADL impairments by observation, interview with family or friends, or by direct self-report of the individual. Narratives must be included in the case file for each IADL identified as an impairment. Narratives must include:
The scale used to rate each IADL task has three basic categories of functioning:
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0: |
Without help. Individual is able to perform task independently, without reminder or assistance. |
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1: |
With help. Individual is able to perform task only with assistance, reminder, or cuing. |
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2: |
Can't do at all. Individual is not able to perform task at all, even with assistance. |