ADL and IADL Assessment: A Complete Guide for Care Planning

The Argument Over Whether Mom Can Stay Home Starts With a Guess

The daughter says her mother is doing fine — a little slower, but fine. The son who lives two states away says the stove was left on twice last month and it's time to talk about assisted living. The care coordinator sitting between them has a folder of intake notes, a phone call transcript, and no shared, defensible answer to the actual question: what can this person still do safely, on her own, today?

That argument happens in almost every intake meeting, and it happens because "fine" isn't a measurement. Two structured, decades-old instruments exist specifically to replace that argument with a number: the Katz Index of Independence in Activities of Daily Living and the Lawton-Brody Instrumental Activities of Daily Living Scale. Both are public-domain, both are still the backbone of functional assessment in home care and geriatric care management, and neither requires a clinical license to administer as a documentation and planning tool. This guide walks through what an ADL IADL assessment actually measures, how to score both instruments correctly, and how the score becomes the first page of a real care plan rather than a form that gets filed and forgotten.

What ADLs and IADLs Actually Measure — and Why the Distinction Matters

"Activities of daily living" is not a vague phrase invented for marketing copy. The term was coined by Sidney Katz in 1950, and it describes a specific, narrow category: the self-care tasks a person must be able to do, unassisted, to survive independently in a single day. Katz formalized six of them into an index in 1963. Everything outside that narrow category — the tasks needed to live independently in a community rather than just survive in a room — falls into a second, later category that Lawton and Brody defined in 1969.

The distinction matters operationally, not just academically. A person can score perfectly on basic ADLs — fully able to bathe, dress, and feed themselves — and still be unsafe living alone because they can no longer manage their medications, get themselves to appointments, or track whether the bills got paid. An ADL IADL assessment that only measures one half of that picture will systematically miss the instrumental gaps that most often trigger a 2 a.m. phone call to a family member. Any complete home care plan needs both scores side by side, not one standing in for the other.

The Katz Index: Scoring the Six Basic ADLs

The Katz ADL measures six functions: bathing, dressing, toileting, transferring, continence, and feeding. Each function is scored on the same three-point logic — independent, needs assistance, or dependent — based on actual observed or reported performance, not on what the person believes they could do if they tried.

The scoring convention, per the Hartford Institute for Geriatric Nursing, collapses to a simple total: a score of 6 indicates full function across all six areas, a score of 4 indicates moderate impairment, and a score of 2 or below indicates severe functional dependence. The instrument is deliberately binary at the item level (independent vs. not) precisely so that two different assessors, on two different days, land on the same number for the same person — which is the entire point of using a standardized tool instead of a narrative note.

A worked example makes the arithmetic concrete. Say an assessor rates a client as independent in bathing, dressing, toileting, and feeding, but needing assistance with transferring and experiencing occasional incontinence. That's four full points and two partial items — a total that lands in the moderate range, not the "she's basically fine" range the family opened with. The number doesn't resolve the family disagreement by itself, but it gives everyone in the room the same starting fact.

The Hartford Institute for Geriatric Nursing (HIGN) publishes the Katz "Try This" instrument for reproduction in not-for-profit educational use, provided the source is attributed — which is why it's safe to build directly into an agency's own intake paperwork rather than treated as licensed, proprietary content. It is a genuinely public instrument, not a shortcut around one. For a full item-by-item breakdown of each of the six functions and how to phrase the intake question for each, see our dedicated walkthrough of the Katz Index.

The Lawton-Brody Scale: Scoring the Eight Instrumental ADLs

Where Katz stops at survival-level self-care, Lawton and Brody's 1969 scale picks up the tasks required to actually live independently in a community: using the telephone, shopping, preparing food, housekeeping, laundry, managing transportation, managing medications, and handling finances.

The IADL score runs from 0 to 8, with 0 representing full dependence and 8 representing full independence across all eight domains — a wider and more granular range than Katz's tighter ADL scale, which reflects how much more variation there is in instrumental tasks than in basic self-care. Someone can be fully capable of every basic ADL and still score a 3 or 4 on IADLs because they can no longer drive, no longer track which pills to take when, or no longer reliably pay a bill on time.

The medication domain deserves a specific callout, because it's the one IADL item most likely to get conflated with clinical practice. Assessing whether someone can manage their own medication schedule is a functional question — can they open the bottle, remember the timing, avoid double-dosing — not a clinical one. It has nothing to do with dosing decisions, drug interactions, or administration, and any tool built around this domain, including the medication section inside a care plan, should function purely as a reminder-and-organization aid rather than anything resembling an eMAR or clinical medication record. That boundary matters both for scope-of-practice reasons and for keeping the plan itself honest about what it is.

For the full eight-domain breakdown with suggested intake phrasing for each, see our Lawton-Brody IADL scale guide.

Running the Assessment: From Interview to Score

In practice, a functional assessment is a structured interview, not a form the client fills out alone. Three habits separate a defensible assessment from a guess dressed up as one:

Observe where possible, ask where you can't. If a home visit allows the assessor to watch someone actually transfer from a chair or manage a pill organizer, that observation outranks a self-report. When observation isn't possible, ask about the most recent instance of the task, not a hypothetical — "when did you last do your own laundry, and how did it go" rather than "can you do your own laundry."

Score each item independently before totaling. The temptation is to form a general impression of the person and then back into a score that matches it. Score bathing on its own evidence, then dressing on its own evidence, and so on — the six or eight independent judgments are what make the total meaningful.

Corroborate with a second source when the client and family disagree. This is the exact scenario from the opening of this guide. When self-report and family report conflict, note both, and where possible, resolve with direct observation or a follow-up conversation with a home health aide or a neighbor. The disagreement itself is useful data — it tells you where the family's blind spot or the client's pride is distorting the picture.

Our companion piece on how to assess activities of daily living walks through the interview script in more detail, including how to phrase questions so a proud or minimizing client gives you an accurate answer rather than the answer they think you want to hear.

Turning a Score Into a Care Plan

A Katz score of 4 and an IADL score of 3 are not the deliverable — they're the input. The score only earns its keep when it drives specific, dated decisions in the plan of care: which tasks the plan assigns to paid caregiving hours, which it leaves with family, which trigger a referral to occupational therapy or a home-safety evaluation, and which items get flagged for a follow-up assessment in 30, 60, or 90 days rather than assumed to be stable.

This is also where the ADL/IADL findings should connect to a home-safety review rather than sit in isolation. Falls are the leading cause of injury for adults 65 and older, with more than 14 million — roughly 1 in 4 — falling each year according to the CDC, and a documented decline in transferring or toileting independence is exactly the kind of signal that should prompt a safety walkthrough rather than wait for an incident to force one. A functional assessment that never connects to the safety and task sections of the plan is a form filled out for its own sake.

Our assessment-to-care-plan process guide covers this handoff in detail — specifically, how to map each low-scoring item to a concrete plan section rather than leaving the score as an isolated number on an intake page.

Why Timestamped, Versioned Assessments Matter for Licensing and Family Trust

An assessment done once at intake and never revisited creates two problems, and they surface at the worst possible moments.

The first is a licensing problem. When a state surveyor or an internal quality reviewer asks what the client's functional status was at the time a specific incident occurred, "we assessed her when she started service eight months ago" is not an answer that holds up — functional status changes, and a plan that hasn't been re-scored since intake is documenting a version of the client who may no longer exist. Documentation and licensing requirements around reassessment frequency vary by state and by program type, so confirm the specific interval your state licensing authority requires rather than assuming a default.

The second is a family-trust problem. When a family member disputes a care level change — "she was fine three months ago, why is the plan suddenly different" — the honest answer is only credible if there's a dated, scored record showing the actual trajectory: a Katz score of 6 in January, a 4 in April, a family conversation in May. Without that timestamped history, every care-level change looks arbitrary even when it's clinically sound.

This is precisely why CareWorkbook's assessment module scores each ADL and IADL item as Independent, Needs Assistance, or Dependent and timestamps every completed assessment automatically, and why finalizing a plan creates a dated, immutable version snapshot rather than overwriting the last one. No client assessment data is stored on CareWorkbook's servers by design — the plan lives in a portable file format the agency or care manager controls — which is an architecture fact worth knowing, not a substitute for confirming your own recordkeeping and privacy obligations with your state licensing body or, if applicable, HHS's Office for Civil Rights.

A score without a date is an opinion. A score with a date is evidence.

Building This Into Your Workflow

A few practical notes for agencies and independent geriatric care managers putting this together for the first time:

• Run the Katz and Lawton-Brody assessments together at intake, not sequentially over separate visits, so the two scores describe the same moment in time.
• Re-score on a fixed cadence — many agencies use 90 days as a working default, adjusted for higher-acuity clients — rather than only when a family member raises a concern.
• Build the ADL and IADL sections directly into your intake paperwork using the public-domain Katz and Lawton-Brody item language, attributed appropriately, rather than drafting a paraphrased version that drifts from the validated wording over time.
• Keep the medication IADL item scoped to organization and reminders in your own documentation, never dosing guidance, to avoid drifting into clinical territory the plan isn't built for.

If you're assembling this from scratch, our ADL assessment tool for seniors and IADL assessment checklist break each instrument down into ready-to-use intake language. For agencies that want the two frameworks pre-built into a scored, exportable format rather than assembled by hand, the ADL/IADL Assessment Pack in our template store includes both instruments with the scoring logic already structured — and the same scored, timestamped assessment logic ships natively inside CareWorkbook's plan builder for agencies and care managers who want the assessment connected directly to the plan, the review-cycle reminders, and the version history rather than living as a standalone document. You can try that workflow yourself before committing to it.