The IADL Assessment Checklist Explained

When "She's Doing Fine" Doesn't Match the Kitchen

A coordinator walks through an intake visit and checks every ADL box without hesitation: the client bathes independently, dresses herself, gets to the bathroom without help, transfers in and out of a chair fine, has no continence issues, and feeds herself three meals a day. By the Katz measure, she looks close to fully independent.

Then the coordinator opens the refrigerator. It's nearly empty except for condiments. The mail on the counter is a month deep, unopened, including two shutoff notices. A pill organizer sits on the windowsill with three compartments still full from earlier in the week. The daughter, standing in the doorway, says quietly: "I don't understand — the assessment said she was fine."

She wasn't wrong to be confused. The Katz ADL index measures whether someone can physically care for their own body. It says nothing about whether they can run a household, manage money, or take medication correctly — and those are frequently the first functions to slip, long before bathing or dressing become a problem. This is exactly the gap the instrumental activities of daily living, or IADLs, were built to close. This walkthrough covers the eight domains, how to score them using the standard 0–8 scale, and how to read a mismatched ADL/IADL profile so it actually changes the care plan instead of just sitting in a file.

Why ADLs Alone Miss the Real Story

Basic ADLs — the six functions in the Katz index — measure self-care at the level of the body: bathing, dressing, toileting, transferring, continence, and feeding. They're foundational, and for good reason; they were the original functional measure developed by Sidney Katz and colleagues and published in 1963. But they were never designed to capture whether someone can live independently in a community setting.

Instrumental activities of daily living sit one layer up. They measure the cognitive and organizational tasks required to run a household and manage a life: paying bills correctly, remembering to take the right pills at the right time, getting to appointments, keeping food in the house. These are typically the first capacities to erode with early cognitive decline, even while physical self-care remains intact — which is exactly the pattern in the scenario above. A care plan built only on ADLs will miss it every time. That's the case for treating an ADL/IADL assessment as a paired instrument, not two separate checklists filed in different places.

The Eight Instrumental Activities of Daily Living

The Lawton-Brody IADL Scale, developed by M. Powell Lawton and Elaine Brody and published in The Gerontologist in 1969, is the long-standing, widely reproduced instrument for this layer of function. It is a public-domain tool that has been used in geriatric assessment for more than fifty years, and it covers eight domains:

1. Ability to use the telephone — looking up numbers, dialing, and holding a conversation.
2. Shopping — capacity to purchase needed items independently.
3. Food preparation — planning, preparing, and serving adequate meals.
4. Housekeeping — maintaining a livable home environment.
5. Laundry — doing personal laundry completely.
6. Mode of transportation — traveling independently, whether driving, arranging rides, or using public transit.
7. Responsibility for own medications — taking the correct medication at the correct dose and time.
8. Ability to handle finances — managing money, paying bills, and tracking a budget.

Each domain is typically scored on a scale from full independence down to complete dependence in that task, and the eight domain scores are then summed into a single functional score.

How Lawton-Brody IADL Scoring Works

The scored range for the Lawton-Brody instrument runs from 0 to 8, where 0 reflects low function (dependent across all eight domains) and 8 reflects high function (independent across all eight). Each of the eight domains contributes one point when the person is independent in that task, and zero points when they are not — a structure that makes the math transparent and the score easy to defend later if a family or a licensing reviewer asks how a number was reached.

Here's a worked example, using round numbers purely to show the method: a client who can use the phone independently, prepares simple meals but can't plan or execute a full meal on her own, does not do her own laundry, cannot drive or arrange transportation, manages her own medication correctly, but has stopped paying her own bills and no longer shops without a companion, would score independent on 3 of the 8 domains — telephone, food preparation (if scored as partially adequate under the tool's criteria), and medication — for an IADL score in the low-to-middle range rather than a strict pass/fail. The exact scoring criteria for partial performance on each domain are spelled out in the instrument itself, and any organization adopting it for real assessments should score against the original domain-level descriptions rather than an approximation.

The value of a scored, documented result over a mental impression is the same reason Lawton IADL scoring interpretation matters as much as the raw checklist: a 3-of-8 score recorded on a specific date, and a 5-of-8 score recorded four months later, is evidence of a documented trajectory — not a coordinator's memory of "she seemed a bit more forgetful lately."

Reading the Score: What a Low IADL, Intact ADL Profile Really Means

The scenario at the top of this piece — full ADL independence paired with a struggling IADL score — is one of the most common and most consequential patterns in early functional decline. It typically shows up first in the domains that require planning and sequencing: finances, medication management, and food preparation. A family member who sees an intact ADL checklist next to a low IADL score has something concrete to act on, rather than a vague sense that "something's different" that's easy to dismiss.

A checklist that only measures what the body can do, without measuring what the mind can organize, will always miss the person quietly running out of groceries while still managing to get dressed every morning.

This is also where the assessment earns its keep for care planning rather than just intake paperwork. A client scoring low specifically on medication and finance domains points toward a very different support plan — pill organization support and a bill-pay safeguard — than a client scoring low on shopping and transportation, who may simply need a driver and a grocery run scheduled into the week. The domain-level detail, not just the summed score, is what should drive which supports actually go into the plan.

Building the Checklist Into a Repeatable Process

A single IADL score, taken once at intake and never revisited, is a snapshot — useful, but limited. The real value comes from repeating the same eight-domain check on a defined cadence and comparing results over time, which is the broader discipline behind functional assessment for care planning. A few practical habits make that repeatable rather than accidental:

• Score all eight domains every time, even when a family reports "no real change" — self-report is frequently optimistic, especially around finances and medication.
• Timestamp every assessment, so a licensing reviewer or a family member can see exactly when a score was recorded and by whom.
• Keep domain-level detail alongside the summed score, not just the total, since the total alone hides which specific supports need to change.
• Compare the current IADL result against the current ADL result side by side — the mismatch between the two is frequently more informative than either score alone.

Doing this consistently across a caseload, rather than on an ad hoc basis per client, is what turns an assessment from a one-time intake form into an actual functional-tracking tool for the practice.

From Checklist to Documented, Versioned Assessment

A paper IADL checklist filled out once and stuck in a folder answers today's question. It doesn't answer the question a family, a new caregiver, or a state licensing reviewer asks six months from now: what was the documented functional status on a specific date, who assessed it, and how has it changed since. Structuring ADL and IADL scoring inside a version-tracked plan — rather than a static form — means every scored assessment carries its own timestamp and stays attached to the plan it informed, so the trajectory is visible rather than reconstructed from memory.

The ADL/IADL Assessment Pack includes structured, scored templates for both the Katz ADL index and the Lawton-Brody IADL scale, built to be filled in at intake and reused on a repeat cadence so domain-level changes are easy to compare assessment to assessment.