In this blog series, we examine the differences between activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and what happens when they become difficult for a person.
Instrumental activities of daily living (IADLs) are the more complex daily tasks that support independent living in the community — activities such as managing finances, shopping, preparing meals, handling medications, driving or using transportation, and maintaining the household.
As noted in part 3 of our “ADLs vs. IADLs” series, the ability to perform IADLs often declines before basic activities of daily living (ADLs) like bathing, dressing, eating, and mobility. Evaluating IADL performance gives clinicians and families useful insight into an individual’s functional health. When IADLs become difficult, the situation can influence decisions about care and the timing of a senior living move.
>> Related: ADLs vs. IADLs Part 1: What Are Activities of Daily Living and Why Do They Matter?
Common routes when IADLs become difficult
Clinicians use IADL ability as a practical measure of how well someone can manage the cognitive and physical demands of everyday life. When IADLs decline, families and clinicians usually consider three main approaches to preserve safety and quality of life. Each option has benefits and tradeoffs, similar to the choices people face when ADLs become a concern.
Unpaid family caregivers
Many families step in first when IADLs become challenging. Adult children, spouses, partners, or friends often help with grocery shopping, transportation, bill paying, and medication reminders.
Recent national caregiving data show that millions of Americans provide unpaid care to loved ones, much of it IADL support. Unpaid caregivers can help an older adult remain at home and retain independence longer, but caregiving can create physical, emotional, and financial strain. Dependence on a family caregiver also introduces vulnerability if that caregiver becomes unavailable.
Paid in-home caregivers or community services
Paid home care aides, homemaker services, grocery and meal delivery, transportation services, and medication management solutions can address many IADL needs. However, these services still require coordination: someone must find, hire, schedule, supervise, and sometimes train providers. Service availability and reliability can vary by region.
For moderate IADL needs, a combination of paid services and home modifications may allow a person to stay safely at home for an extended period. Keep in mind Medicare generally does not cover most personal care services; some people may qualify for Medicaid waivers or Veterans benefits. Private pay costs can accumulate quickly, so affordability is an important consideration.
>> Related: Home- and Community-Based Services: An Increasingly Popular Care Option
Moving to assisted living (or a continuing care community)
When IADL needs are persistent, complex, or paired with early ADL decline or cognitive concerns, a residential care community may be the safest or most practical choice. Assisted living communities typically provide meals, transportation, medication management, and housekeeping, simplifying daily life and improving safety.
A continuing care retirement community (CCRC) or life plan community offers a full continuum of care — from independent living to assisted living and skilled nursing — often on a single campus. Moving proactively to a CCRC while still relatively healthy can reduce stress for the individual and family and provide quicker access to higher levels of care if needs increase. That said, CCRCs often require financial planning and certain contract types may not be available to people who already require significant care.
>> Related: Understanding the CCRC Health Evaluation Requirement: When Is the Right Time to Move?
Practical steps for assessing long-term IADL needs
It is normal for some IADLs to become harder with age. Making a clear decision about staying at home with supports or moving to a community setting becomes easier when you honestly assess current needs, supports, and options for the future. Key steps to consider:
- Take stock of which IADLs you can do independently and which you find difficult. Consider this list and be candid with yourself:
- Managing money and paying bills
- Shopping for groceries and essentials
- Preparing meals
- Using transportation or driving
- Managing medications and appointments
- Using a phone or other technology
- Keeping the home reasonably clean and safe
- Try short-term in-home supports such as a paid aide, grocery or meal delivery, or a medication management service to see what difference help can make.
- Assess whether relying on unpaid family caregivers is sustainable, and whether paid in-home help is affordable and reliably available long term.
- Tour CCRCs and care communities early while you are still healthy to preserve more options and make informed comparisons.
- Plan financially by researching senior living contract types, entrance fees, monthly costs, and which services are included versus which carry extra charges.
>> Related: When “What If” Happens: What to Do After a Health Crisis
Acting early on IADLs keeps your options open
Difficulty with IADLs is often an early sign that independent living may require additional support over time. Recognizing these changes and making a plan — whether that means arranging home-based help, modifying the home, or touring senior living communities — helps people age more safely and with greater confidence.
Taking proactive steps now, such as honestly assessing IADL abilities and exploring living options while healthy, can preserve independence longer and reduce the likelihood of a crisis-driven move, which is often stressful for both the older adult and their loved ones.