As anyone caring for an elderly parent knows, it’s difficult to decide when you need more help. The Katz Index of Independence in Activities of Daily Living (Katz ADL) can aid you in determining when it’s time to get extra assistance for your loved one. 

Read on to learn more.

A lady is helping an elderly gentleman get out of a chair.

What is the Katz Index of Independence in Activities of Daily Living?

While it may be a mouthful, the Katz Index of Independence in Activities of Daily Living (Katz ADL) is a simple tool. In a nutshell, it’s a test used to help determine how much assistance a person may need with their activities of daily living (ADL). 

Activities of daily living are a fancy way of saying the things we must do every day to survive and have a happy life, such as eating and bathing ourselves. When we are unable to perform these essential tasks, our quality of life suffers, and we must have help to manage.

The Katz ADL has been around for many years and is considered to be a valid and reliable tool. Simply put, the instrument is used to assess a person’s ability to perform basic self-care tasks and can be used to not only assess where a person is at concerning their level of independence but also monitor how they progress over time.

Developed in the 1960s by Dr. Sidney Katz, a rehabilitation medicine specialist for the prognosis and assessment of elderly or chronically ill patients, the Katz ADL has six components: 

  • Dressing
  • Bathing, 
  • Toileting
  • Transferring 
  • Ambulation  
  • Feeding

Now that you know the Katz ADL let’s look at how it is administered and, specifically, what an ADL score is.

What is an ADL Score?

Healthcare professionals use the Katz ADL instrument to assign an ADL score, which is a measure of an individual’s functional status. The Katz ADL scale rates the ability to perform the six activities of daily living we listed above. 

During the assessment process, each activity is rated on a four-point scale from complete independence (4 points) to complete dependence (0 points). A person’s overall ADL score is the total of the scores for each of the six activities.

Once an ADL score is assigned to a patient, these scores can be used to determine how much support the patient will need from others to complete their activities of daily living. The higher the score, the more support the patient will need.

There is another number you should be aware of, and that is the Instrumental Activities of Daily Living score.  The IADL is used when assessing daily tasks that are more complex than the six basic tasks in the Katz ADL but are still necessary for an independent life. Tasks on the Katz IADL are things like going shopping or managing medication.

For this article, we will first focus on the basics, so let’s dig a little deeper into the six activities of daily living measured by the Katz ADL.

What does the Katz Index Measure?

The Katz Index of Independence in the Activities of Daily Living breaks down the things we do daily into six measurable activities. Here’s a little more information on each.

1. Bathing

When a person is assessed for their ability to bathe, this means that the individual can perform activities like showering or taking a bath unaided. This is an important part of daily living, as hygiene is crucial for good health, not to mention maintaining a sense of dignity for the elderly person. 

2. Dressing

The term “dressing” on the Katz ADL refers to the ability to put on and take off a shirt, trousers, or skirt; this also includes being able to manage buttons, zips, and laces.

3. Toileting

Toileting refers to using the toilet without help and also includes being able to sit on and off the toilet seat, as well as wiping oneself clean afterward. Again, this is an important part of daily living for obvious reasons.

4. Transferring

Transferring means moving from one place to another, such as moving from a bed to sitting in a chair. The ability of a person to transfer oneself from one place to another is crucial for maintaining independence and quality of life.

5. Continence

Continence describes the ability to control one’s bladder and bowel movements. A person who is continent can hold their urine or stool until they can go to the toilet at an appropriate time. 

6. Feeding

Food is a necessity of life, and when people lose their ability to feed themselves, it can be devastating. The Katz ADL measures feeding by looking at a person’s ability to lift food from the plate to their mouth successfully.

Now that we know the six activities of daily living that are monitored by the Katz ADL, keep reading to learn how each activity is scored.

How Do You Score Activities of Daily Living?

The scoring system for the Katz ADL is straightforward. If a person can perform a task with no one to guide them or offer assistance, they score one point for that task. 

If, however, they require assistance, or need direction, or care to complete the action, they score a zero for that task. 

The total number of points possible is six. The higher the points, the more independent the person is in their activities of daily living.

So, you know the tasks, and you know how they’re scored. You’re likely wondering if you should use the Katz ADL to determine if you need help for your elderly loved one or maybe get an even more extensive picture of their situation by using the Katz IADL.

When Should You Use the Katz IADL for Your Elderly Loved One?

It’s never easy to recognize when it’s time to reach out for extra help when you’re caring for an elderly relative or friend. Once you’ve created a general picture of how your loved one is coping with the six basics of daily living, the Instrumental Activities of Daily Life will give a clearer picture of your loved one’s abilities in other areas, like communication or money management.

The Katz IADL doesn’t just pinpoint overall ability; it also gives you a window into specific areas where your loved one may need extra help, giving you and your healthcare team a chance to create an individualized care plan. 

The added bonus (besides peace of mind) to obtaining an IADL rating is that it will help you obtain Medicaid and Medicare coverage for services you may need, such as homecare or other fees that may arise due to necessary support or interventions required by your loved one.

Because the Katz IADL looks at more comprehensive skills than the basic ADL, it will give you a more accurate assessment of a person’s needs. So, just how accurate is it?

Is the Katz IADL Accurate?

Dr. Katz assessed many individuals and characterized many characteristics of daily life to develop IADL. Over time, the test has been tweaked and enhanced to develop a thorough and complete picture of the activities required in everyday life and the different skills needed to accomplish them.

Because of this careful development,  the Katz IADL is highly accurate for gauging a person’s level of function in their day-to-day life and the help they may need. There are some instances where more in-depth testing is needed, but in most cases, the IADL is all that is required by the government and insurance companies to determine the level of help needed. 

In addition, because the Katz IADL is easy to use and understand, it is the go-to test for creating individualized support plans for elderly people. So what’s the next step?

What Should Your Next Step Be After the Test?

After you have your Katz IADL rating and know the areas where your loved one needs help, the next step is to find a care plan that will work for both of you. This may include in-home care, assisted living, or nursing home care. 

You can also look into respite care to give yourself a break from caring for your loved one. Be sure to talk with your loved one about their preferences and needs before making any decisions.

Make sure to research all possible resources or plans of support, such as the Consumer Directed Personal Assistance Program (CDPAP) offered in the State of New York, which would allow you to choose an in-home caregiver of your choice.

There are many options out there, and you don’t have to do it alone. By utilizing the Katz Index of Independence in Activities of Daily Living and working together with your healthcare provider, both you and your loved one can get the help you need for a happier, more independent life.

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