Activities of Daily Living (ADLs) are the foundation of caregiving and will determine how individuals receive care. Like we talked about last week, ADLs have a large impact on what programs are accessible to you.
Let’s start first with the definition of ADLs. ADLs are fundamental skills required for independently caring for yourself. If any of these skills are impaired, then someone will need to step in to provide support or complete the skill themselves in an effort to preserve quality of life. ADLs can include bathing, toileting, hygiene, mobility, and nutrition.
Most people will gradually need help with each ADL over time. As your loved one needs increasing amounts of assistance with multiple ADLs, it is likely a good idea to explore getting professional help so that your loved one is comfortable with receiving care before they progress further into their ADL needs.
ADLs also play a big role in our EPAGA Accredited Caregiver Training, which every caregiver we hire must pass before going into a family’s home. We spend 16 hours covering each ADL, so caregivers are prepared for any situation they may encounter. We utilize a group called PA Home Care to provide video training to our caregivers, which is also available to the public. We recommend that families explore this resource as well if they hope to play a role in supporting their loved ones through ADLs. Visit https://www.pahomecare.org/ for more information about their training.
Safety
One of the most important reasons to go through ADL training is to ensure you are safely assisting your loved one or client. There are many injuries that can occur if you are not properly using safe techniques.
One of the most dangerous areas for both the caregiver and the care receiver is the bath. Not only does this pose risk for hurting your back during lifting, but there is increased slipping hazard with wet floors.
Bathing
Bathing can be made much safer with fairly inexpensive, simple modifications. Adding extra handles, shower seats, and hand-held shower heads can provide more safety; not only for you, but also for the person you’re caring for as well. For those who may still prefer to stand while showering, consider adding a traction mat to the floor of the shower to prevent slipping. We’ve even encountered situations where bathing isn’t a viable option if the shower is on a different level of the home. In such cases, there are tools such as portable showers that we’ve seen implemented and utilized successfully.
Aside from the safety of bathing, there are other hygiene factors to consider based on the individual. Generally, seniors don’t need to bathe as frequently as people may think. Since they generally aren’t doing as much physical activity, it is very normal for seniors to bath only a few times per week. However, there are situations where daily bathing is necessary. Individuals with incontinence issues may need to bathe more often (as needed); sometimes even multiple times a day, if necessary.
Seniors also need supplemented skin care/hydration as their skin ages. It is crucial to monitor their skin health closely as water temperatures in the bath/shower can be more damaging to their skin than a younger person. Another important part of bathing is applying lotion afterwards to keep the skin healthy. As skin ages, it becomes more brittle and requires more moisture to keep it healthy.
Hair care is also an important factor in bathing. For those who may be bed bound, it is vital to ensure that the individual’s hair is regularly brushed to prevent matting.
Toileting
Toileting is one of the most invasive and personal ADLs and can bring the most discomfort to the care receiver if not handled with the utmost professionalism. These moments require caregivers to practice the EPAGA love that we frequently reference—agapé love.
Aside from balancing privacy and health of the client, there are other concerns to keep in mind for successful assistance. Be sure to have all of your supplies on hand and ready to go so you don’t have to leave the individual alone while you leave to grab something you may have forgotten. Have gloves, wipes, and toilet paper readily accessible and ready to use. Be diligent in sanitation—be sure to wash your hand thoroughly with soap and warm water before and after assisting with toileting.
For the time in between toileting, consider using Depends or Pull Ups to prevent accidents for those struggling with incontinence. For those with Depends or Pull Up Underwear, be sure to change them regularly, as Urinary Tract Infections are common in elderly and extremely difficult to treat. Keeping Depends or Pull Ups on too long can cause bacterial transmission and is a primary vector for UTIs among seniors.
Dental Care
Dental hygiene is important to overall health. It’s important to know the proper protocols for caring for dentures and teeth. Consult with your loved one’s dentist to ensure you and your caregiver are providing the proper care.
Transfers and mobility
As we mentioned in bathing, back safety is a must when lifting or providing mobility support. It can be easy to find yourself in a situation where a loved one has fallen and you lift them back up, only to injure yourself. This is a very common scenario and will put even more challenges on the family. Be sure to always know your limits when lifting or transferring someone. While we are in the home to serve them, it should never come at the cost of our own health.
Performing an unsafe lift can also put your loved one at risk. If you were to hurt yourself while doing a lift and drop them, this can further injure them. Waiting for a second lifter to assist you might feel excessive, but is often times the right thing to do if you truly need help.
For some, just a slight boost is all that is needed. We love using chair lifts for these situations. Not only are they great tools, but it allows the user to maintain some level of independence. Other tools we use are hoyer lifts, gate belts, and stair lifts. These not only provide safety to the caregiver, but also to the care receiver.
Eating and Meal Preparation
Ensuring that the care receiver’s nutritional needs are met is crucial to keeping them healthy at home. There are many factors that impact nutritional needs including but not limited to pre-existing conditions, injuries to the throat, and difficulty with swallowing. Be sure to follow the doctor’s recommendations for your client’s diet closely. Blend and liquify meals for those who struggle with swallowing.
Another often forgotten component of nutritional intake is protein consumption. This can be challenging, as protein is generally difficult to consume on a regular basis for those with shrinking appetites. We’ve seen great success with protein shakes and smoothies, and they are a great way to ensure that daily protein requirements are met.
For small appetites, try having snacks around like nuts, pretzels, and trail mix. Sometimes this is a great way to get those who can’t eat entire meals to meet their nutritional requirements periodically throughout the day.
The most important nutrient of all is water. Dehydration is one of the most dangerous conditions that is often overlooked, and can have detrimental affects on our health, especially in an elderly patient with increasing vulnerability.
Exercise
Ensuring that your loved one or client gets up and moving is vital. Simple movements will keep blood flowing and prevent muscle atrophy from long periods of stagnancy. Little tricks we’ve found have been encouraging laps around the living room, walking to the mailbox, or even just sitting down and standing up 10 times. It doesn’t have to be much, but getting some movement out of their muscles will help all of their physiological systems thrive.
Incidental Activities of Daily Living (IADLs)
IADLs are incidental tasks that can be further affected if certain ADLs are not possible. While these tasks in and of themselves are critical to daily life, it is important these tasks get done regularly to keep a safe and suitable environment. Some IADLs might include laundry, light housekeeping, transportation to appointments, medication reminders, community integration, and communicating with family members. These are not tasks caregivers generally do on their own, but rather in combination with other ADL tasks.
ADLs are the foundation of caregiving and which ones need intervention will dictate what level of care a person needs. Understanding these activities will help you better identify when a loved one might need additional care.