Pennsylvania Definitions of ADLs and IADLs

When you start to review senior care options, you will hear professionals talk about functional needs. Pennsylvania regulations divide these needs into two main categories: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

According to the state’s Older Adult Daily Living Centers regulation (6 Pa. Code §11.3), ADLs are the basic physical tasks required for personal self-care. IADLs are the more complex tasks required to manage a household and live independently.

Understanding these categories helps you communicate effectively with doctors, social workers, and home care agencies. It also directly impacts your loved one’s ability to get state assistance.

Why ADLs Determine Medicaid Waiver Eligibility

In Pennsylvania, adults who need long-term services and supports can apply for the Community HealthChoices (CHC) waiver. To qualify, your loved one must meet financial limits and be found Nursing Facility Clinically Eligible (NFCE).

The functional assessment is conducted by a local Area Agency on Aging assessor. In Philadelphia, this is the Philadelphia Corporation for Aging (PCA). The assessor performs a Functional Eligibility Determination (FED) by looking at your loved one’s abilities over the last three days.

The FED strictly counts hands-on help with ADLs. It does not count help with IADLs. If you spend hours every day cooking, cleaning, and shopping for your parent, the state does not count those hours toward nursing facility eligibility.

To meet the NFCE standard, applicants must fall into one of two groups. Group 1 requires at least one severe factor, such as needing hands-on help with three or more ADLs (bathing, personal hygiene, dressing, walking, toileting, eating), being bed bound, being in a coma, or being frequently incontinent of bowel.

Group 2 requires at least three factors from a broader list. This list includes hands-on help with two ADLs, mild to severe cognitive impairment, memory problems, confused or disorganized thinking, behavioral symptoms like wandering or aggression, using a wheelchair or scooter, or needing significant help managing medications.

You can learn more about these specific rules in our guide to Pennsylvania Medicaid waiver eligibility.

The Challenge of Cognitive Impairment in Assessments

The FED tool has a known limitation. It ignores the need for supervision or cueing. If your loved one has dementia, they might physically be able to dress themselves, but only if you stand next to them and hand them each item of clothing.

Because the FED strictly looks for hands-on physical help, people with cognitive impairment may be wrongly denied services.

If the Office of Long-Term Living (OLTL) denies your loved one’s eligibility, they will send a notice with appeal rights. You must appeal in writing within 30 days of the notice to request a Department of Human Services Fair Hearing. If they are already receiving services and face a cut, you must appeal within 15 days to keep those services in place during the hearing process. You can contact the Pennsylvania Health Law Project (PHLP) at 1-800-274-3258 for free legal help with appeals.

Need help finding the right care? New Century Home Care provides non-medical assistance across the Philadelphia region. Call us at 215-974-0000 or contact our Philadelphia office online by selecting “I am a client” and “I need services.” Our staff speaks English, Russian, and Ukrainian.

How ADLs and IADLs Shape Your Care Plan

Once your loved one is approved for the CHC waiver, a service coordinator from their CHC health plan will create a person-centered service plan. This plan dictates the types of services they receive and how many hours are approved per week. If you are paying privately, the home care agency uses these same definitions to assign the right caregiver.

Pennsylvania home care law (28 Pa. Code §611.5) defines home care services based entirely on ADLs and IADLs.

Personal care services involve direct physical assistance with ADLs. Caregivers provide help with self-administered medications, feeding, oral care, skin care, shaving, ambulation, bathing, hair care, grooming, dressing, toileting, and transfer activities.

Companionship services focus on socialization and support with IADLs. A companion can help your loved one manage their schedule, safely use transportation, and stay active in the community.

Homemaker services handle the household IADLs. Caregivers can manage incidental tasks like washing linens, cleaning bath towels, and doing dishes from meal preparation when no one else is available to do them.

Home care agencies provide non-skilled care. Aides cannot perform skilled nursing tasks. They cannot do wound care, give injections, administer medications, or perform nursing assessments. If your loved one needs skilled medical care, they will require a prescription for a separate home health nurse.

Preparing for an Assessment: An At-Home Checklist

When the local Area Agency on Aging assessor arrives, you must accurately present your loved one’s functional limits. Many families make the mistake of describing a “good day” or minimizing the struggle out of pride.

You must describe a typical bad day. Follow these steps when you apply for Medicaid home care to ensure the assessor gets a clear picture:

1. Track hands-on help: Write down every time you physically touch your loved one to help them bathe, dress, eat, transfer, or use the toilet over three consecutive days.
2. Document cognitive symptoms: Note specific instances of memory problems, confused thinking, or behavioral symptoms like wandering, verbal aggression, or socially disruptive behavior.
3. Separate the IADLs: Make a list of the meal prep, shopping, and housework you do. Keep this separate, as you now know these tasks will not qualify them for the waiver.
4. Gather medical evidence: Ask the doctor’s office to return the IEB’s Physician Certification form within 5 business days, and share any medical records you want considered at the assessment.

Other Pennsylvania Programs Relying on Functional Needs

If your loved one does not qualify for the CHC waiver, their ADL and IADL needs still matter for other state programs.

The Pennsylvania Caregiver Support Program provides reimbursement for caregiving expenses. It requires the care receiver to be 60 or older with functional deficits, or any age with Alzheimer’s disease or a related disorder. Caregivers can receive up to $600 per month in reimbursement for approved supplies and respite care. You apply for this program through your local Area Agency on Aging.

The LIFE program (PA’s PACE) also relies on functional needs. Participants must be 55 or older and meet the same NFCE standard based on ADLs and cognitive needs. They must also be financially eligible for Medical Assistance and able to live safely in the community.

Getting the right support starts with understanding your loved one’s daily needs. Call New Century Home Care at 215-974-0000 or fill out our online form by choosing “I am a client” and “I need services.”