Why is helping residents with Activities of Daily Living (ADLs) so important?

In many cases, older Australians in residential aged care require assistance with Activities of Daily Living (ADLs) – a term to describe daily self-care activities within the facility. ADLs are used as a measurement of a person’s functional status. These are basic, essential tasks that are part of every person’s daily life, and therefore, it’s important that you understand what ADLs are, as well as their clinical significance. In the business of providing care, the phrase “activities of daily living” is the basic skills needed to properly care for oneself and meet one’s physical needs in six areas: eating, dressing, bathing, toileting, continence and mobility. You can help a resident with everyday activities while supporting his/her independence and helping the resident keep a sense of self-respect.

Why is helping residents with everyday activities so important?

ADLs represent everyday tasks that challenge both mental and physical capabilities. A person needs to have the physical ability to perform ADL tasks themselves, and the planning and mental capacity to conceptualise the tasks and understand what needs to be done. Think about all of the little things you need to do each day. Just to start your day you must get out of bed, take care of your personal hygiene (bathe or shower, shampoo hair, brush teeth, etc.), pick out clothes, get dressed and get something to eat. As the day goes on there are many more activities that are so basic that most of us take them for granted. In completing most of these activities many little steps are involved. For example, getting out of bed requires that you are able to roll to the side of the bed, swing your legs over the edge of the bed, place your feet on the floor and stand.

Now think about what would happen if you couldn’t do these things any longer or had great difficulty in doing them. Like most people, you would find that life was getting more difficult and you might feel frustrated, helpless or vulnerable. For many people, a loss in the ability to do the simple daily things can make them feel badly about themselves and angry with the world around them. If the residents you serve have these kinds of feelings about everyday activities, you can be sure that the quality of their lives will not be as high as it could be. This is important because a major part of what you do as a personal care worker is aimed at helping people maintain or improve the quality of their lives.

WHAT ARE ACTIVITIES OF DAILY LIVING (ADLS)?

The term activities of daily living was first coined by Sidney Katz in 1950. ADL is used as an indicator of a person’s functional status. The inability to perform ADLs results in the dependence of other individuals and/or mechanical devices. Health professionals routinely refer to the ability or inability to perform ADLs as a measurement of the functional status of a person, particularly in regards to people with disabilities and the elderly. ADLs are best defined as; “The things we normally do…such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure.” While basic categories of ADLs have been suggested, what specifically constitutes a particular ADL in a particular environment for a particular person may vary.

TYPES OF ACTIVITIES OF DAILY LIVING:

The activities of daily living are classified into basic ADLs and Instrumental Activities of Daily Living (IADLs). The basic ADLs (BADL) or physical ADLs are those skills required to manage one’s basic physical needs, including personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating. The Instrumental Activities of Daily Living (IADLs) include more complex activities related to the ability to live independently in the community. This would include activities such as e.g., managing finances and medications, food preparation, housekeeping, laundry. Understanding how each category affects a person’s ability to care for themselves can mean the difference between graceful and independent aging and needing daily assistance.

ACTIVITIES OF DAILY LIVING (ADLS) are basic tasks that must be accomplished every day for an individual to thrive. Generally, ADLs can be broken down into the following categories:

  • Bathing and ShoweringIncludes washing one’s face and body in the shower or bathtub.
  • Personal Hygiene – This refers to choosing outfits, dressing one’s self, and the ability to manage one’s appearance adequately. eg. shaving, oral, nail and hair care.
  • Continence Management – A person’s mental and physical ability to use the toilet; being able to control one’s bowels and bladder. In this situation, in terms of getting to and from the toilet, using it correctly, and the personal hygiene involved with cleaning oneself afterward. 
  • Dressing – A person’s ability to select and wear appropriate garments and being able to dress and undress, having no trouble with buttons, zippers or other fasteners.
  • Feeding – Whether a person can feed themselves or needs assistance.
  • Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.

If a person is not fully independent with ADLs, more information is provided about the amount of assistance they require. For each ADL, people can vary from needing just a little help (such as a reminder or “stand-by assist”) to full dependency, which requires others to do the task for them.

MORE COMPLEX OR INSTRUMENTAL ADLS (IADLS) are somewhat more complex thinking skills, but nevertheless also reflect on a person’s ability to live in the community independently. They generally require greater thinking skills, including organisational skills:

  • Using the telephone: being able to dial numbers, look up numbers, etc.
  • Managing medications: taking the appropriate medications and correct dosages on time
  • Preparing meals: making appropriate food choices and preparing meals safely
  • Maintaining the home: doing or arranging for housekeeping and laundry
  • Managing finances: budgeting, paying mortgage/rent and bills on time, etc.
  • Shopping: being able to shop for groceries and other small necessities, and transport purchases from store to home
  • Using transportation: being able to drive or use public transportation for appointments, shopping, etc.
  • Companionship and mental support – This is a fundamental and much needed IADL for daily living. It reflects on the help that may be needed to keep a person in a positive frame of mind

As you can see, many activities are part of everyday life. For some of the residents you assist, your help with ADLs and IADLs will have a great impact on their ability to participate in and enjoy life. For others, you will be the only way they are able to complete much of what they need to keep safe and healthy from day to day.

WHAT CAUSE CHANGES IN ADL’s AND IADL’s?

Many things can cause a change in a resident’s ability to perform these basic activities. It is important to know four basic things about changes in ADLs and IADLs:

  1. Some residents have been unable to perform some activities for quite some time, maybe years. These residents have had a longer time to adjust to their loss and also know a great deal about how they like to be helped. Eg. Mrs. Smith may like to brush her teeth before brushing her hair, or she may like to get dressed by putting on clothes in a particular order, or go to bed at a certain time. Wherever possible, it is important to honour these preferences.
  2. Other residents have experienced a recent loss of ability, which means that they have had less time to adjust to their losses and may still be learning about how they can best receive help. In some cases the resident is also trying to adjust to the fact that they may never recover the ability they’ve lost. Some residents have a high ability to adjust to their loss, while others find it more difficult and may display sadness, anger or frustration. It is important to know that the angry things a resident may say is probably not directed at you, but is really anger at the loss. To overcome and adjust to loss in ability, it is often helpful that residents have a strong sense that they can still have some control in their everyday lives. For this reason it is important to involve residents in choosing how activities will be completed and encourage them to do as much as they can do on their own.
  3. It is likely that a number of residents with whom you work will have experienced loss in the ways their brains function and are unable to remember, solve problems or even be fully aware of what is taking place around them. For some of these individuals, each time you interact with them is like the first. Being patience and understanding are critical elements of being a caring worker. You must accept and honour that their experiences are real for them. You can also provide hints and suggestions for these residents. Eg. Mr Brady forgets to bring a jacket when going outside in cold weather. You can give him a cue by saying, “Mr. Brady, the weatherman says it is cold outside today. I’m going to get my jacket. Would you like me to get yours?”
  4. Finally, some residents will be experiencing a temporary loss in their mental or physical abilities from which they will eventually recover. This loss may be due to a mental illness, dementia, injury or the process of recovering from surgery. These residents will not have the same sense of having to make permanent adjustments in how they do things. So, it is not unusual for them to be impatient with the recovery process. Once again, patience and understanding on your part are important tools to use when you interact with these residents. Additionally, they may need encouragement to do as much as possible as part of their recovery. You should always check their care plan or speak with the RN to see how you can best assist.

FOUR GENERAL HELPING RUKLES TOI ASSIST CARE WORKERS:

  1. The care plan is the starting place for knowing what kind of help is needed by each resident. The care plan is the tool that provides the basic information for how you will care for a resident. Each care plan should give a clear picture of the resident’s needs and preferences. Always make sure you read and understand the care plan for each resident you assist.
  2. When you are unsure about preferences or if help is needed, ask. Sometimes you will observe a resident struggling with a task, or even after having read the care plan, you may not be sure of the resident’s needs or preferences. While your immediate impulse might be to simply start helping, it is better to ask first. If you have a resident who cannot understand or respond to your questions, try to find out from the RN or other care workers who know about the resident’s preferences. 
  3. Try to use a “person-centered” approach. A “person centered” approach involves respecting and honoring the uniqueness of each resident and respecting that person’s right to be involved in all decisions that impact on his/her life. These include the little decisions about how ADL’s and IADL’s are accomplished with your help.
  4. If you believe the resident is in immediate danger of injury, move to help right away. For example, if a resident has fallen asleep and is about to fall out of a chair, get another care worker and move to help reposition him/her immediately.

WHY ARE ADL’s IIMPORTANT?

Functional status and the ability to care for oneself have a significant impact on a senior’s quality of life. Changes in ADLs can be caused by underlying medical conditions, but failing to recognise these growing needs can also contribute to a cycle of physical and mental health problems. Unmet needs for help with activities of daily living can lead to malnutrition, poor personal hygiene, isolation, illnesses like urinary tract infections (UTIs) and falls. Ensuring a resident has the daily care they need can help prevent new and worsening health issues.

When assisting residents with ADLs, remember that your goals are different to theirs. What might be a work task to you is another person’s daily routine and life. For example, while you might be rushing to transfer a resident from their bed to a chair because you know you have other residents to attend to, the client might just want to watch television without being disturbed (ATrain Education 2014). It’s also important to understand where independent living is encouraged, being unable to perform ADL’s may cause feelings of fear and distress due to the associated loss of autonomy. (Edemekong et al. 2020).

AS CARE WORKERS, WE CAN :

  • supervise or assist older people during walking, transfers and ADLs if required
  • create a continence and mobility plan that fits with patients sitting out of bed for meals
  • adjust bed height to allow for safe, independent transfers
  • orient our residents to the ward, showing them where the toilet is
  • provide a culture that encourages incidental exercise
  • provide aids to assist with optimal transfers and mobility
  • avoid using bed rails, which may limit mobility and be a hazard
  • improve our understanding of the risks of restricting mobility and provide strategies to prevent de-conditioning.

WHEN ASSISTING RESIDENTDS WITH ADL’S, WE CAN :

  • allow the resident to express their wishes and respect their autonomy (e.g. accept that a client might not want to do a particular task);
  • make eye contact when speaking to them;
  • be patient, and use a calm demeanour and voice;
  • offer the resident choices e.g. would you like apple juice or orange juice?;
  • be empathetic;
  • give the resident enough personal space and avoid crowding them;
  • use non-challenging body language;
  • allow plenty of time to assist the resident with the ADL;
  • give the resident clear, simple instructions.

AN AGED CARE ENVIRONMENT IS IMPORTANT IN PROMOTING MOBILITY AND SELF CARE FOR RESIDENTS. WE SHOULD ;

  • clear any clutter;
  • ensure obstacles to mobility or self-care are moved;
  • ensure any tools or aids for mobility or self-care are clean and maintained;
  • ensure bed and chair heights are optimal for independence;
  • avoid using bed rails, which may limit mobility and be a hazard;
  • supervise and assist residents who are acutely unwell during walking and transfers.
  • consult the RN in Charge if we are in doubt about the supervision needs of residents.

In addition to the basic steps already listed, several other things should be considered. It is important that the residents’ cultural preferences and beliefs be considered. Eg. you may have a resident who wants to pray before each meal. While you do not have to pray with the resident, it is important that you sit quietly and respectfully while the resident does this. You should also be sensitive to the fact that many people’s food preferences are strongly influenced by their culture, ethnic background and religion. These preferences should be honoured when possible.

You may also have responsibilities to help prepare the dining room for meals. You might be involved in removing clutter or hazards, reducing distractions such as loud noise or cleaning the table. You may also encounter residents who don’t eat at times pre-set by the aged care facility. Eg. you may have a resident who likes to wake up at 10 a.m. and breakfast in their room instead of the 8 a.m. breakfast call. Honour preferences by being flexible.

As a Residential care worker, you will need to have a personality that is empathic, understanding, non-judgemental and above all, be able to create a positive and safe living environment for the resident.  No two days are the same for a Residential care worker, you will be responsible for providing physical care, recreation, teach daily living skills and create a positive and safe living environment.

In response to the COVID-19 pandemic, aged care workers must enhance infection prevention and control measures to reduce the risk of transmission. COVID-19 is a significant health risk particularly for older people and individuals with co-morbidities or low immunity. International, national and state reports show residential aged care facilities (RACFs) are particularly susceptible to COVID-19 outbreaks.

Infection prevention and control practices can include:

  • hand hygiene and respiratory hygiene (cough etiquette)
  • face masks (if within 1.5 metres of patients/residents)
  • PPE if in contact with bodily fluids, including donning and doffing of PPE if required
  •  aseptic techniques for clinical procedures
  • disposing waste
  • disinfecting home environment and equipment shared by residents each time – staff should wear impermeable disposable gloves, a surgical mask, and eye protection or a face shield while cleaning and avoid touching their face, especially their mouth, nose, and eyes when cleaning.

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