Activities of Daily Living (ADL) – Daily Life Functions 

Purpose: 

• To assist residents in achieving maximum function. 

• To provide necessary assistance to residents. 

• To supervise and assess resident function to plan care and maintain optimum ADL function as long as possible. 

• To re-educate residents in techniques of daily life functions. 

• To teach residents the use of assistive devices to maintain optimum ADL function as long as possible. 

• To improve quality of life. 

Equipment: 

• Appropriate clothing. 

• Appropriate footwear. 

• Appropriate assistive devices. 

Procedure: 

1. General Guidelines: 

• Ensure verbal directions are clear and concise; speak directly in front of the resident and repeat directions as needed. 

• Demonstrate techniques when necessary. 

• Use frequent repetition, especially with confused residents. 

• Place articles of clothing within easy reach of the resident, encouraging their participation. 

• Support residents with balance issues to prevent falls. Seat them in a sturdy chair against a wall or use a wheelchair with brakes set. 

• If the resident cannot sit in a chair, dressing can be completed partially or entirely in bed. 

• Adjust clothing to fit the resident's needs, such as larger sizes, loosely fitting sleeves, front or back openings, large buttons, and easy-to-wear materials. 

2. One-Handed Dressing Techniques: 

Shirt or Blouse with Front Opening: 

• Method I: 

1. Grasp the collar and shake the shirt out with the unaffected hand. Position the shirt on the lap with the inside facing the resident and the collar toward the chest. 

2. Position the shirtsleeve for the affected side with the unaffected hand, making the opening as large as possible. 

3. Place the affected hand into the sleeve and work it up over the elbow by pulling on the garment. 

4. Insert the unaffected arm into the sleeve and raise the arm to shake the sleeve into position past the elbow. 

5. Gather the garment at the middle of the back from hem to collar with the unaffected hand and raise it over the head. Lean forward and pass the garment over the head. 

6. Adjust the garment by leaning forward and working it down past the shoulders on both sides with the unaffected hand. 

7. Button the garment starting from the bottom. 

8. Fasten the cuff on the unaffected side by buttoning before putting on the garment. Use elastic thread or Velcro if needed. 

• Method II: 

9. Position the garment and work it onto the arm as described above. 

10. Position the sleeve on the affected side up to the shoulder. 

11. Grasp the tip of the collar with the unaffected hand. 

12. Insert the unaffected arm into the sleeve by directing the arm upward and outward. 

13. Adjust the garment and button as described above. 

Removing a Shirt or Similar Garment: 

• Method I: 

14. Unbutton the garment. 

15. Lean forward and free the garment from the back. 

16. Gather the garment up the back with the unaffected arm. Lean forward, lower the head, and pull the garment over the head. 

17. Remove the garment from the unaffected arm first, then the affected arm. 

• Method II: 

18. Unbutton the garment. 

19. Throw the garment back off the shoulder on both sides and pull down on the sleeve of the unaffected side. 

20. Lean forward, bring the garment across the back, and remove it from the affected side. 

Pullover-Shirt Type of Garment: 

• Putting On: 

21. Position the garment on the resident’s lap with the bottom toward the chest and the collar facing downward. 

22. Roll the bottom edge of the garment to the sleeve on the affected side. 

23. Position the sleeve opening as large as possible and place the affected arm into the sleeve. 

24. Insert the unaffected arm into the sleeve. 

25. Adjust the garment on the affected side onto the shoulder. 

26. Gather the garment at the back, lean forward, lower the head, and pass the garment over the head. 

27. Adjust the garment. 

• Removing: 

28. Start at the top back, gather the garment, lean forward, lower the head, and pull forward over the head. 

29. Remove from the unaffected arm, then the affected arm. 

3. Trousers (Adaptable for Shorts or Underwear): 

• Method I – Sitting Position: 

30. Resident sits in a straight chair or wheelchair. 

31. Position the unaffected leg directly in front of the midline of the body with the knee flexed to 90 degrees. Lift the affected leg over the unaffected leg. 

32. Slip trousers onto the affected leg up to the knee. 

33. Uncross the affected leg and insert the unaffected leg. 

34. Stand and pull trousers over hips, using a belt loop or suspenders if needed. 

35. Sit down to button the garment. 

• Method II – Unable to Stand: 

36. Secure the wheelchair or place a straight chair against the wall. 

37. Cross the affected leg over the unaffected leg and work trousers up to the knee. 

38. Insert the unaffected leg and work the trousers up onto the hips. 

39. Lift hips from the bed using the unaffected leg and arm to pull trousers over hips. 

40. Sit down to button the garment. 

• Method III – Lying Position: 

41. Position the bed so the resident is partially sitting. 

42. Cross the affected leg over the unaffected leg and work trousers onto the unaffected leg. 

43. Lift hips from the bed using the unaffected leg and arm to pull trousers over hips. 

44. Sit down to button the garment. 

Removing Trousers: 

• Method I – Able to Stand: 

45. Unfasten trousers and work down on hips. 

46. Stand and let trousers drop past hips or work them down. 

47. Cross the affected leg over the unaffected leg, remove trousers, and uncross legs. 

48. Remove trousers from the unaffected leg. 

• Method II – Unable to Stand: 

49. Unfasten trousers and work down on hips. 

50. Lean back and push down to elevate hips. 

51. Proceed as in Method I. 

• Method III – In Bed: 

52. Lift hips and work trousers down. 

53. Remove from the unaffected leg, then the affected leg. 

4. Brassieres: 

• Hook brassiere in front and slip the fastener to the back at waist level. 

• Place the affected arm through the shoulder strap, then the unaffected arm. 

• Add elastic to straps for ease if needed. 

5. Stockings (Socks): 

• Resident sits in a straight chair with arms or in a wheelchair. 

• Cross the affected leg over the unaffected leg. 

• Open the top of the stocking and work it onto the foot, eliminating wrinkles. 

• Work the stocking up onto the leg. 

6. Short-Leg Braces: 

• Putting On: 

54. Resident sits in a straight chair or wheelchair. 

55. Cross the affected leg over the unaffected leg. 

56. Pull the tongue of the shoe up through the laces. 

57. Hold the brace by the top inside portion of the metal bar. 

58. Swing the brace back and forward so the heel is between the uprights. 

59. Swing the shoe forward and insert toes into the shoe. 

60. Turn the shoe inward slightly and insert the foot into the shoe. 

61. Use a shoe horn if needed to help the foot slip into the shoe. 

• Removing: 

62. Cross the affected leg over the unaffected leg. 

63. Unfasten straps and laces. 

64. Push down on the upright until the shoe is off the foot. 

Compliance and Documentation: 

• Ensure all ADL assistance procedures comply with CMS guidelines and the Requirements of Participation for Long-Term Care Facilities. 

• Document all aspects of ADL assistance accurately in the resident’s care plan. 

• Regularly review and update ADL techniques according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper ADL assistance techniques to ensure resident safety and comfort. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.