Assisting With IADLS for Direct Care Workers: Getting Started

As we celebrate National Nursing Assistants’ Week, which is June 18 to 25 this year, we consider the important role direct care workers like you can play in helping elderly clients maintain their independence.

The Service Plan

Mrs. Fong is 83 years old and lives by herself at home. Her husband died years ago and, until now, she has been managing most of her chores and needs by herself. Now she needs a little help with shopping, meal preparation, housecleaning, and laundry.

You arrive at Mrs. Fong’s home and introduce yourself. You have a conversation about her service plan and the things that she would like you to help her with. She says she could use some help with grocery shopping today.

Mrs. Fong tells you that she has diabetes and tries to follow diet recommendations from the Mayo Clinic. She says she likes to eat:

  • Fish a couple times per week
  • As many fruits and vegetables as possible
  • Plenty of fiber-rich foods
  • A good amount of healthy fats from avocados and olive oil

Mrs. Fong looks through her diabetic recipe book. She asks you to choose a recipe that you think sounds good. You choose one and check the cupboards to see if she has the ingredients the recipe calls for. Then you make a list of all the missing ingredients and plan your route to the grocery store.

Mrs. Fong says she has some coupons that you may use and hands them to you. She says she would like to have a little exercise and get out of the house. She asks to go with you.

Since she is going with you, she will be paying for her own groceries. You both have proof of identification in case anyone asks.

You follow your organization’s transportation policy to get to the grocery store. You assist Mrs. Fong with shopping according to her service plan, which lists the following tasks:

  • Fetch items from the shelves
  • Pack the grocery cart
  • Carry the grocery bags into the house
  • Put the groceries away
  • Assist with meal prep as needed

After your shopping trip, you return to Mrs. Fong’s home. You continue to follow her service plan and carry her groceries inside. Then you help her put them away. You stay and help her prepare the recipe that you chose earlier.

IADLs

Your role in the home is to provide companionship and unskilled services that serve the needs of clients who need support, such as Mrs. Fong. Your clients should perform their daily activities as independently as possible. You are there to help them do that. Your supervisor will create a service plan for you to follow which will outline your tasks and will likely include assisting with IADLs.

IADLs are instrumental activities of daily living. They are complex activities that permit a person to be self-reliant and live independently. They are meant to keep the person and their living environment healthy.

ADLs

IADLs are different from ADLs, which are activities of daily living. ADLs are activities that are necessary for a person to perform the basic functions of life, and you can remember them by thinking about the opposite term, DEATH, as noted in Assisted Living Today:

  • Dressing
  • Eating
  • Ambulating, meaning walking
  • Toileting
  • Hygiene, meaning bathing and grooming

IADLs

To help you remember the IADLs, Assisted Living Today suggests thinking of SHAFT:

  • Shopping
  • Housekeeping, which may include laundry, housecleaning, and pet care
  • Accounting or money management
  • Food preparation
  • Telephone and transportation

Your duties regarding clients’ IADLs may also include assisting clients with self-administering their medications. Every state has regulations that define your scope of practice for this task. It is important for you to know the regulations that you must follow. Those include both your state regulations and your organization’s policies.

IADLs require a high level of mental and physical ability. They involve complex activities that we perform every day and often take for granted. The ability to perform an IADL is important for a person to remain independent. When a person is unable to manage one or more IADL, their ability to remain in their own home is threatened.

A client may need you to help them put groceries away or reach items on a shelf. Another client who has difficulty with mobility may need you to do all of their grocery shopping and food preparation. Never assume that you know how much help a client needs. Follow the service plan and provide person-centered care, as noted in the Relias course Assisting With IADLs.

Person-Centered Care

To give good care you must use person-centered care. This is care that should focus on that specific client’s needs and abilities.

Use these principles for person-centered care:

  • Protect clients’ well-being, privacy, and dignity.
  • Promote independence.
  • Be kind and understanding.

The care you give must match the person. Know:

  • What they like
  • How they like things to be done
  • What supports or assistive devices they use and how they should use them

Involve them in their care as much as possible while following the service plan. Be an advocate for them. Be creative with the way that you support your clients with shopping, housekeeping, money management, food preparation, and other instrumental activities of daily living.

Finally, remember that the way you speak and act shows how you feel and think about yourself and others. Speak clearly. Use kind words. Connect with people in a meaningful way. What you say matters, but the way you say it matters, too!

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Jennifer Burks

Content Developer, Relias

Jennifer W. Burks, RN, MSN, has over 25 years of clinical and teaching experience, and her areas of expertise are critical care and home health. She earned her Bachelor of Science in Nursing from The University of Virginia in 1993 and her Master of Science in Nursing from The University of North Carolina, Greensboro, in 1996. Her professional practice in education is guided by a philosophy borrowed from Florence Nightingale’s Notes on Nursing, “I do not pretend to teach her how, I ask her to teach herself, and for this purpose, I venture to give her some hints.”

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