Instrumental activities of daily living and eligibility for long term home health care

Federal eligibility criteria for non-institutionalized long term care stipulates that older persons must require human help with two personal activities of daily living (ADL) before they qualify for services. Therefore, physically healthy cognitively impaired persons may be discriminated against. The purpose of this study was to compare and contrast a demented, physically healthy group with a non-demented, physically compromised group to determine if instrumental activities of daily living (IADLs) rather than ADL function, is a better indicator of the need for long term home health care services (LTC). Although the Alzheimer group had significantly higher ADL function than the non-demented medically ill group, both groups showed similar impairment on IADL function. This would suggest that IADL function is sensitive to both cognitive and non-cognitive changes. We conclude that IADL rather than ADL function, is a more equitable criterion in determining eligibility for long term home health care.