Katz ADL Index: How to Assess Your Parent's Daily Living Abilities

What the Katz ADL Index Measures

The Katz Index of Independence in Activities of Daily Living is a clinical scoring tool developed by Dr. Sidney Katz in 1963. It evaluates a person's ability to perform six basic self-care tasks without help:

1. Bathing — Can they wash their entire body independently?
2. Dressing — Can they choose clothes and put them on, including undergarments and fasteners?
3. Toileting — Can they get to the toilet, use it, and clean themselves?
4. Transferring — Can they move from bed to chair and back without assistance?
5. Continence — Do they have full control over bladder and bowel?
6. Feeding — Can they bring food from plate to mouth independently?

Each activity is scored 1 (independent) or 0 (dependent), using the activity-specific criteria below. Total score ranges from 6 (independent across all six activities) to 0 (dependent across all six activities).

The order matters. The six ADLs are listed in the order that function is typically lost: bathing goes first, feeding goes last. A parent who can't bathe independently but can still feed themselves is following the expected trajectory. A parent who suddenly can't feed themselves but bathes fine warrants an immediate medical evaluation — that pattern suggests a new problem, not typical aging.

How to Score Your Parent

Run through each activity and score honestly based on what you observe, not what your parent tells you they can do. Cognitive decline makes self-reporting unreliable — a parent with early dementia may genuinely believe they showered yesterday when they haven't bathed in a week.

Bathing (most commonly lost first):

• Score 1 if they bathe independently or need help with only a single body part (for example, the back)
• Score 0 if they need help washing more than one body part or need total help bathing

Dressing:

• Score 1 if they retrieve clothes independently and manage all fasteners, including shoes
• Score 0 if they need help dressing or must be completely dressed by another person

Toileting:

• Score 1 if they manage transfers, clothing, and perineal hygiene without assistance
• Score 0 if they need help transferring or cleaning themselves, or use a bedpan or commode

Transferring:

• Score 1 if they move in and out of bed or a chair unassisted; mechanical aids are allowed
• Score 0 if they need help transferring or require a complete manual transfer

Continence:

• Score 1 if they have complete voluntary control over urination and bowel movements
• Score 0 if they have any accidents, or need scheduled prompting to avoid them

Feeding:

• Score 1 if they get food to their mouth independently (someone else may prepare the meal and cut the food)
• Score 0 if they need physical assistance eating

What the Score Means for Care Decisions

Score 6: Independent. Your parent is independent across the six activities as scored. They may still benefit from companionship and meal support.

Score 3–5: Moderate dependence. Your parent is dependent in some activities. Use the pattern to identify where targeted assistance and home modifications may help, and discuss needs with a clinician or care manager.

Score 1–2: Severe dependence. Your parent is dependent in most activities. Discuss daily home-care support and broader care planning with a clinician or care manager.

Score 0: Total dependence. Your parent is dependent in all six activities. Ask a clinician or care manager to assess whether the current home-care plan is safe.

Why Tracking Changes Over Time Matters More Than Any Single Score

A one-time assessment tells you where your parent is today. Monthly reassessments show you the trajectory — how fast function is declining and which capabilities are slipping next.

This trajectory data serves three critical purposes:

Care planning. If bathing independence dropped from 1 to 0 three months ago and dressing just dropped this month, use that change to plan ahead for other needs. You can install a raised toilet seat and grab bars before a fall forces the issue.

Benefit applications. VA Aid and Attendance benefits, UK Attendance Allowance, and Medicaid HCBS waivers may use evidence of functional dependence. A dated log of Katz ADL scores — especially showing progressive decline — can help document the parent's needs, although each program has its own eligibility rules.

Family conversations. When siblings disagree about whether your parent "really needs help," a series of declining Katz scores provides objective evidence that cuts through subjective impressions from occasional visits.

Using This Assessment at Home

You don't need a clinical license to administer the Katz ADL Index. Print a simple six-row scoring sheet, observe your parent over a typical day, and record what you see. Repeat monthly.

The Handling Hygiene Resistance toolkit includes a fillable Katz ADL Self-Assessment worksheet designed for family caregivers, with guided prompts for each activity and space to track scores across months so you can see the trajectory rather than just the snapshot.