Activities of daily living (ADLs) are the very specific things, unique to each client, that we get paid to assist them with every day. They are called “activities of daily living” because they are all the things that a young, healthy person without a disability would not need help with in their day to day life under normal circumstances.
Most of the Basic ADLs are taught to us before school. For example, our habits of eating and dressing were taught to us by our caregivers.
You can see how these would be impacted by communication deficits! No communication means no real teaching can take place.
More complex tasks, called Instrumental ADLs, such as handling our own finances or buying our own clothing, may have been taught to us by professionals or we learned it on our own by communicating with others; so it makes sense that the nonspeaking individual’s difficulty with managing their activities of daily living may often be rooted in communication deficits. This is one area in which our work as DSPs with AAC can really be impactful and satisfying.
ADLs are divided formally into two categories: Basic and Instrumental Activities of Daily Living.
The individual’s needs assessment team will meet to discuss the activities of daily living (ADLs) that the individual needs assistance with, and the best way to support them; and from that meeting the service coordinator will write up a person centered plan that directs how you will support your client. The shift notes and progress notes you write for your agency as a DSP then serve as a record for the Medicaid agency in your state of how and how much you assisted with these two types of activities.
These are the skills you need for the basic physical necessities of life, such as eating, dressing, bathing and other hygiene, transferring and ambulating, and toileting. If your client cannot do these things, the assessment team will likely find that they need daily assistance.
These are the skills that are more complex, requiring planning and organization to carry out.
Is your nonspeaking client currently either passive or oppositional about doing their Activities of Daily Living? Well, that’s their only input. Can you blame them for not being invested?
You can immediately generate more enthusiasm for ADLs by offering choices within the activity.
Every single time I approach an ADL, I think about what choices are possible. I only make choices for the individual reluctantly, if there’s no way to get out of it; otherwise, the choices are all his. If there’s no way to avoid making a choice for him, I develop a strategy to change that in the days to come.
Food choices. You can set up food choices, as well as timing choices, to give the individual some control over how they approach their activities of daily living.
Clothing choices. If your client cannot dress themselves, or cannot make weather appropriate clothing choices, that’s okay. They can still make some decisions about what they want to wear within the options available, and you can use AAC to explain the limits, being mindful not to say “no” to any choice to avoid shutting them down, even if what they want to wear is a bikini in January! Our answer is “yes, and which sweatshirt?”
Note: choices are exhausting! If your client is not used to making choices, start with a simple few and work your way up. Remember the choices the individual made in the past, so you can smoothly step in if they seem to have temporarily lost the will to do it themselves.
I would not use this as an opportunity to push them or trick them into making choices in the interest of “motivating” them towards independence. Trust building is the key.