Pennsylvania offers Medicaid waiver programs under the Community HealthChoices (CHC) umbrella and the Pennsylvania Department of Aging (PDA) Waiver (often referred to as the PA Council on Aging Waiver). These programs help older adults and individuals with physical disabilities remain in their homes or community settings instead of entering nursing facilities. CHC and the PDA Waiver provide long-term services and supports (LTSS) based on assessed functional needs, emphasizing assistance with ADLs and IADLs. Covered services may include personal care assistance, adult day services, home-delivered meals, transportation, home modifications, assistive technology, and respite care for family caregivers. In addition, Pennsylvania’s CHC Waiver offers Participant-Directed Services that allow participants to hire and manage their own caregivers, including family members. To qualify, applicants must be Medicaid-eligible, at least 60 years old (for PDA Waiver) or 21+ (for CHC), and require a nursing facility level of care as determined through a standardized functional assessment of ADLs/IADLs. In this article, we explain what Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are and how needing help with these tasks is central to qualifying for Pennsylvania’s Medicaid waivers like CHC and the PDA Waiver.
What Are ADLs (Activities of Daily Living)?
Activities of Daily Living (ADLs) are fundamental self-care tasks that a person must perform daily to maintain independence. Difficulty with ADLs often signals a need for supportive services. Core ADLs include:
- Mobility (Ambulating/Transferring): Safely walking, getting up from a chair, or transferring from a bed to a wheelchair.
- Dressing: Selecting and putting on appropriate clothing (including handling fasteners) without assistance.
- Eating: Feeding oneself—using utensils to get food from a plate to the mouth and consuming it.
- Personal Hygiene: Bathing or showering and performing grooming activities like shaving, brushing teeth, and combing hair on one’s own.
- Toileting (Continence): Independently using the toilet—getting to the toilet, transferring on and off, and cleaning oneself afterward.
When someone can no longer perform several ADLs without help, it indicates that ongoing care or support is likely needed.
What Are IADLs (Instrumental Activities of Daily Living)?
Instrumental Activities of Daily Living (IADLs) are more complex tasks that allow a person to live independently in the community. While not necessarily performed daily, they are essential for managing one’s household and life. Key IADLs include:
- Shopping for Essentials: The ability to shop for groceries, pick up prescriptions, or purchase clothing and other necessities.
- Meal Preparation: Planning and cooking meals—gathering ingredients and safely using kitchen appliances.
- Housekeeping: Keeping the home clean and livable tasks like cleaning, laundry, and taking out the trash.
- Money Management: Handling finances, such as paying bills on time, managing bank accounts, and budgeting.
- Transportation: Getting around or arranging transportation—driving oneself or using public transit or rides to run errands and attend appointments.
- Medication Management: Managing and taking medications properly remembering to take the correct medicines at scheduled times and refilling prescriptions.
- Communication: Using the phone or computer to communicate—looking up phone numbers, making calls, sending emails, and staying in touch with others.
Trouble with IADLs is often one of the first signs that someone needs more support, even if basic ADLs are unaffected.
Why ADLs and IADLs Matter for Medicaid Waiver Eligibility
In Pennsylvania, needing help with ADLs and IADLs is a central eligibility criterion for the CHC and PDA Waiver programs. These waivers serve individuals who would otherwise qualify for nursing facility care but prefer to remain in their own homes or community settings. Eligibility is determined through both financial and functional assessments. The functional assessment evaluates whether an individual requires hands-on assistance with ADLs and/or significant help with IADLs, thereby meeting a “nursing facility level of care.” Pennsylvania uses standardized tools—often the Pennsylvania Long‐Term Care Assessment System (PaLTAS) or the Minimum Data Set‐Home Care (MDS‐HC)—to score independence in ADLs and IADLs.
During the functional evaluation, an assessor reviews abilities such as transferring from bed to chair, walking safely, eating, toileting, meal preparation, housekeeping, medication management, and managing money. Cognitive issues—such as memory problems due to dementia—are also considered since they impact daily functioning. If an individual cannot perform multiple ADLs without assistance or has significant deficits in IADLs, they are likely to meet the level-of-care requirement and become eligible for waiver services.
