Developed by Dr. Sidney Katz in the 1960s, the Katz Index of Independence test is a measure of an individual’s ability to take care of themselves and remain independent. The test is designed to be used primarily for elderly patients, but it can (and has) also been used in other contexts with younger people whose independence is somehow compromised.
The Katz test is one of the most important tools currently in use today that quickly and effectively communicates levels of independence to both healthcare professionals and laymen alike.
What is the Katz IADL?
The acronym IADL stands for “Instrumental Activities of Daily Living”. The Katz IADL specifically refers to a set of predetermined activities that require more complex thought and effort. The skills included in the list of IADL activities are those activities that are learned by older children, teenagers, and young adults, such as cleaning, shopping, and money management.
The Katz IADL score measures how well an elderly or compromised individual is capable of performing these tasks and indicates the amount of help that they need to accomplish these tasks (if any is needed).
What is an ADL score?
In contrast, an ADL (Activities of Daily Living) score measures the activities and actions that an individual must be able to execute in order to take care of their most essential needs. These activities are more oriented toward basic self-care and self-management and include actions such as walking (“ambulating”), bathing, and feeding, to name a few. An ADL score, similar to the Katz IADL score, looks at the degree of assistance that an individual needs to complete these activities.
What does the Katz index measure?
The Katz ADL index of independence measures the following six categories:
● Bathing (patient can bath themselves without help, or only with help cleaning an isolated area of the body such as the back or a disabled body part)
● Dressing (patient chooses clothes and put them on and take them off without help)
● Toileting (patient can get on and off the toilet, remove clothing and put clothing back on, and clean genital area without assistance)
● Transferring (moving from one location to another with or without the help of mechanical transfer aides, but without the help of another person)
● Continence (ability to control defecation and urination without problem)
● Feeding (ability to feed oneself; does not take into account whether or not the patient can prepare the food themselves)
These six activities are the core activities essential to general independence according to what Dr. Katz observed in his patients. The administrator of the test will observe the patient to determine the degree of independence in each of these categories, and then will assign a score to each based on whether or not the individual was able to successfully complete each activity with or without help. The test administrator may make additional notes in certain categories, if needed.
The Katz IADL index of independence measures 8 total categories, each with a number of gradations due to the higher complexity of the tasks:
● Ability to use telephone
● Shopping
● Food preparation
● Housekeeping
● Laundry
● Responsibility for own medications
● Ability to handle finances
These activities are more complex but are the core abilities needed for total adult independence. The score that a patient receives in each of these categories determines the amount of day-to-day assistance they need with completing basic life and household tasks. The type of help that’s needed for individuals who score lower on the IADL index is different than the type of help needed for individuals who score lower in the ADL index.
How do you score activities of daily living?
There are 6 activities of daily living that are assessed by the Katz ADL test, and each is measured simply and in a straightforward way according to whether or not the individual is able to successfully execute the basic tasks without assistance. The final assessment score is based on how many of the activities the individual can successfully complete without help. This final score can either be viewed as a cursory overview of the patient’s independence, or a more careful look at the review can reveal important details regarding which areas the individual lacks independence in their daily life.
If the individual being tested fulfills the requirements of independence in one of the 6 categories of the ADL test, then that activity receives one point. There are 6 total points that can be received (one for each activity) and the higher the score, the more independent the individual is rated to be. A person with a score of 6 is completely functional (“patient independent”), while someone with a score of 0 would need full-time assistance (“patient very dependent”). Most patients score somewhere between 0 and 6 on the Katz test.
The Katz IADL score is determined in a similar though slightly different manner. Because the IADLs are more complex, the scoring system is also a bit more complex. However, in essence, the score is still determined in the same way, with one point being given to each successfully completed task and the final assessment being given based on the total number of points received. Each individual task has gradations of success that specify whether a task has been successfully completed or not.
For the Katz IADL test, men are rated on a scale of 0-5 points and women are rated on a scale of 0-8 points; the IADLs include certain domestic chores that elderly males of a certain generation may struggle with regardless of their independence. This point alteration exists to avoid gender bias.
When should you use the Katz IADL for your elderly loved one?
If you have an elderly loved one, it’s a top priority to help them obtain the best care possible for their individual needs. And although many people believe that they are more than capable of handling the care of elderly loved ones, using the Katz IADL score can help determine the amount and type of help that’s actually necessary so that a healthcare professional can assess the situation and suggest an effective solution.
Besides being a way to help people assess the true needs of their loved ones, having a Katz IADL score can also help patients obtain Medicaid and Medicare coverage for home care and other assistance-oriented fees and costs. And in addition, a Katz IADL score can more accurately reflect the specific needs of your elderly loved one so that they can find and receive care that’s appropriate to their situation.
How accurate is the index test?
The Katz Index of Independence test is one of the best tests available to assess independence because of both its ease of use as well as its comparatively high level of accuracy. Dr. Katz, the creator of the Index of Independence test, studied hundreds of individuals in various situations with varying degrees of independence to be able to carefully develop the target areas and ratings that characterize this test. Because the Katz IADL test has been developed over time to reflect specific activities and ability levels in each of those activities, it has a high level of accuracy when it comes to assessing independence in elderly individuals.
While the Katz index test is highly effective and accurate, there may be certain situations when a more in-depth assessment and testing protocol may be needed. If your elderly loved one is demonstrating a lower score on this test and it appears that they may need more sophisticated care, a detailed, comprehensive geriatric test and examination performed by a healthcare professional is recommended. However, in many situations the Katz index test is sufficient to determine the approximate amount of care needed and to prove what’s necessary to insurance agencies and government funded health organizations so that healthcare costs are covered.
What should your next step be after the test?
After the test, if it has become clear that your loved one needs some kind of assistance, it’s important that you help your elderly loved one obtain the help that they need in a respectful manner. The Katz test is designed to help patients, their caretakers, and their healthcare providers understand the specific needs and limitations of the patients in order to provide the best care possible. Thus, the logical next step is to locate adequate care for your loved one.
Because the Katz test measures specific needs, the next step after the test is to find resources and people who can meet those specific needs. Starting with the individual who administered the Katz test and then progressing to your loved one’s primary healthcare provider and/or insurance provider, ask for guidance on which resources are available to your loved one to help them in their situation. Most of the time there will be many options available to choose from, so there are careful decisions to make at this stage. Keep in mind that these are personal decisions that you will need to discuss with your loved one if at all possible.
If your parents can’t take care of themselves what is your next move?
Deciding what to do when one or both your parents are no longer able to take care of themselves is one of the most difficult and important decisions to make as an adult child. If you aren’t personally able to take care of your parents, then it’s necessary to find a way that they can still receive the care they need in a comfortable and high quality manner that fits with the family’s personal needs and preferences. This is a very personal choice and there are many different solutions to choose from.
The first step is to understand the amount of care that your parents’ currently need, and then examine the type of care they might need in the near future. The Katz Index of Independence test is a starting block for understanding the particular kind of care that is needed. Depending on their situation, home care may be perfectly possible and even preferable, but in other cases it may be recommended that you move your parents to a nursing home or assisted living facility. Examine your options and ask for help when needed.
Below are three of the most popular options for care when your parents are no longer able to take care of themselves:
- Nursing Homes -Nursing homes are one of the simplest solutions available, but they come with both advantages and disadvantages. If you and your parent(s) decide to find a suitable nursing home facility, make sure that you feel comfortable with the staff and environment and that the technology and resources at the home are adequate to take care of your elderly parent(s).
- CDPAP (Consumer Directed Personal Assistance Program)If you and/or your parents would prefer home health care, but you want the choice of who will provide the care and of how it will be administered, the CDPAP program is an excellent choice. With this program you (and your parent(s) if they’re involved) can personally choose a caregiver and provide them with specific day-to-day instructions for care. This is particularly good for elderly parents who still have some independence and want to remain in their homes, or for individuals with strict religious or lifestyle requirements.
- Family-Created Caregiver Agreements
In some situations, it may be possible for family members to enroll in a program that will allow them to create a caregiver agreement to provide care to their loved ones. It isn’t always possible for adult children to care directly for their parents, but when it is possible, creating a formal caregiver agreement can help you save costs on healthcare, medications, and technologies.
After you understand the options that are available to you, compile a short list of possible facilities or home care professionals and begin researching the options more closely. If your parents can be involved in any way in this research or the final decision, this will make the process much smoother and more comfortable for everyone involved. Ask about the amount of care the facility or professional can provide, the costs involved, daily life, whether the costs are covered by Medicaid/Medicare, and about any other relevant details.
When the time comes to make the move or to start a program with a home care professional, be available to your parents to help them make the transition. Being available to your parents will make them feel more at ease and will also put you in a calmer state knowing that you can support your parents in some way in their older years.