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Printed on 6/29/2026
For informational purposes only. This is not medical advice.
The Katz Index of Independence in Activities of Daily Living is one of the most widely used instruments for assessing functional status in older adults. It evaluates six basic functions: bathing, dressing, toileting, transferring, continence, and feeding. Each activity is scored as independent (1 point) or dependent (0 points), yielding a total score of 0-6. A score of 6 indicates full function, 4-5 indicates moderate impairment, and 0-3 indicates severe functional impairment. The Katz Index is used in geriatric assessment, rehabilitation planning, long-term care placement decisions, and research on aging. Assess fall risk with [Morse Fall Scale](/tools/morse-fall-scale) and mobility with [Timed Up and Go Test](/tools/get-up-and-go). Quantify overall frailty with [Clinical Frailty Scale](/tools/clinical-frailty). For oncology patients, compare functional status using [ECOG Performance Status](/tools/ecog-performance).
Formula: Total score = sum of 6 items (each 0 or 1). Range 0-6. 6 = fully independent, 0 = fully dependent.
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Evaluate the patient's actual performance in each of six basic activities of daily living: bathing, dressing, toileting, transferring, continence, and feeding. The critical principle is to score what the patient actually does, not what they are capable of doing or what they say they can do. Direct observation or reliable collateral history from a caregiver is preferable to patient self-report, because many patients overestimate their own functional abilities. For each activity, determine whether the person completes it without human assistance (adaptive equipment is acceptable) or requires any hands-on help from another person.
Each of the six activities is scored independently as 1 (independent) or 0 (dependent), yielding a total score that ranges from 0 to 6. A score of 6 indicates complete independence in all six basic activities of daily living. Scores of 4 to 5 reflect mild to moderate impairment, indicating dependence in one or two activities. Scores of 2 to 3 indicate significant functional impairment requiring substantial daily assistance. Scores of 0 to 1 indicate severe dependence, with the patient requiring help with nearly all basic self-care. Note both the total score and which specific activities are impaired — this pattern carries as much clinical information as the total.
Apply the Katz hierarchical model when interpreting the score: ADL functions are typically lost in a predictable order (bathing first, then dressing, toileting, transferring, continence, and feeding last) and recovered in reverse order during rehabilitation. A patient who is dependent in bathing but independent in all other activities is at an earlier stage of decline than one who is also dependent in dressing and toileting. Unexpected patterns — for example, a patient who can bathe but cannot dress — may signal acute illness, delirium, medication effects, or a focal neurological deficit rather than classic progressive decline. Use the score and pattern together to guide care planning and level-of-care decisions.
Hospitalists, case managers, social workers
The Katz ADL Index is the standard tool for determining whether a patient can return home safely or requires a higher level of care such as a skilled nursing facility or inpatient rehabilitation. Comparing the admission score to the patient's baseline functional status (pre-illness) helps distinguish acute functional decline from chronic impairment and informs realistic discharge goals. Patients with a Katz score of 3 or below at discharge typically cannot manage safely at home without 24-hour supervision. Case managers use the score to document medical necessity for post-acute care placement and home health services.
Geriatricians, primary care physicians, nurse practitioners
The Katz ADL is a core component of the Comprehensive Geriatric Assessment (CGA), providing a standardized baseline of physical function that is tracked over time to detect deterioration or improvement. It is paired with the [Lawton IADL scale](/tools/lawton-iadl) to capture both basic and instrumental activities, the [Clinical Frailty Scale](/tools/clinical-frailty) for global frailty staging, and cognitive assessments such as the MMSE or MoCA. Serial assessments using the Katz ADL allow clinicians to monitor disease progression in dementia, Parkinson's disease, heart failure, and other chronic conditions affecting functional status.
Surgeons, anesthesiologists, perioperative medicine specialists
Pre-operative Katz ADL scoring helps quantify functional reserve before elective surgery, particularly in older adults. Patients with Katz ADL scores below 4 have significantly higher rates of post-operative complications, delirium, prolonged hospital stays, and discharge to skilled nursing facilities. The Katz ADL is often combined with the [Clinical Frailty Scale](/tools/clinical-frailty) for surgical risk stratification. Documenting pre-operative functional status also establishes a baseline for measuring post-operative recovery and identifying patients who may benefit from prehabilitation.
Home health agencies, insurance reviewers, discharge planners
The Katz ADL Index is used to determine eligibility for home health services and to define the type and intensity of assistance needed. Payers and home health agencies use specific ADL dependencies to establish medical necessity and to guide the care plan. For example, dependence in bathing and dressing may qualify a patient for home health aide services, while dependence in feeding and transferring typically requires more intensive services. Tracking ADL scores over time allows home health agencies to document clinical progress or decline and justify continuation or modification of services.
Neurologists, rehabilitation specialists, long-term care staff
Repeated Katz ADL assessments are used to track the trajectory of functional decline in Alzheimer's disease and other dementias, where ADL loss follows a predictable course that correlates with disease stage. In rehabilitation settings, improving Katz ADL scores document recovery after hip fracture, stroke, joint replacement, and critical illness. ADL gains are used to justify continued rehabilitation and to set discharge milestones. Documenting that a patient has regained independence in transferring and dressing, for example, supports a transition from skilled nursing to home care.
The most common error with the Katz ADL is scoring what patients say they can do rather than what they actually do. Many patients — particularly those with mild cognitive impairment or depression — significantly overestimate their functional abilities. When possible, observe the patient perform the task or obtain confirmation from a family caregiver. Ask: 'Does he actually shower himself?' rather than 'Can he shower himself?' The answer is often different and more accurate.
Bathing is the most demanding ADL and is typically lost first; feeding is the simplest and is lost last. A patient who is dependent in bathing but independent in all others is at an early stage of decline. If you find a patient who can bathe independently but cannot dress, this is an atypical pattern that warrants further investigation — it may indicate acute illness, delirium, medication side effects, or a focal neurological problem rather than classic progressive decline.
Acute illness routinely causes temporary ADL decline — a patient admitted with pneumonia may drop from a Katz score of 5 to 2 during hospitalization. Always document and compare to the patient's baseline (pre-illness) functional status. A drop of 2 or more points from baseline during an acute hospitalization is associated with significantly worse outcomes and higher risk of institutionalization. Reassess ADLs after the acute illness has resolved before making permanent care planning decisions.
The Katz ADL captures only basic self-care functions. Instrumental ADLs — managing medications, handling finances, cooking, shopping, using the telephone, and managing transportation — are typically lost earlier in the course of cognitive and functional decline and are critical for independent community living. Always use the [Lawton IADL scale](/tools/lawton-iadl) alongside the Katz ADL to identify patients who appear independent in basic self-care but require assistance with higher-level tasks.
As a clinical rule of thumb, patients with a Katz ADL score of 3 or below typically require around-the-clock supervision or care and are unlikely to be safe living alone without significant support. This threshold is commonly used in discharge planning to identify patients who need skilled nursing facility placement rather than home discharge. However, always consider the specific pattern of dependence and available caregiver support rather than applying the cutoff rigidly.
Delirium profoundly affects ADL performance, and ADL assessments performed during acute delirium do not reflect true baseline function. A patient in delirium may appear fully dependent across all six domains when their true baseline may be a score of 5 or 6. Always reassess the Katz ADL after cognitive recovery from delirium before making care planning or discharge decisions. Use the [Morse Fall Scale](/tools/morse-fall-scale) to manage fall risk during the delirium recovery period.
A patient who bathes independently using a shower chair, grab bars, or a handheld showerhead is scored as independent — equipment and environmental adaptations are not considered dependence in the Katz framework. Similarly, a patient who transfers independently with a walker or bed rail scores as independent for transferring. This is an important distinction from tools like the Barthel Index, which grades the level of physical assistance. However, document the equipment used, as it is clinically relevant for home safety assessment.
Your Katz ADL score indicates the level of independence in six basic activities of daily living. A score of 6 means full independence in bathing, dressing, toileting, transferring, continence, and feeding — the person can perform all these activities without human assistance. A score of 4 to 5 indicates moderate functional impairment, with dependence in one or two activities, suggesting that some supervised or hands-on assistance is needed but the person retains significant independence.
A score of 2 to 3 indicates significant functional impairment requiring substantial daily assistance, while scores of 0 to 1 indicate severe dependence, meaning the person requires help with nearly all basic self-care activities. Beyond the total score, the specific activities where dependence occurs are clinically important. Functional decline typically follows a predictable hierarchy: bathing ability is usually lost first, followed by dressing, toileting, transferring, continence, and finally feeding.
This hierarchical pattern is useful for anticipating future care needs and setting realistic rehabilitation goals. For example, a patient who has lost the ability to bathe and dress independently but remains independent in other areas is at an earlier stage of functional decline than one who also requires assistance with transferring and feeding. Recovery during rehabilitation tends to follow the reverse order, with feeding regained first.
The Katz ADL Index should be used as part of a comprehensive geriatric assessment for older adults, particularly during hospital admission, discharge planning, rehabilitation evaluation, and long-term care placement decisions. It provides a standardized baseline of functional status that can be tracked over time to detect improvement or decline.
This tool is especially valuable when making decisions about the level of care a patient requires — whether they can live independently, need home health assistance, require assisted living, or need skilled nursing facility placement. It is also used in research on aging, disability, and outcomes of geriatric interventions. The Katz ADL Index is appropriate for any clinical setting where an objective, standardized measure of basic functional ability is needed.
The Katz ADL Index assesses only basic activities of daily living and does not capture instrumental activities of daily living (IADLs) such as managing medications, finances, cooking, shopping, and transportation, which are often lost earlier in the course of functional decline. A patient may score 6 on the Katz ADL but still require significant assistance with these higher-level activities. The Lawton IADL scale should be used as a complement.
The scoring is binary (independent or dependent) for each activity, which does not capture the degree of difficulty or the amount of assistance needed. A person who needs minimal cueing to dress is scored the same as someone who requires full physical assistance, limiting the sensitivity of the tool to detect incremental changes in function.
The Katz ADL Index does not account for the use of adaptive equipment or environmental modifications that may enable independence. A person who bathes independently using a shower chair and grab bars is scored the same as someone who bathes without any aids. Additionally, assessment may be affected by the acute illness or hospitalization itself, and scores obtained during acute illness may not reflect the patient's baseline functional status.
For related assessments, see Morse Fall Scale, Clinical Frailty Scale and Timed Up and Go.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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