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Adult Day Services

What Are Adult Day Services?

Adult day services are community-based group programs with specialized plans of care designed to meet the day-time needs of individuals with functional and/or cognitive impairments. Adult day centers provide this comprehensive and structured care in a protective setting and generally operate during normal business hours five days a week. Some centers offer services in the evenings and on the weekends as well.

Adult day services can help people with disabilities live at home and postpone or avoid nursing home or assisted living care. The centers provide important respite to informal caregivers and help to those caregiving family members or friends who juggle work with caregiving responsibilities by providing services and supervision during working hours.

The number of adult day centers has grown rapidly since 1974, when there were just 18 adult day centers in operation. According to a national survey of adult day centers by Partners in Caregiving, the U.S. had 3,493 adult day centers when the survey was compiled in 2001-2002. Most of these centers (78%) operate on a non-profit basis.

Types of Services

Almost all adult day centers offer some personal assistance and therapeutic activities, but vary in the extent of the services (see Table 1). Many centers focus on the provision of non-medical services including: transportation, meals, and social opportunities. However, some centers adhere to a more medical model of care by offering a range of health services, including weight and blood pressure monitoring and distribution of medications, provided by a nurse on staff.

According to the Survey, 37 percent of adult day centers are based on a social model, while 21 percent are based on a medical model. The remaining 42 percent of adult day centers represent a combination of the two models.

TABLE 1
Percentage of Adult Day Centers That Provide Specific Service
Type of Service % Centers
Therapeutic Activities 97%
Personal Assistance 96%
Meals 84%
Social Services 82%
Health-related Services 74%
Medication Management 70%
Transportation 68%
Personal Care Services 64%
Caregiver Support Groups 60%
Rehabilitation Therapy 28%
Source: Partners in Caregiving, 2001-2002

The Adult Day Services Population

The average age of an adult day center participant is 72. Participants also have a variety of chronic conditions including physical disabilities, dementia, and mental retardation/developmental disabilities, among others. Because of their disabilities, a number of participants require assistance with activities of daily living, such as bathing, dressing, and eating. For instance, 37 percent need assistance with walking, while 24 percent require help with eating. On average, adult day centers have 42 people enrolled at any given time and serve 25 people per day. The average length of enrollment is 2 years.

Cost

The cost of adult day services varies, depending on the region of the country and the services provided by the center. According to the Survey, the average cost of adult day services was $56 per day in 2001-2002. Centers that adhere to a medical model tend to have a higher daily rate compared with those based on a social model of care.

Financing

For the most part, adult day services are a private-pay option. Participants and their families typically pay out-of-pocket to cover the cost of adult day services. Increasingly, private long-term care insurance policies are covering home- and community-based care, but private insurance remains a very minor source of financing for any long-term care services, including adult day services.

Public funding is limited for adult day services. On average, centers in the Survey reported that 38 percent of their revenues came from public funds. Among centers receiving public revenues, state Medicaid home- and community-based waiver programs were the most frequently named source. Such waivers allow states to develop and implement alternatives to nursing home care for Medicaid-eligible individuals. Other sources of public funding reported were the Older Americans Act, the Veteran's Administration, and the Social Services Block Grant.

Most adult day services are not covered under Medicare; however, if a center offers a particular service that meets Medicare requirements, such as physical or speech therapy, the program will reimburse for that service.

In December 2000, Congress passed a bill clarifying Medicare's "homebound" requirement. Before the passage of the bill, Medicare beneficiaries were required to be confined to the home to receive coverage for any home health services. Now, Medicare beneficiaries can leave home to receive therapeutic, psychosocial, or medical treatment in an adult day program without losing their Medicare home health benefits, provided the program is licensed by the state.

Regulation

Adult day centers may be licensed or certified by the state, and may also be accredited by a private accrediting agency or organization. Licensed or certified centers must meet minimum standards for health and safety and for program operations. A center can be accredited if, after self evaluation and inspection by the overseeing agency, it meets the requirements of the accrediting organ-ization. Accreditation is a voluntary process, while licensing and certification are typically state requirements.

In the Survey, the majority of the 3,493 centers reported that they were licensed or certified by their particular state. Thirteen percent of centers indicated that their state does not offer licensure or certification; another 7 percent reported that licensure or certification is optional in their state and they have chosen not to be licensed or certified. Only six percent of surveyed centers reported being accredited.

All adult day centers are required by states to follow, at minimum, specific building codes, fire codes, and zoning laws. Centers that elect to receive state Medicaid waiver or Medicare funding for adult day services must be licensed by their respective states. In addition, certain center employees, including registered nurses, must be licensed.

Footnotes

  1. National Study of Adult Day Services, Partners in Caregiving: The Adult Day Services Program, Wake Forest University School of Medicine, Winston-Salem, NC, 2001-2002. Except where noted, the data in this fact sheet are from this newly released survey, hereafter referred to as the "Survey."
  2. R. Smyth, N. Cox, B. Reifler and C. Asbury, Adult Day Centers, Chapter 5 of To Improve Health and Health Care 2000, Robert Wood Johnson Foundation Anthology, http://www.rwjf.org.

Written by Sheel M. Pandya, AARP Public Policy Institute
February 2004
©2004 AARP
All rights are reserved and content may be reproduced, downloaded, disseminated, or transferred, for single use, or by nonprofit organizations for educational purposes, if correct attribution is made to AARP.
Public Policy Institute, AARP, 601 E Street, NW, Washington, DC 20049

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