Regulatory Review of Adult Day Services: Final Report, 2014 Edition - Executive Summary

Adult day services (ADS)--a non-residential service provided outside an individual's home for less than a full day--provides direct care to older adults and younger adults with physical disabilities. These services also meet caregivers' need for respite in order to work, fulfill other obligations, and recover from the demands of continuous caregiving. Many caregivers who use ADS are providing care to family members with dementia who need constant supervision to ensure their safety. By providing respite to unpaid caregivers, ADS can potentially delay or prevent nursing home placement.

This report provides information about each state's approach to regulating this key community service. Three ADS models are generally recognized: a social model; a health or medical model, which is sometimes combined with the social model; and a specialized model that provides services to meet the unique needs of individuals with a specific diagnosis, most often dementia.

The social model is designed for individuals who need supervision and activities but not extensive personal care and medical monitoring. The medical model provides more extensive personal care, medical monitoring, and rehabilitative services in addition to structured and stimulating activities.

States generally term these two models as ADS and adult day health services, and have more extensive requirements for the latter, particularly for nurse staffing. While some states license the models separately, others license providers to offer both models. The provision of health-related and medical services--particularly health monitoring, preventive health care, and ensuring the timely provision of primary care--can help to reduce health care costs.

While states vary in their approach to regulating ADS, all have some form of regulation and exercise oversight of ADS. About half require licensure, 11 require providers to meet certification standards, four require licensure for one ADS model and certification for another, and 13 use some other type of regulation, such as contractual requirements for providers receiving public funding. In over half the states, providers of Medicaid-funded ADS must meet additional Medicaid requirements.

Because ADS providers must meet Medicaid State Plan or waiver contracting requirements to furnish services to Medicaid beneficiaries--either in addition to or in lieu of state licensing or certification requirements--they are regulated at a level which allows them to furnish health-related and medical services, as well as long-term care services to elderly persons with a high level of nursing and medical needs.

For all these reasons, ADS are an important component of states' long-term care systems. Every state provides funding for these services through either the Medicaid State Plan or a waiver program and 24 states fund them through non-Medicaid programs as well. In 2012, 273,200 participants were enrolled in ADS centers.