Regulatory Review of Adult Day Services: Final Report - Section 1. Definitions of Adult Day Services


States vary considerably in the terms they use for ADS. For example, Arizona and Pennsylvania license adult day health care facilities, Delaware and New Mexico license adult day care facilities, and Oklahoma licenses adult day care centers. West Virginia licenses medical adult day care centers as a special type of ambulatory health care center. Nonetheless, the majority of state regulations define only one or two types of adult day services.

In those states with two types, the most frequent distinction between the two hinges on the provision of health and nursing services. For example, in Washington, adult day care is defined as a supervised daytime program providing core services appropriate for adults with medical or disabling conditions that do not require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician. Adult day health care is defined as a supervised daytime program providing skilled nursing and rehabilitative therapy services in addition to core services provided in adult day care. However, in some states that define just one type of adult day services, which is not specified as day health services, these programs are allowed to provide a high level of care that would be considered an intermediate level of nursing home care in many states.

A few states define several delivery models within their basic definition, generally based on the level of need or the specialized needs of participants. For example, Ohio distinguishes between two level of adult day services--enhanced and intensive--and defines them as follows:

  • Enhanced adult day service includes supervision of all activities of daily living (ADLs) and supervision of medication administration and/or hands on assistance with one ADL (except bathing) and medication administration, comprehensive therapeutic activities, and health assessment and intermittent monitoring of health status.
  • Intensive adult day service includes all services mentioned in enhanced services above, plus assistance with two or more ADLs; assistance with bathing; health assessment and regular monitoring of, or intervention with, health status; skilled nursing services (e.g., dressing changes and other treatments), and rehabilitative nursing procedures; rehabilitative and restorative services, including physical therapy, speech therapy, and occupational therapy; and social work services.

Colorado defines a specialized adult day services center as one that provides intensive health supportive services for participants with a primary diagnosis of Alzheimer's or other dementias, Multiple Sclerosis, brain injury, chronic mental illness, or developmental disabilities or for post-stroke participants who require extensive rehabilitative therapies. However, as noted above, very few states have a specific licensing category for ADS providers serving individuals with specific conditions.

Definitions of adult day services generally incorporate a statement about their purpose, thresholds for the number of people who can be served, limits on the number of hours a person may be served, and parameters for who may or may not be served. Definitions range from general to specific. Examples of states' definitions follow:

  • Georgia defines adult day services as a program for providing a safe group environment with coordinated health and social services aimed at stabilizing or improving self-care as well as preventing, postponing, or reducing the need for institutional placement. The purpose of adult day services is to provide support for elderly individuals who do not fully function independently but who do not need 24-hour nursing care. Participants may have physical, social, and/or mental impairments, need assistance with ADLs less than that requiring placement in an institution, or have recently returned home from a hospital or institutional stay.
  • Rhode Island defines adult day services as a community-based group program designed to meet the bio-psychosocial needs of adults with impairments through individual plans of care. These structured, comprehensive, nonresidential programs provide a variety of health, social, and related support services in a protective setting. By supporting families and other caregivers, adult day services enable participants to live in the community.
  • Utah defines adult day care as continuous care and supervision, for three or more adults 18 years of age and over for at least 4 but less than 24 hours a day, that meets the needs of functionally impaired adults through a comprehensive program that provides a variety of health, social, recreational, and related support services in a protective setting.
  • Vermont defines adult day services as community-based non-residential services to assist adults with physical and/or cognitive impairments to remain as active in their communities as possible by maximizing their level of health and independence and ensuring their optimal functioning. Adult day centers provide a safe, supportive environment where participants can receive a range of professional health, social, and therapeutic services. Adult day services also provide respite, support, and education to family members, caregivers, and legal representatives.

Participant thresholds and hourly limits. States do not vary much with regard to the maximum number of participants that providers may serve before licensure or certification is required. The maximum is generally between three and five individuals who are unrelated to the provider. Tennessee is an exception, setting the threshold at ten individuals.

States vary more with regard to specifying the maximum hours of services that ADS providers may furnish. For example, in Idaho participants may be served during any part of the day but only for less than 14 hours. Iowa's maximum is 16 hours in a 24-hour period. Some states, such as Kansas, do not specify minimums or maximums but only that facilities must operate fewer than 24 hours a day. On the other hand, Tennessee defines adult day care services as those that are provided for more than 3 hours per day but less than 24 hours per day, implying that providers who furnish services fewer than 3 hours a day do not have to be licensed.

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