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


States vary in their approach to licensure, primarily licensing providers of specific ADS programs or operators of specific types of facilities or centers. Some states license a single program; others cover two or more program types under a single licensing category; some have separate licenses for specific types of programs in addition to basic licensure.

For example, Maine licenses two types of programs--adult day health services and social ADS programs--as Adult Day Services. Either program may operate a night program that provides services to persons with dementia. However, the ADS provider must have a separate license to operate a night program and must keep record keeping distinct.

States do not generally license by levels of care. Louisiana is an exception. The state licenses both adult day care and adult day health care and has a unique system of licensing with six distinct types of licensed services settings related to the capacities of the clients with developmental disabilities whom they serve. Louisiana is the only state that defines adult day care as a service only for persons with developmental disabilities rather than for "older persons with disabilities" or "adults with disabilities."

EXHIBIT 1. Approach to Regulation by States
Licensure and Certification Requirementsa
State Licensure Only Certifiction Only Both Required Other
TOTAL 25 10 4 13
  1. For more detailed information, please consult the individual state profiles in Section 2. For example, Kentucky requires licensure or certification depending on the type of services offered; adult day health care is licensed and adult day care is certified.
Alabama       X
Alaska   X    
Arizona X      
Arkansas X      
California     X  
Colorado   X    
Connecticut   X    
Delaware X      
District of Columbia   X   X
Florida X      
Georgia       X
Hawaii X      
Idaho       X
Illinois       X
Indiana   X    
Iowa   X    
Kansas X      
Kentucky     X  
Louisiana X      
Maine X      
Maryland     X  
Massachusetts       X
Michigan       X
Minnesota X      
Mississippi       X
Missouri X      
Montana X      
Nebraska X      
Nevada     X  
New Hampshire X      
New Jersey X      
New Mexico X      
New York       X
North Carolina   X    
North Dakota       X
Ohio   X    
Oklahoma X      
Oregon       X
Pennsylvania X      
Rhode Island X      
South Carolina X      
South Dakota       X
Tennessee X      
Texas X      
Utah X      
Vermont   X    
Virginia X      
Washington       X
West Virginia X      
Wisconsin   X    
Wyoming X      

Several states address licensure in the context of co-location of an adult day care facility within an already licensed acute or LTC setting. For example, Florida does not require licensed assisted living facilities, licensed hospitals, and licensed nursing homes that provide adult day care services to adults who are not residents to be licensed as adult day care centers (ADCCs), providing they do not represent themselves to the public as ADCCs. However, the state must monitor the facility during the regular inspection and at least biennially to ensure adequate space and sufficient staff. Other examples include:

  • Hawaii licenses adult day health centers (ADHCs) under state administrative rules for freestanding ADHCs and also under state administrative rules for skilled nursing facilities and intermediate care facilities when they operate an adult day health center. The relevant provider regulations are very limited, for example, specifying only that the ADHC staff requirements do not reduce the requirements for the overall skilled nursing or intermediate care facility.
  • Minnesota requires an identifiable unit in a licensed nursing home, hospital, or boarding care home that regularly provides day care for six or more functionally impaired adults who are not residents of the facility to be licensed as an adult day care center or ADS center. Additionally, the state allows licensed adult foster care providers to be licensed to provide family ADS.
  • Nebraska does not require separate licensure if a licensed health care facility provides adult day care services exclusively to individuals residing in that health care facility.
  • Tennessee requires adult day care programs, regardless of their location or affiliation, to comply with the adult day care services licensing requirements.

States generally do not license dementia-specific facilities or programs separately from adult day service programs. Few states have separate licensing requirements for providers who serve persons with dementia or other special needs. However, many states have special requirements in their standard ADS licensing requirements for providers who serve individuals with dementia. These requirements generally relate to staffing and training--requiring lower staff-to-participant ratios and dementia-specific training.

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