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


The majority of states require inspections--most of them annual inspections that coincide with an initial license application and annual license renewal. Several states also stipulate that unannounced visits by state personnel can occur at any time. Only one state does not have external monitoring. Alaska does not license or monitor ADS. The state's rules require only that an adult day care program conducts an internal evaluation, at least annually, of its operation and services. However, site visit inspections are required for programs receiving state grant funds.1

States vary in the extent of their monitoring of ADS providers. For example:

  • Arizona renews licenses for 2 years, as opposed to 1 year, if a licensee has no deficiencies at the time of the licensure inspection.
  • Florida's Agency for Health Care Administration may conduct an abbreviated biennial inspection of key quality-of-care standards (in lieu of a full inspection) of a center that has a record of good performance.
  • Delaware requires regular inspections only once in a 3-year period.
  • Montana conducts routine, unannounced licensure surveys every 1-3 years. A license's duration is dependant on the number and type of deficiencies found during inspection, and if any deficiencies relate to the health, safety, and welfare of a resident, a provisional license or a 1-year license is issued.
  • Nebraska authorizes inspections of up to 25 percent of ADS providers based on a random selection of licensed providers. The state also conducts focused inspections in response to complaints and incidents or when 5 years have passed without an inspection.
  • New Hampshire requires the Department of Health and Human Services to make at least one annual unannounced inspection and to monitor the utilization of adult day program services.
  • Mississippi has Area Agencies on Aging monitor ADS providers on site each quarter. The state's Bureau of Audit and Evaluation in the Department of Human Services also monitors the providers annually, but does not necessarily visit the site.
  • Missouri requires its Division of Aging to make at least two inspections per year, at least one of which is unannounced to the operator or provider.
  • North Carolina monitors adult day health programs at least monthly to assure compliance with standards and also conducts an annual inspection.

A few states specify provisions for addressing complaints. For example, the Arkansas Office of Long Term Care conducts complaint inspections in adult day health care facilities to determine their validity, and in Missouri the state makes unannounced visits for investigative purposes when complaints have been filed regarding a program.

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