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Adult Day Services Rules and Regulations By State

Rules and Regs by State


Adult Day Services Rules and Regulations By State
@Tom Grill, Getty Images

With the growing trend for payers to want to keep people out of assisted living and skilled nursing facilities, other aging services become increasingly important. One of those is adult day care or adult day services (ADS). And with increased importance comes increased scrutiny. This article provides an overview of adult day care rules and regulations. They will continue to evolve.

Licensing, Certification, and Other Requirements

The majority of states require licensure or certification in accordance with state standards. The majority require licensure, fewer require certification; and even fewer require both licensure and certification.

“Certification” means to certify the individual adult day services program by measuring the ability of the adult day services program to meet the Department of Human Services, Seniors and People with Disabilities Division standards.

States that require certification distinguish between different types of ADS programs. Colorado is one state that does have specialized requirements for dementia-specific facilities. The state certifies specialized ADS centers (SADS) to provide intensive health supportive services for participants with a primary diagnosis of Alzheimers or other dementias, Multiple Sclerosis, brain injury, chronic mental illness, or developmental disability or post-stroke participants who require extensive rehabilitative therapies. The state has staffing and service requirements specifically for SADS centers that differ from those for ADS centers.

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. States do not generally license by levels of care. Several states address licensure in the context of co-location of an adult day care facility within an already licensed acute or long-term care setting.

With the growing of the aging population expect specific standards will continue to evolve.

Other Required Types of Provider Agreements

States that neither license nor certify generally require publicly funded ADS providers to enter into official, most often contractual, agreements with a state agency, specifying that they will comply with mandated requirements. These states do not have any requirements for providers who serve only private-pay clients.


Definitions of Adult Day Services

States vary considerably in the terms they use for ADS. 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. A few states define several delivery models within their basic definition, generally based on the level of need or the specialized needs of participants. 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.

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.

Required and Optional Services

All states identify a range of required and optional ADS in their licensing or certification requirements or other types of agreements. These include: ADL assistance; medication administration; skilled nursing services; health education; nursing services; social services; health monitoring; physical, occupational, and speech therapy; transportation.


Our article on the MetLife Mature Market Institute report on adult day care comprehensively summarizes the scope of services for the industry.

States generally require adult day health care or medical adult day care providers to furnish more services than adult day care providers.

Staffing Requirements

States vary with regard to the number of staff required. Most states specify minimum staff-to-participant ratios. Mandatory ratios range between one to four and one to ten. Some states require different ratios for different types of ADS.


In addition to staffing ratios, virtually all states require specific types of staff for ADS programs. The major difference in requirements between adult day care and adult day health care is that states require the latter to have licensed nurses available in some capacity.

To put the role of adult day care in perspective, learning more about aging in place and all inclusive programs like PACE is helpful.

Following are state by state regulations for adult day care.

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