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Adult Day Care Overview

A Complement to Aging in Place and a Much Needed Social Outlet


Adult Day Care Overview
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The MetLife Mature Market Institute report on adult day care sheds light on this growing industry. Elder day care offers both respite for caregivers as well a much needed socialization for seniors. Let's take a look at what MetLife has uncovered.

The typical Adult Day Services (ADS) program was initiated in 1992 as a single-site, stand-alone, private, non-profit service provider. Here are characteristics of a typical center.

  • Operate on a Monday-Friday schedule from 6:30 a.m. to 6 p.m.
  • Fifteen percent of ADS centers are also open on Saturdays, and approximately 4% are open on both Saturday and Sunday.
  • Have a 1,000- 5,000 square foot facility.
  • Administered by a professional in the Business/Healthcare Administration, Nursing, or Social Work field.
  • Services provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) available for at least 8 hours per day.
  • Activity, recreational, and therapy professionals are on site and the center may have a social work professional available.
  • A Center collects a full day average fee of $61.71, from a public source, including Medicaid waiver, Veterans Administration, State/local social services, or directly from a private-pay participant.
  • The average daily costs of providing care to each participant is $68.89.
  • The ADS center provides over 8,500 combined participant days of service each year.
  • Nationally, more than 37,500,000 service days are provided by adult day services centers annually.

Years of Operation

The number of years ADS centers had been in business ranges from over 50 years to less than one year, with an average of 17 years of operation.

Profit Status

For-profit status is increasing. Twenty-seven percent of centers reported private for-profit status compared to 22% in 2002. Almost three-quarters of all centers (71%) are non-profit (56%) or affiliated with the public or government sector (16%). The majority are state-certified or licensed.

Administration and Staffing

  • One third of the center directors have business or healthcare administration backgrounds.
  • Almost 60% come from nursing, social work, and activities/recreation therapy.
  • Almost 80% of ADS centers have either a registered nurse (RN) or a licensed practical nurse (LPN) on staff.
  • The average direct care worker-to-participant ratio was calculated at one direct care worker for every six participants (1:6). This is an improvement over the last study that found it at 1:8.
  • On an average shift, 40% of providers had eight or more hours of registered nursing services provided; 28% had eight or more hours of licensed practical nursing services delivered and 26% had social work services for eight or more hours delivered.

Funding and Fees

  • Half (55%) of the funding comes from publicly paid participant fees and one-quarter (26%) from privately paid participant fees.
  • Medicaid and state and local funding are the top two sources of funding.
  • The Veteran's Administration (VA) accounts for 10% of total revenue but is growing.
  • Standard fees average $61.71 based on number of hours of care or a flat daily fee of $57.96.
  • The average daily cost of providing care to one participant is $68.89.
  • Approximately 80% of ADS centers offer transportation with fees ranging from no cost to $20 per round trip.
  • The majority centers maintain a balanced budget; 17% reported an annual deficit, and 13% report an annual profit.

Participation and Demographics

  • The average maximum capacity has increased to 51 people.
  • The average number of participants served per day is 34.
  • Approximately 29% of centers have a wait list.
  • The average length of participant enrollment is approximately 32 months.
  • The majority of participants are women; 69% of participants were age 65 and older, 21% of participants were age 41 to 64, and 9% of participants were age 40 and younger.
  • The "average" participant is a 65-plus-year-old, white female with dementia, hypertension, or physical disability requiring assistance with toileting or other activity of daily living (ADL) and medication management.
  • Sixty one percent of participants are White, 16% Black, 9% Hispanic, and 9% Asian.

Health Conditions

  • The three most prevalent conditions experienced by ADS participants are dementia (47%), hypertension/high blood pressure (46%), and physical disability (42%).
  • About a third of participants experienced cardiovascular disease (34%) and diabetes (31%).
  • Chronic mental health issues were experienced by 25% of participants and 20% had a developmental disability.
  • Nearly half of all ADS participants need assistance with toileting (45%) and medication management (44%) and about one-third needed assistance with bathing (30%).
  • One-quarter need assistance with transferring (25%) and less than 20% needed assistance with eating.
  • Centers are increasingly providing nursing, rehabilitation, and transitional support after a hospital stay.

Services Provided

  • Care Planning
  • Assistance with activities of daily living (ADLs) - walking, toileting, and bathing as an example.
  • Nursing and health-related services.
  • Therapeutic and Medical services.
  • Meals and Transportation.
  • Psychosocial Services, Therapeutic Activities, and Targeted Programs.
  • Wellness Practices and Disease-Specific Programs

Challenges Facing ADS

  • Funding/financial concerns.
  • Maintaining the number of participants.
  • Educating the public as well as other health and social service professionals about who they are and what services they provide.

MetLife recommended that in anticipation of future needs and growth, ADS:

  • Need to understand the evolution that needs to take place as society grows to demand these services.
  • Be prepared to treat a higher acuity client.
  • Advocate for new funding sources as community-based care evolves with healthcare reform.
  • Market to other key players in the long-term care network, such as hospital discharge planners.
  • Reach out to employers who can use these programs to aid caregivers and complement EAP programs.
  • Educate policymakers about the vital role day services play in society.

As society moves away from institutionalized care to home based care and aging in place, the vital role that adult day services play will grow. Now is the time to consider this as a viable business option.

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