Adult Day Services
“Adult day services (ADS) are professional care settings in which older adults, adults living with dementia, or adults living with disabilities receive individualized therapeutic, social, and health services for some part of the day” (National Adult Day Services Association 2018).
There are an estimated 4,600 ADS centers serving over 260,000 participants (primarily older adults) across the United States (Anderson et al. 2012). ADS centers offer a wide range of services and programming to meet the health and social needs of older adults and younger adults with physical and/or cognitive limitations in a community-based group setting. Services can include social and recreational activities, transportation, nutrition, health care, rehabilitation, and caregiver support. ADS also provide much-needed respite for family members of participants, allowing caregivers to take a break, to attend to other tasks and needs (e.g., personal care, child care), and in some cases, to remain in the workforce. ADS centers are often categorized as medical or social models; however, most centers provide a combination of medical and social services. Specialty ADS programs, such as those focused on specific conditions (e.g., dementia, intellectual and developmental disabilities) are also prevalent, as are programs that serve specific populations, such as Asian–American and Latino older adults (Fields et al. 2014). ADS are also one of the most cost-effective forms of home- and community-based services with a national median daily rate of $72 per day, compared to $22 per hour for home health care and $245 semiprivate room/$275 private room per day for nursing home care (Genworth Financial 2018).
Key Research Findings
Over the past several decades, evidence of the benefits and effectiveness of ADS has grown. An early systematic review found that ADS attendance can have positive impacts on participants’ functioning and emotional well-being and on family caregivers’ stress and mental health. These positive outcomes can delay older adults’ entering institutional care, although ADS do not serve as an alternative to nursing home care (Gaugler and Zarit 2001). A more recent systematic review found additional support for the positive influence of ADS attendance on participants’ and family caregivers’ psychosocial well-being, but suggested that the effectiveness of ADS on physical health may be program-specific and related to targeted interventions, such as fall prevention. Recent evidence has also suggested that ADS utilization may delay nursing home placement, particularly when the caregiver is an adult child (Fields et al. 2014). More recent research has continued to build evidence of the effectiveness of ADS using sophisticated methods, such as cortisol tests to measure caregiver stress (Liu et al. 2017). In another promising research area, a recent study found that ADS use can result in lower rates of emergency room visits, hospital admissions, and days in the hospital (Kelly 2017). An emerging role for ADS is in rehabilitation and post-acute care following hospitalization and/or surgery. For example, an older adult may be hospitalized for an acute care event, such as a fall or an illness. Upon discharge to home, the older adult may be able to access ADS to receive rehabilitation services, such as physical and occupational therapy. This approach has the potential to reduce healthcare costs if therapists are able to treat multiple patients in one location and ease the burden of caregivers and patients as they receive services in a one-stop location (Dabelko-Schoeny et al. 2018).
Future Directions of Research
Researchers should continue to seek data that evaluate the effectiveness of ADS in three areas – participant well-being, family caregiver well-being, and healthcare utilization. To this end, researchers have called for the adoption of universal outcome measures in ADS. This would be a significant step in increasing our ability to evaluate ADS, similar to the Minimum Data Set used in nursing homes (Anderson et al. 2018). Researchers should also explore the role that ADS can play in care transition, such as hospital to home. Finally, researchers should continue to increase the rigor of the research designs and approaches, such as the use of large data sets and experimental designs and collaborations with health economists to elucidate the potential cost savings associated with ADS.
Adult Day Services (ADS) provide health and social services to older adults and other adults with limitations and needs in congregate community-based settings. There is growing evidence to support the use of ADS to improve the well-being of participants and caregivers and to reduce healthcare utilization and costs. In the future, our growing understanding of the effectiveness and capacities of ADS may increase the use and availability of this important platform within the home- and community-based spectrum of care.
- Anderson KA, Geboy L, Jarrott S et al (2018) Developing a uniform set of outcome measures for adult day services. J Appl Gerontol; Published ahead of print. https://doi.org/10.1177/2F0733464818782130
- Dabelko-Schoeny H, Shin JW, Kowal E et al (2018) Staff perceptions of adult day centers providing post-acute care for persons with dementia. J Appl Gerontol; Published ahead of press. https://doi.org/10.1177/2F0733464818757001
- Genworth Financial (2018) Genworth.com. https://pro.genworth.com/riiproweb/productinfo/pdf/131168.pdf. Published October 10, 2018. Accessed 31 Jan 2019
- National Adult Day Services Association. Nadsa.org. https://www.nadsa.org/learn-more/about-adult-day-services/. Published November 1, 2018. Accessed 31 Jan 2019