An Inside Look at Adult Day Care Services

Adult day services (ADS) provide non-residential services outside an individual’s home, typically for less than a full day. This includes providing caregivers respite so that they can work and meet their other obligations as well as recover from the demands involved in continuous caregiving.

There are three ADS models: social; health or medical model, which is sometimes combined with the social model; and a specialized model that provides services to meet the unique needs of individuals with a specific diagnosis, most often dementia. The social model is designed for those who need supervision, social interaction and activities but not extensive personal care and medical monitoring. The medical model provides more extensive personal care, medical monitoring, and rehabilitative services in addition to structured and stimulating activities.

Adult care services are regulated by the states, although regulations differ from one state to the next. According to the Department of Health and Human Services, about 50% of states require licensure, 11 require providers to meet certification standards, four require licensure for one ADS model and certification for another, and 13 use some other type of regulation, such as contractual requirements for providers receiving public funding. In more than half the states, providers of Medicaid-funded ADS must meet additional Medicaid requirements either in addition to or in lieu of state licensing or certification requirements. Well-reputed adult day care centers should have a staff to participant ratio of 1:8 or better, and some states even require a ratio of 1:4 or 1:6.

Regardless of how a state regulates ADS, providers must comply with all applicable federal, state, departmental, or local statutes, laws, ordinances, rules, and regulations (e.g., fire safety, environmental, and food service requirements). Providers as a result may undergo multiple inspections in addition to the one conducted by the state licensing, certifying, or contracting entity. Many states also require ADS providers to have an internal evaluation process, which can include annual evaluations, utilization reviews, participant satisfaction surveys, and participant improvement, or care plan audits. Nearly every state has requirements for orientation and initial training for workers, with the amount of staff training varying.

As specialists in the home health care and hospice sectors, Manchester Specialty Programs also offers a comprehensive insurance program specifically designed for adult day centers that includes Professional Liability coverage, a General Liability/Package policy, and Worker’s Compensation. For more information about how we can help you protect your insureds, please contact us at 855.972.9399.