Regulatory Review of Adult Day Services Shows Major Changes Since 2005

Members | January 22, 2017 | by Peter Notarstefano

The U.S. Department of Health and Human Services (HHS) Office of Disability, Aging and Long-Term Care Policy (DALTCP), under contract with the Research Triangle Institute, released the Regulatory Review of Adult Day Services: Final Report, which demonstrated the major changes in adult day regulations over the past 10 years.

The U.S. Department of Health and Human Services (HHS) Office of Disability, Aging and Long-Term Care Policy (DALTCP), under contract with the Research Triangle Institute, released the Regulatory Review of Adult Day Services: Final Report

This report updates the ASPE report from 2005 and also provides additional information on licensing, certification, characteristics of the adult day centers, staffing, and funding.  

The Regulatory Review of Adult Day Services: Final Report 2014 and the State Profile Addendum are a useful resource for researchers and policymakers to advance the use of adult day services to improve care outcomes and reduce the costs of long-term services and supports. 

The report covered: 

  • Licensing, certification, and other requirements.
  • Staffing requirements and staffing ratios by state.
  • Public funding for adult day services state plan, 1915 (i), 1915(k), 1915(c), managed care waiver and non-medicaid programs.
  • Required and optional services.
  • Admission and discharge criteria.
  • States with provisions for ADS Centers serving participants with special needs.

Licensing, Certification, and Other Requirements 

  • 26 states require licensing for adult day services.
  • 10 states require certification only.
  • 4 states require both licensing and certification.
  • 15 states have other requirements to operate an adult day program.

States with Provisions for ADS Centers Serving Participants with Special needs

  • 25 States have regulatory provisions for centers that serve individuals with dementia.
  • 10 States have regulatory provisions for centers that serve individuals with mental illness, traumatic brain injury, stroke, Multiple Sclerosis, Parkinson’s Disease, HIV/AIDS, and/or intellectual developmental disabilities.

Staffing Requirements and Staffing Ratios by State  

  • 9 states require a staff to participant ratio of 1:4.
  • 7 states require a staff to participant ratio of 1:5.
  • 20 states require a staff to participant ratio of 1:6.
  • 6 states require a staff to participant ratio of 1:7.
  • 20 states require a staff to participant ratio of 1:8.
  • 4 states require a staff to participant ratio of 1:9.
  • 3 states require a staff to participant ratio of 1:10.

Staffing ratios depend on services offered, as well as the population being served, for example a Dementia specific adult day program may have a staffing ratio of 1:3.

Public Funding for Adult Day Services 

  • 9 states pay for adult day services through their Medicaid state plan.
  • 1 state pays for adult day services through 1915(i) state plan (this information was valid as of October 2014, since then the District of Columbia covers adult day health through 1915 (i)).
  • 1 state pays for adult day services through 1915(k) state plan.
  • 40 states pay for adult day services through their 1915 (c) waiver.
  • 14 states pay for adult day services through a managed care waiver (mainly 1115 waiver).
  • 24 states pay for adult day services through a non-Medicaid program.

Janet O’Keeffe, who recently retired from RTI International, was the main author of the report, which was published June 8 on the website of the Assistant Secretary for Planning and Evaluation (ASPE) Disability, Aging, and Long-Term Care Policy.