Adult day health care regulations

Written by kimberly jones
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Adult day health care regulations
(Image courtesy of Neighborhood House Association)

Adult Day Health Care (ADHC) is a day treatment program for adults 18 years and over who have physical and/or mental health problems that affect their ability to perform activities of daily living. According to Jennifer Hurlow-Paonessa, Director of the Neighborhood House Association's Adult Day Health Care program, adult day services are regulated at the state level and there are currently no federal regulations in place. While regulations for these programs can vary considerably from state to state, The National Adult Day Services Association (NADSA) sets voluntary standards for adult day service providers throughout the nation.

Why Choose a Day Treatment Program

According to Hurlow-Paonessa, ADHC programs allow for someone who needs around-the-clock care to live at home, instead of in a nursing facility, by providing respite care to primary caregivers. "Many of the participants in our care live with their adult children and are with us during the day while their children are working or taking care of their own kids," says Hurlow-Paonessa. "Many families couldn't keep their ageing or disabled family members at home if it weren't for ADHC." Hurlow-Paonessa adds that, in addition to respite care, "ADHC provides rehabilitative services to maximise participants’ functional capacities, which allows them to continue to live at home with their caregiver of choice, as opposed to being institutionalised.”

Adult day health care regulations
Image courtesy of Neighborhood House Association


According to NADSA, the following services are offered at most ADHC sites:

• Social activities and interaction with other participants

• Transportation to and from the centre

• Help with personal care and activities of daily living (toileting, eating, etc.)

• Nutritious meals and snacks

• Therapeutic activities, including exercise and mental interaction

Hurlow-Paonessa adds that many states also require the following services:

• Rehabilitation services, including occupational, physical and speech therapy

• Individual assessments and treatment plans created and administered by a medical professional

• Psychiatric and psychological services

Adult day health care regulations
Image courtesy of Neighborhood House Association


According to Hurlow-Paonessa, approximately 85 per cent of ADHC participants in her program are funded through Medicaid. Many ADHC programs can also be paid for via Veterans Administration contracts, waiver programs and other federal and state funding sources. Some clients are able to pay through long-term health insurance or out-of-pocket on a sliding scale fee basis.

Adult day health care regulations
Image Courtesy of Neighborhood House Association

How To Qualify

Eligibility requirements can vary by funding source, says Hurlow-Paonessa. For example, to meet Medicaid’s eligibility criteria, as it is administered in California by Medi-Cal, the participant must meet the following criteria from the Medi-Cal website:

• Be 18 years of age or older.

• Have one or more chronic or post acute medical, cognitive or mental health condition that is identified by the participant's personal health care provider as requiring monitoring, treatment and/or intervention without which the participant's condition will likely deteriorate and require emergency department visits, hospitalisation or other institutionalisation.

• Have functional impairments in two or more activities of daily living (such as toileting, grooming, eating and paying bills).

• Require ongoing or intermittent protective supervision, skilled observation, assessment or intervention by a skilled health or mental health professional to improve, stabilise, maintain or minimise deterioration of the medical, cognitive or mental health condition.

• Have insufficient support, outside of ADHC, to maintain in the community. This would include an individual who lives alone with no family or caregivers available to provide sufficient and necessary supervision or who lives with a caregiver who is either unable to provide sufficient and necessary supervision or needs respite.

• Have a high potential for the deterioration of their medical, cognitive or mental health condition or conditions in a manner likely to result in emergency department visits, hospitalisation or other institutionalisation if ADHC services are not provided.

Adult day health care regulations

Finding a Facility

If you or a loved one qualify for ADHC, your health care provider should be able to refer you to a facility in your area. Your local area Agency on Aging or senior centre can also refer you to an appropriate facility. NADSA recommends calling various centres and requesting brochures, monthly menus and monthly activity calendars to find the right centre for you. The agency also recommends looking for the following things when choosing a centre:

• Owner or sponsoring agency

• Years of operation

• License or certification (If required in your state)

• Hours of operation

• Days open

• Transportation

• Cost and available financial assistance

• Health conditions they accept (memory loss, limited mobility, incontinence,etc.)

• Staff credentials

• Number of staff per participant

• Activities provided

• Menu

NADSA recognises two other types of adult day service models, in addition to the health care model. These are social day centres, which provide socialisation and recreation to participants and specialised treatment centres that focus mostly on one type of health or mental issue (such as dementia). It is important, when researching ADHC facilities, "to make sure you are looking at facilities that provide the level of care that you need,” adds Hurlow-Paonessa.

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