Endnotes
i Because the literature as well as most states' materials refer to medical day care (MDC) as adult day health services (ADHS) or adult and pediatric day health services, these terms will be used instead of medical day care throughout this report unless we are specifically referring to the NJDHSS Medical Day Care Program. For simplicity, we will only use the term ADHS even when studies refer to both ADHS and ADS programs.

ii Databases that were searched include MEDLINE, HEALTHSTAR, PROQUEST, and DIGITAL DISSERTATIONS. Organizations that were contacted were Research Triangle Institute, Human Services Research Institute, National Adult Day Services Association (NADSA), CMS (Centers for Medicaid & Medicare Services, formerly HCFA), National Council On the Aging (NCOA), American Association of Retired Persons (AARP), Partners in Caregiving: The Dementia Service Program as well as several state adult day services associations. Most of the searches were about policy, reimbursement, and general information on adult day health services.

iii Federal funding comes from several sources through the Social Security Act including Medicaid (Title XIX), Social Services Block Grants-Title XX (SSBG), and Older Americans Act (Title III) programs. Medicare does not cover ADHS, although it may reimburse for medical rehabilitation services provided in an ADHS facility that is CARF-certified as a comprehensive out-patient rehabilitation facility. Nevertheless, Medicaid is the primary source of public funding. The Department of Veterans' Affairs also contract to reimburse ADHS for eligible veterans in select locations (Weaver, 1996).

iv A few surveys such as NADSA (1998) and Weissert et al. (1990) used national samples of ADHS facilities, while other studies focused on one state or a comparison of selected state programs for ADHS(NJDHSS, 1998; Travis & McAuley, 1999; 2000; Weaver, 1996); still others evaluated special-purpose day health service facilities such as ADHS for disabled veterans (Hedrick, Rothman, Chapko, Inui, Kelly, & Ehreth, 1993), and ADHS for individuals with dementia (Jarrott, S.E., Zarit, S.H., Parris-Stephens, M.A., Townsend, A., & Green, R. 1999; Leitsch, S. A. Zarit, S.H., Townsend, A., & Green, R.2001; Zarit, S.H., Parris-Stephens, M.A., Townsend, A., & Greene, R., 1998).

v It should be noted that the majority of these sources focus on the adult population. A minimal amount of information was found that addressed child day health services.

vi Evaluative surveys of ADHS and integrated services that were reviewed by Gaugler & Zarit (2001) include: Arling, Harkins, & Romaniuk, 1984; Branch, Coulam, & Zimmerman, 1995; Capitman, 1982; Cohen, 1998; Gaugler, 1999; Harder, Gornick, and Burt 1986; Hedrick, Rothman, Chapko, Ehreth, Diehr, Inui, Connis, 1993; Jarrott, Zarit, Stephens, Townsend, & Greene, 1999; Lawton, Brody, & Saperstein, 1989; Montgomery and Borgatta, 1989; Newcomer, Fox, Yordi, Wilkinson, Arnsberger, Donatonni, & Miller, 1998; Strain, Chappell, & Blandford, 1988; Weissert, Elston, Bolda, Zelman, Mutran, & Mangum, 1990; Weissert, Lesnick, Musliner, & Foley, 1997; Weissert, Wan, Livierators, & Katz, 1980;; Wimo, Wallin, Lundgre, Ronnback, Asplund, Mattsson, & Krakau, 1990Zarit, Stephens, Townsend, & Greene, 1998.