Individuals with Developmental Disabilities and/or Mental Retardation in Adult Day Health Services: Perspectives from Several States and New Jersey

Executive Summary 

Introduction 
As a result of our previous work comparing adult day health service programs (ADHS) across the 50 states (Scotto Rosato, Lucas, & Howell-White, 2005), several questions have emerged about how the profile and needs of the client with developmental disabilities of ADHS is different from those of the elderly client of ADHS. Are different types of therapeutic and personal services needed and provided in ADHS for those with developmental disability and/or mental retardation? How have ADHS programs in other states attempted to meet these needs, if different? And, do these services require different staff levels and services? 
 

Methods 
To answer these important questions, the Center for State Health Policy engaged in a number of exploratory activities. First, we used a telephone survey of state program staff to obtain specific details about program services, reimbursement for ADHS, and the needs of the DD/MR population. Second, an analysis of data where client identifiers were removed was conducted to describe client characteristics of individuals with and without DD/MR in New Jersey ADHS. Two datasets were used to complete this analysis: one dataset was obtained from the Division of Aging and Community Services (DACS), Department of Health and Senior Services, and the other was obtained from the Division of Developmental Disabilities (DDD), Department of Human Services. The DACS data included Medicaid funded individuals who 
attended ADHS some time during the period of 2004 and 2006 (n=209). To select individuals with DD/MR from this group, we used the criteria of individuals having a diagnosis of mental retardation and/or cerebral palsy. Although we know that the term developmental disability encompasses more disabilities than mental retardation and cerebral palsy, we restricted our definition to these criteria because the information in the dataset was limited and we were unable to distinguish whether certain other diagnoses or functional and cognitive abilities of individuals were due to a developmental disability or aging in general. The DDD data, on the other hand, included individuals with potentially any developmental disability in addition to mental retardation and cerebral palsy (e.g., autism, epilepsy) who attended ADHS at one time during the period of 2003 and 2006 and where assessment information was available (n = 120). 
 

Conclusion and Recommendations 
Based on the findings from our states' ADHS programs review and analysis of the two datasets, we conclude that New Jersey is not dissimilar to other states. Like New Jersey, most states don't have special provisions such as regulations and standards for DD/MR focused ADHS centers. However, New Jersey may consider restructuring their reimbursement method to address the different levels of care needs of special populations such as those with DD/MR. 
 

Although some comparisons were made between individuals with DD/MR and those without DD/MR, the comparisons were limited by the lack of comparable data available and the lack of history of cognitive/functional status for designation of DD/MR. Having an integrated data system that includes health information and service needs of individuals served from multiple departments would help New Jersey in planning for appropriate care, reviewing eligibility, and looking at health outcomes. An integrated data system would assist New Jersey in not only assessing individuals at one point in time but also in tracking individuals through the long term care system as they age.