State Adult Day Health Services Programs: A National Profile (2001-2002)

EXECUTIVE SUMMARY 

Background 
With increased interest in adult day health service (ADHS) programs and the current discussion to expand the Medicare program to explore the use of ADHS as a substitute for Medicare reimbursable home health care, there is a strong need for states to review their programs. A better understanding is needed of who utilizes the services, what services they need and receive, and how current state ADHS program budgets may change if eligibility requirements are altered. To enlighten and expand the current national discussion, CSHP conducted a study of state ADHS programs. 
 

Purpose 
This review of state ADHS programs has been developed to assist policymakers, program administrators, and consumer and provider groups in ADHS planning. Our findings should help expand and enlighten the current national discussion. 
 

Method 
Center staff conducted telephone interviews with State ADHS program administrators utilizing a semi-structured survey interview guide between 2001 and 2002. We also reviewed web sites and requested and reviewed public documents including program regulations, program materials, and annual reports. When available, we also contacted state adult day service associations to obtain additional information about ADHS in their respective states. Summary data were then submitted to state progran1 officials for review, changes, and verification. 

Conclusion 
There is significant variation among states in their structure, policies, and investment in ADHS programs. Most states are now using Medicaid Waiver programs for ADHS. With more restrictive eligibility criteria ( e.g., must meet nursing home eligibility criteria), these may ultimately limit entry to only the most frail and severely impaired thus reducing any potential effect that ADHS may have on delaying institutional care. 
 

Several states demonstrated innovative approaches to funding such as Michigan using tobacco settlement money for ADHS programs. Other states such as Ohio and Indiana have established unique reimbursement structures that are based on the level of intensity of care. These can ensure access for persons with more complex care problems as demand and chronicity of disability among ADHS clients rise. 
 

Unfortunately little research exists on the cost effectiveness and role of ADHS in the long-term care continuum. More research and broader discussions are needed to identify the potential roles of ADHS within the continuum of care for older adults and to assess its effectiveness within this continuum for both older adults and special populations.