What if someone told you that there is a therapy for people living with dementia that research shows can improve mood, reduce behavioral symptoms, slow cognitive decline, and support better quality of life for patients and their caregivers? Believe it or not, such a therapy does exist, and it does not come in the form of a pill or costly infusion. It comes in the form of adult day services, more commonly known as adult day care.
For decades, policymakers and the public have viewed these centers as venues for “dancing and playing dominoes,” when, in fact, research suggests that adult day centers are highly effective platforms for chronic disease management, and a fundamental lifeline for chronically ill and cognitively impaired people and their families. There are approximately 5,000 adult day centers in the United States serving chronically ill, frail and cognitively impaired adults.
These centers represent a vital but overlooked sector of long-term care that help older adults remain in their communities as they age. On a daily basis, people — the majority of whom are racial/ethnic minorities — receive meals, medication, physical activity and socialization. Through productive engagement, peer-to-peer activities, and support with disease management and care management, adult day centers support meaningful improvements for quality of life, and help older adults delay and/or avoid nursing home placement. Notably, this is all done at a national average price of $80 per day, representing a discount on more costly sources of long-term care such as nursing homes.
Yet, perhaps because of connotations and damaging stigma associated with adult day care, centers were deemed nonessential services in many states during the COVID-19 pandemic. As a result, many centers were forced to close temporarily, putting older adults at risk of isolation, food insecurity, and functional loss, and depriving caregivers of much-needed respite.
In the post-pandemic world, given that nursing homes and congregate settings were associated with devastatingly high rates of mortality, people are now increasingly seeking out in-home services and supports as they age. This has led to permanent closures of adult day programs throughout the country, with the supply of adult day centers falling by 11.5% between 2020-2021. This has compromised not only the industry’s long-term viability, but also the well-being of the families they serve.
Relying on individualized home care services alone is both a problematic and unsustainable response to the nation’s long-term care crisis and burgeoning aging population. Not only is the United States facing a shortage of direct care workers to support individualized in-home services, home care does not provide the same opportunity for socialization or productive engagement that has been found to be a fundamental determinant of health. Keeping people at home only exacerbates loneliness and social isolation.
We need to call on policymakers to recognize the comprehensive services provided within adult day centers and acknowledge the evidence that demonstrates their impact on the well-being of participants and caregivers. Beyond that, policymakers should provide equitable reimbursements and funding to adult day programs, many of which have not seen rate increases in decades. Supporting funding beyond Medicaid, such as through Medicare Advantage, can ensure that more centers can operate and provide the highest standards of care to those they serve.
We are at a critical tipping point in the fate of adult day services in the United States. It is time for the public to acknowledge potential biases, and recognize that these programs are more than just dancing and dominoes —but rather, vital sources of care that enable aging in place.
Tina Sadarangani, PhD, RN, is an assistant professor at NYU Rory Meyers College of Nursing and an affiliate faculty of the Hartford Institute of Geriatric Nursing (HIGN) for which she co-chairs the Policy Steering Committee. Her research, funded by the National Institutes of Health, focuses on advancing the health of older, vulnerable adults, including leveraging the strengths of community-based adult day health care centers to target health disparities.
