National Census Finds Most U.S. Counties Don't Have Enough Adult Day Centers

March 15, 2003

A national study of adult day centers found that 56 percent of U.S. counties did not have enough adult day centers to meet the need, according to Nancy J. Cox, M.S.W., national director of Partners in Caregiving.

Cox, who also is an instructor in psychiatry and behavioral medicine at Wake Forest University Baptist Medical Center, told the 2003 Joint Conference of the National Council on the Aging and American Society of Aging today (March 15) in Chicago that the census showed 3,407 adult day centers are operating in the United States, serving primarily people with dementia (including Alzheimer''s disease) and the frail elderly who do not have dementia.

But, she said, "5,415 new adult day centers are needed nationwide -- 1,424 in rural areas and 3,991 in urban areas."

The study, which was supported by The Robert Wood Johnson Foundation, also found that adult day centers are a viable, cost-effective long-term care option. "They help keep individuals who are in need of chronic care at home, in the community, with family and friends as long as possible," Cox said.

The study found that most people attending an adult day center live either with an adult child or a spouse. The existence of the center relieves that person of constant care giving, at least Monday through Friday during the day -- the hours the typical center is open.

Cox reported that 43 percent of individuals enrolled in adult day centers need help with toileting, 37 percent with walking and 24 percent with eating.

She said many people are not aware of the level of sophistication of the typical adult day center, "dispelling the myth of being just a babysitting service." She said the survey showed the average cost of adult day centers is $56 per day, which is considerably under the cost of most other options for the frail elderly and people with dementia. The survey showed that the average daily charge, however, is only $46, indicating that many centers are not yet charging enough to survive without subsidy. Centers working with Parners in Caregiving tend to be self-sufficient, charging enough to cover costs.

Who pays for adult day center services? "About 51 percent is paid by Medicaid and other public funds, 47 percent is paid directly by the families, and less than 1 percent is covered by long term care insurance," Cox said.

Cox said the availability of adult day services has been expanding rapidly, "with 26 percent of all adult day centers opening in the past five years."

She said some existing adult day centers are not fully utilized, pointing to the need for public awareness campaigns in those communities.

But at the same time, the national need is growing both because of the projected increase in the number of disabled elderly people and also because centers are now also serving younger people who have chronic conditions such as mental retardation, physical disabilities or chronic mental illness.

Partners in Caregiving is headquartered at Wake Forest University Baptist Medical Center and is a national adult day services resource center. Supported by a Robert Wood Johnson Foundation grant, the program was developed to stimulate additional adult day centers in the country. That program was started after the Dementia Care and Respite Services Program -- headquartered at Wake Forest and supported by a Robert Wood Johnson Foundation grant -- demonstrated that such centers were viable and could be self-sufficient.

Cox said PMD Advisory Services, LLC of Hebron, Ky., and the Seniors Research Group of Market Strategies, Inc. of Livonia, Mich., assisted in the study.


Contact: Robert Conn (, Karen Richardson ( or Barbara Hahn ( at (336) 716-4587.

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