April 2004

Grant Results

SUMMARY

For two years beginning in November 2000, staff at the Wake Forest University School of Medicine conducted a national study of adult day services. The staff had directed the Partners in Caregiving: The Adult Day Services Program, a national program of the Robert Wood Johnson Foundation (RWJF).

Key Findings

  • The current number of adult day centers — 3,407 — falls far short of what is needed to serve the needs of the population of adults with chronic, debilitating illnesses and their family caregivers. The study estimates that the U.S. population base can support 8,520 adult day centers, with 5,415 more centers needed.
  • Average overall enrollment in adult day centers was 42; average daily attendance was 25. The average length of stay was two years.
  • The top three problems of adult day centers were adequate funding, recruiting/retaining staff and maintaining census/attendance.

Funding
RWJF provided $401,083 for the study of adult day services.

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THE PROBLEM

No solid data existed about the number, locations and types of adult day centers. Accurate data would help:

  1. Inform RWJF programmatic work.
  2. Provide baseline information to policymakers regarding the state of the field of adult day services.
  3. Assist state and national organizations in reaching centers regarding education and advocacy efforts.

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RWJF STRATEGY

RWJF funded two programs to improve the functioning and financing of adult day services. The first was the Dementia Care and Respite Services Program, which from 1988 to 1992 demonstrated that adult day centers for people with dementia could provide needed services to individuals across a wide range of disease severity, and could become financially viable, especially by focusing on the private pay market. RWJF then launched Partners in Caregiving (see the Grant Results). In extending the work of the first program — through 50 sites nationwide — Partners in Caregiving basically asked three additional questions:

  • Could lessons learned in the Dementia Care Program be applied at adult day centers more quickly and economically and with similar success?
  • Is the adult day center model appropriate for people with other chronic disabling conditions (for example, multiple sclerosis)?
  • Can results be achieved through technical assistance only, or is funding a requisite to the success of an individual adult day center?

To address the last question, 25 program sites received funding (typically under $100,000) and limited technical assistance. Another 25 sites received a broad spectrum of technical assistance, pertinent to both service and growth, with little or no RWJF funding. Results showed that the lessons learned in the Dementia Care Program could be applied swiftly and effectively, that adult day centers can effectively serve people with other chronic conditions and that technical assistance could be just as effective as funding in helping adult day centers replicate models of care — and become financially viable at the same time.

In 1998 (under grant ID# 024202) the Wake Forest University School of Medicine conducted a 2.5-year intensive information dissemination phase through Partners in Caregiving to disseminate lessons learned in this program to adult day centers across the United States.

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THE PROJECT

Staff at the Partners in Caregiving National Program Office at Wake Forest University School of Medicine (with assistance from PMD Advisory Services and the Seniors Research Group of Market Strategies, working under subcontracts) conducted this national study of adult day services to provide the following information:

  1. A census of the number and location of adult day service providers.
  2. A survey of providers to determine populations served and services offered.
  3. Identification of gaps in the current adult day service delivery system.

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FINDINGS

Findings from the national study of U.S. adult day service providers include the following:

  • The current number of adult day centers — 3,407 — falls far short of what is needed to serve the needs of the population of adults with chronic, debilitating illnesses and their family caregivers. The study estimates that the U.S. population base can support 8,520 adult day centers, with 5,415 more centers needed.
  • Average overall enrollment in adult day centers was 42; average daily attendance was 25. The average length of stay was two years.
  • Seventy-eight percent of adult day centers reported that they were nonprofit organizations; 22 percent reported that they were for-profit organizations.
  • Thirty-seven percent of adult day centers are based on a social model of care (with no nursing services provided); 21 percent are based on a medical model (providing nursing services and in some instances rehabilitation therapy); 42 percent are based on a combination of social and medical models. Twenty percent of all adult day centers were exclusively devoted to caring for people with dementia.
  • The top three problems of adult day centers were adequate funding, recruiting/retaining staff and maintaining census/attendance.

Communications

The Wall Street Journal published an article on the study, "When Your Parents Need a Baby Sitter: Adult Day-Care Centers in Short Supply," on December 19, 2002.

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AFTER THE GRANT

Through the RWJF Television Health Series, a video news release was developed around the national study. Falling Short: Too Few Adult Day Centers aired 91 times on 74 stations in 60 markets with a total of 2,367,436 viewers (as of January 9, 2004).

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GRANT DETAILS & CONTACT INFORMATION

Project

National Study of Adult Day Services

Grantee

Wake Forest University School of Medicine (Winston-Salem,  NC)

  • Adult Day Services Census
    Amount: $ 401,083
    Dates: November 2000 to November 2002
    ID#:  037535

Contact

Nancy J. Cox
(336) 716-4941
njcox@wfubmc.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Book Chapters

Cox NJ, Henry RS. "Day Programs for Adults." In Encyclopedia of Retirement and Finance, Vitt LA (ed.). Westport, Conn.: Greenwood Press, 2003.

Articles

"Adult Day Services." Aging Committee Hearing Finding Summary: A Report Presented by the Senate Special Committee on Aging, United States Senate (June 2002). Washington: U.S. Government Printing Office, 2002.

Reports

National Study of Adult Day Services, 2001–2002. Winston-Salem, N.C.: Partners in Caregiving: The Adult Day Services Program, Wake Forest University School of Medicine, 2002.

The Role of Adult Day Services. Winston-Salem, N.C.: Wake Forest University School of Medicine, 2003.

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Report prepared by: Lauren Green
Reviewed by: Robert Crum
Reviewed by: Molly McKaughan
Program Officer: Rona Henry