Adult day services

What it means

Adult day services fill the hours when a person cannot safely be alone and a family member is at work. Attendance is by the day or the half-day, transport is often included, and the person sleeps at home.

There are two broad kinds and the difference matters. A social model provides supervision, meals and activity. A medical or adult day health model adds nursing oversight, medication administration, and sometimes therapy — and is the one that can substitute for a good deal of paid home care.

Almost every program has a ceiling on what it can manage. Wandering, a two-person transfer, aggressive behavior or a medical need beyond the staffing model will end attendance, usually with little notice. Asking where that line sits, at the point of enrollment rather than at the point of crisis, converts a future emergency into a scheduled decision.

Why it matters

It is often the arrangement that lets somebody stay at home longest, and it costs a fraction of residential care.

It is also the arrangement families discover last, because nobody refers to it and it does not advertise.

When you are likely to meet it

• When somebody cannot be left alone during the working day.
• When a caregiver needs regular hours back without arranging live-in help.
• When a hospital discharge plan proposes it as an alternative to a facility.

How this varies by state

Licensing, what a program may do, and whether Medicaid pays for it are all set by the state.

Related terms

• Activities of daily livingThe everyday self-care tasks — bathing, dressing, eating, using the toilet, moving from a bed to a chair, continence — that care assessments and insurance policies measure.
• Area Agency on AgingA local agency, part of a national network, that arranges and coordinates services for older adults in its own area.
• Assisted livingHousing with help for daily tasks and staff on site, but without the licensed clinical care a nursing facility provides.
• Custodial careHelp with everyday living rather than medical treatment — bathing, dressing, eating, moving about. It is what most long-term care actually is.
• Home and community-based services waiverA Medicaid program paying for care at home instead of in a nursing facility.
• Home careNon-medical help at home — bathing, dressing, meals, housekeeping, company. Medicare does not pay for it.
• Memory careResidential care designed for dementia — secured, higher-staffed, and more expensive than ordinary assisted living.
• Respite careShort-term care that gives an unpaid family caregiver a break — a few hours, a day, or a stay of some days.

Sahvelo guidance that uses this

• Housing and care transitions