Research That Matters (January 17 - 20, 2008)

Adult Day Service programs provide health and social support to older adults with functional impairments outside of their home setting. The current field of practice identifies Adult Day Services as an effective and successful community-based program, and also notes these programs are an important inaugural component in the long-term care continuum for older adults. In 2001 the Robert Wood Johnson Foundation performed a national study and reported finding under-representation and underutilization of Adult Day Services in Iowa. In response to those findings, Adult Day Service policies and regulations in Iowa were seriously and extensively revised. This study sought to assess the present needs and capacity of Adult Day Services in this primarily rural state subsequent to those policy and regulatory changes.

This mixed methods study of quantitative and qualitative data included the examination of both professionals and consumers in the field of home and community-based services for older adults to understand the present use, barriers and possible need for expansion of Adult Day Services. Surveys to providers asked about present services and barriers to expansion. Open-ended interviews were conducted with Area Agency on Aging directors and related professional trade association leaders. Six sets of focus groups were conducted throughout the state in two main groupings, 1) area professionals in gerontology, as well as 2) current or potential users of Adult Day Services in their area. The interviews and focus groups assessed the strengths, weaknesses and areas for potential policy change within Iowa's Adult Day Services.

Surveys were analyzed with SPSS using descriptive and inferential statistics. Interviews and focus groups were analyzed using grounded theory through open coding and the constant comparison method. High inter-rater reliability was found among three independent raters.

Four key barriers to the representation and utilization of Adult Day Services in the state of Iowa were found. First, the target population of older adults were found to largely stigmatize Adult Day Services. Second, a lack of technical assistance was present, which included the need for help with marketing, development of a business plan, board development, or staff training, for instance. Thirdly, there was also a lack of adequate funding or resources for the establishment and maintenance of Adult Day Service programs and facilities. Finally, Adult Day Service programs were challenged by the inappropriateness of fit of universal guidelines imposed on contrasting urban and rural areas in Iowa.

This study supports Adult Day Services as a critical component of the long-term care continuum and suggest areas for potential policy changes to ensure that is continued and strengthened in Iowa. Recommendations for policy changes to the Department of Elder Affairs (DEA) include initiating a tiered model for programs with differing expectations dependent upon age of program, type of facility, and location; increased governmental funding for new programs; and the creation of an Adult Day Service liaison at the DEA to be responsible for creating and maintaining a repository of information for consumers. Implications for gerontological social workers include increased referrals to ADS and advocating for elder independence.