Heterogeneity within Adult Day Services: Comparing Programs That Serve Diverse Populations

Purpose: Adult day services (ADS) provide congregate care for individuals with functional limitations during the day.  Social workers play key roles in ADS and serve as administrators in almost 20% of all programs.  While much of the research on ADS has focused on older adult participants and their caregivers, ADS also serve younger adults with intellectual and developmental disabilities (I/DD).  Unfortunately, we know little in terms of the differences between programs that serve these very different groups.  The aim of this study was to describe and compare three different types of ADS programs: (a) I/DD specific programs; (b) older adult programs; and, (c) blended programs serving mixed populations.  The findings from this study move us away from thinking of ADS as a homogenous service platform and provide a more nuanced and informed view of this evolving industry.

 

Methods: Using data drawn from the MetLife National Study of Adult Day Services (Anderson, Dabelko-Schoeny & Johnson, 2012), 490 ADS programs (N = 490) were categorized as I/DD specific (n = 51), older adult (n = 352), and blended (n = 87).  One-way ANOVA analyses were run to identify between-group and within-group differences in terms of participant, staffing, and organizational characteristics.  Sheffé test post-hoc comparisons were then run to identify statistically significant differences between each type of ADS program. 

Results: In terms of participant characteristics, I/DD specific programs had significantly lower percentages of female participants and participants who lived alone compared to older adult and blended centers.  In terms of staffing, I/DD specific programs had significantly fewer direct care worker and registered nurse hours per day compared to older adult and blended centers.  I/DD programs also had significantly fewer LPN hours per day compared to blended centers and significantly fewer social worker hours per day compared to older adult centers.  On the organizational level, I/DD specific centers had significantly longer enrollment periods and a significantly higher percentage of their budgets derived from public funding compared to older adult and blended centers.

Implications:  The results from this study reveal significant differences between ADS programs on the participant, staffing, and organizational levels.  Most notably, I/DD specific programs provide services with fewer front line and professional staffing hours, including social workers.  This suggests that I/DD specific programs are either more efficient in their use of staffing or understaffed and poorly equipped to meet the complex needs of this population.  I/DD specific programs also provide care for much longer periods of time, illustrating their potential to impact the lives of participants.  Finally, I/DD specific ADS centers rely much more heavily on public funding, which speaks to possible problems should government priorities shift.  For social workers serving as administrators in ADS, these findings provide valuable assistance in key planning and programmatic efforts.  In terms of policy and funding, the findings illustrate the diversity that exists in the ADS industry and suggest that regulations and funding be tailored to each specific type of program.