35% Increase in Number of Centers; Participant Number Doubles

There has been significant growth in the number of Adult Day Services centers in the U.S. over the past eight years, according to a new study by the MetLife Mature Market Institute. As reported in “The MetLife National Study of Adult Day Services: Providing Support to Individuals and Their Family Caregivers,” there are more than 4,600 Adult Day Services (ADS) centers nationwide, a 35% increase since 2002.

The study, produced in collaboration with the National Adult Day Services Association (NADSA) and The Ohio State University College of Social Work, reports that these centers serve about 260,000 people, an increase of more than 100,000 since 2002. Twenty-nine percent of the centers have waiting lists. More than half of the participants (58%) are women; 30% are under age 65.

The study, accompanied by a consumer guide, “The Essentials: Adult Day Services,” also found that centers have significantly upgraded the level of services they provide; 80% now have a professional nursing staff and 50% have a social work professional. Half provide physical, occupational or speech therapy.

Approximately 90% of centers offer cognitive stimulation programs, while 80% have memory training. Most centers provide programs for caregivers, including education, support groups and individual counseling. The ratio of direct care worker-to-participant is now 1:6.

“We’re seeing that more and more Adult Day Services centers have become a staple in communities in recent years,” said Dr. Sandra Timmermann, director of the MetLife Mature Market Institute. “Older Americans, people with disabilities and family caregivers rely on them for the services they provide. ADS centers make it possible for people to continue to live in their homes and receive affordable care in a supportive, professionally staffed, community-based setting. They also benefit family caregivers by enabling them to remain in the workforce or receive needed respite and support services. The passage of the Patient Protection and Affordable Care Act (the health care reform bill), and an increasing focus on managing chronic illness within the Medicare program, speaks to the importance of developing care models such as Adult Day Services to meet the needs of a growing population of older Americans.”

According to Dr. Holly Dabelko-Schoeny of The Ohio State University College of Social Work, in addition to providing needed long-term care services, Adult Day Services centers serve as an emerging provider of transitional care from the hospital to home, providing short-term rehabilitation following discharge from the hospital. “Centers are also offering disease-specific programs to address chronic conditions and meet the needs of participants who have higher levels of chronic conditions and increasing physical disability,” said Dr. Dabelko-Schoeny.

The study provides a snapshot of the typical Adult Day Services center in the U.S.:

  • Most operate Mondays through Fridays from 6:30 a.m. to 6:00 p.m. in a 1,000–5,000 square foot facility. Centers are usually administered by a professional in the business/health care administration, nursing or social work field. Professional services are provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) and recreational and therapy professionals. The typical direct care worker-to-program participant ratio is 1:6.
  • Fees average $61.71 per day and typically come from a public source, including Medicaid waiver, the Veterans Administration, state/local social services or directly from a private-pay participant. Since the average daily cost of care is $68.89 per person, centers supplement revenue with grants and donations.
  • Though participants are diverse in age, ethnicity and ability, the average participant is a 65-plus-year-old, white female with dementia, hypertension or a physical disability requiring assistance with at least one activity of daily living (ADL) and medication management. She lives with an adult child or spouse, or lives alone, but primarily receives care from an adult child.
  • The average length of enrollment in a program is 24 months.
  • The majority of the ADS centers (86%) reported they were state-certified or licensed, a 10% increase from 2002.
  • The study reports an increase in the number of for-profit ADS centers. Currently, 27% are for profit today, compared with 22% in 2002.

The MetLife National Study of Adult Day Services,” a collaborative partnership of the MetLife Mature Market Institute in conjunction with the National Adult Day Services Association (NADSA) and The Ohio State University College of Social Work, was conducted in 2010. Data was collected and analyzed from a representative sample of 557 Adult Day Services centers, focusing on the characteristics of adult day services, a profile of participants and the range of services offered. When possible the 2010 findings were compared with the findings from the first national study of adult day services conducted in 2002 by the Partners in Caregiving program and the Wake Forest University School of Medicine.

“The MetLife National Study of Adult Day Services” and the accompanying consumer guide, “The Essentials: Adult Day Services,” can be downloaded from It can also be ordered by e-mailing or by writing to: MetLife Mature Market Institute, 57 Greens Farms Road, Westport, CT 06880.

National Adult Day Services Association
The National Adult Day Services Association (NADSA) is a membership organization developed for the purpose of advancing the success of its members through advocacy, education, technical assistance, research, and communication services. It serves as the leading voice for the diverse Adult Day Services community.

The Ohio State University College of Social Work

The Ohio State University is one of the largest and most comprehensive institutions of higher education and consistently ranks in the top 20 public universities in the U.S. First accredited in 1919, The Ohio State University College of Social Work is the oldest continuously accredited public social work program in the country. Dr. Holly Dabelko-Schoeny and Dr. Keith A. Anderson served as co-principal investigators for the study. Dr. Dabelko-Schoeny’s practice and research interests focus on improving the delivery of community-based services for older adults and their caregivers through collaboration with community agencies. Dr. Anderson’s practice and research centers on well-being and quality of life for older adults and their caregivers across the long-term care spectrum.

The MetLife Mature Market Institute®
Established in 1997, the Mature Market Institute (MMI) is MetLife’s research organization and a recognized thought leader on the multi-dimensional and multi-generational issues of aging and longevity. MMI’s groundbreaking research, gerontology expertise, national partnerships, and educational materials work to expand the knowledge and choices for those in, approaching, or caring for those in the mature market.

MMI supports MetLife’s long-standing commitment to identifying emerging issues and innovative solutions for the challenges of life. MetLife, Inc. (NYSE: MET), through its subsidiaries and affiliates, is a leading provider of insurance, employee benefits and financial services with operations throughout the United States and the Latin American, Europe and Asia Pacific regions.

For more information about the MMI, please visit:


DJC Communications
Debra Caruso
Shalana Morris
Joseph Madden