NCHS Data Brief ■ No. 296 ■ February 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Variation in Adult Day Services Center Participant 

Characteristics, by Center Ownership: United States, 2016

Jessica Penn Lendon, Ph.D., and Vincent Rome, M.P.H.

Key findings 

Data from the National 

Study of Long-Term 

Care Providers

● A higher percentage of 

participants of a race and 

ethnicity other than 

non-Hispanic white were in 

for-profit centers compared 

with nonprofit centers.

● About 73% of participants 

in for-profit centers paid 

for services using Medicaid 

compared with 58% in 

nonprofit centers.

● The percentage of 

participants with Alzheimer 

disease and with intellectual or 

developmental disability was 

higher in nonprofit centers than 

in for-profit centers.

● The percentage of 

participants needing assistance 

with bathing, dressing, 

toileting, transferring in or out 

of a chair, or eating was higher 

in nonprofit centers than in 

for-profit centers.

● A higher percentage of 

participants in nonprofit centers 

(10%) than in for-profit centers 

(6%) had fallen in the last 90 

days.

An estimated 286,300 participants were enrolled in adult day services centers 

in the United States in 2016 (1). The percentage of for-profit adult day 

services centers has grown in recent years, from 40% in 2012 to 44% in 2014 

and remaining stable at 45% in 2016 (2–4). This report presents the most 

current national estimates of selected characteristics of participants in adult 

day services centers and compares these characteristics by center ownership 

type. State-level estimates for the characteristics presented are available from: 

https://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

Keywords: medical conditions • activities of daily living (ADLs) • home and 

community-based services • National Study of Long-Term Care Providers

The racial and ethnic composition of participants in adult 

day services centers varied by center ownership.

Figure 1. Percent distribution of race and ethnicity among adult day services center participants,

by center ownership: United States, 2016

 

NOTES: Percentages are based on unrounded numbers; estimates may not sum to totals because of rounding. See "Data source 

and methods" for details on the study and methodology. Access data table for Figure 1 at: 

https://www.cdc.gov/nchs/data/databriefs/db296_table.pdf#1.

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016. 
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● About 31% of participants in for-profit centers were non-Hispanic white, 29% were 

Hispanic, 24% were of other race and ethnicity, and 14% were non-Hispanic black, 

compared with 54% non-Hispanic white, 15% Hispanic, 12% other race and ethnicity, and 

17% non-Hispanic black in nonprofit centers (Figure 1).

Selected sociodemographic characteristics of adult day services center 

participants differed by center ownership. 

● A higher percentage of participants had some or all services paid by Medicaid in for-profit 

centers (73%) compared with participants in nonprofit centers (58%) (Figure 2).

● A higher percentage of participants in for-profit adult day services centers were aged 65 and 

over (65%) compared with nonprofit centers (60%).

● For-profit adult day services centers had a slightly higher percentage of female participants 

(59%) compared with nonprofit centers (58%).

 

NOTES: Changes in wording in the 2016 Medicaid use item may have contributed to a difference in estimates from earlier surveys. See "Data source and 

methods" for details on the study and methodology. Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db296_table.pdf#2.

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016. 

Figure 2. Selected sociodemographic characteristics among adult day services center participants, by center

ownership: United States, 2016

 
NCHS Data Brief ■ No. 296 ■ February 2018

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The prevalence of selected diagnosed medical conditions among adult day 

services center participants differed by center ownership. 

● A higher percentage of participants in for-profit centers than in nonprofit centers had a 

diagnosis of diabetes (38% compared with 24%), depression (32% compared with 24%), 

heart disease (30% compared with 24%), and severe mental illness (11% compared with 

8%) (Figure 3).

● A lower percentage of participants in for-profit centers than in nonprofit centers had 

a diagnosis of Alzheimer disease or other dementias (26% compared with 37%) and 

intellectual or developmental disability (21% compared with 36%).

 

NOTES: Changes in wording in the 2016 heart disease item may have contributed to a difference in estimates from earlier surveys. Cases with missing data are 

excluded; missing data for all conditions ranged from 11.2% for Alzheimer disease or other dementias to 14.1% for heart disease. See "Data source and methods" 

for details on the study and methodology. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db296_table.pdf#3.

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016. 

Figure 3. Selected diagnosed medical conditions among adult day services center participants, by center ownership:

United States, 2016

 
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Nonprofit adult day services centers had a higher percentage of 

participants needing assistance with selected activities of daily living 

(ADLs) than for-profit centers.

● Nonprofit centers had a higher percentage of participants needing assistance with bathing 

(41%) compared with participants in for-profit centers (37%) (Figure 4).

● A higher percentage of participants in nonprofit centers than in for-profit centers needed 

assistance with toileting (40% compared with 28%), dressing (39% compared with 34%), 

transferring in or out of a chair (30% compared with 27%), and eating (28% compared 

with 19%).

 

NOTES: See "Data source and methods" for details on the study and methodology. Access data table for Figure 4 at: 

https://www.cdc.gov/nchs/data/databriefs/db296_table.pdf#4.

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016.

Figure 4. Need for assistance with selected activities of daily living among adult day services center participants, by

center ownership: United States, 2016

 
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The prevalence of emergency department visits, discharges from overnight 

hospital stays, and falls among adult day services center participants 

differed by center ownership.

● Nonprofit centers had a higher percentage of participants who had fallen in the last 90 days 

(10%) compared with for-profit centers (6%) (Figure 5).

● A slightly higher percentage of participants in nonprofit centers than in for-profit centers 

had emergency department visits (8% compared with 7%) and discharges from an overnight 

hospital stay (5% compared with 4%) in the last 90-day period.

 

NOTES: See "Data source and methods" for details on the study and methodology. Access data table for Figure 5 at: 

https://www.cdc.gov/nchs/data/databriefs/db296_table.pdf#5.

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016.

Figure 5. Emergency department visits, discharges from overnight hospital stays, and falls among adult day services

center participants, by center ownership: United States, 2016

 
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Summary

In 2016, U.S. adult day services center participants differed by type of center ownership for each 

of the characteristics examined in this report. As in previous years (5,6), the sociodemographic, 

functional and health status, and service utilization characteristics of center participants varied 

by type of center ownership. For-profit adult day services centers had a higher percentage of 

racial and ethnic minorities, served a somewhat older population (aged 65 and over), and had 

more participants with services paid by Medicaid compared with nonprofit centers. For-profit 

centers served higher percentages of participants with a diagnosis of heart disease, diabetes, 

depression, or severe mental illness compared with nonprofit centers. Conversely, compared with 

for-profit centers, nonprofit adult day services centers served a higher percentage of participants 

with a diagnosis of Alzheimer disease or other dementias, and with intellectual or developmental 

disability. Nonprofit centers served more participants who needed assistance with selected ADLs. 

Slightly higher percentages of participants in nonprofit centers than in for-profit centers had an 

emergency department visit, a discharge from an overnight hospital stay, or a fall in the last 

90 days.

Definitions

Adult day services center: A community-based center, generally open on weekdays, that provides 

long-term care services, including structured activities, health monitoring, socialization, and 

assistance with activities of daily living (ADLs) to adults with disabilities. 

Assistance with selected activities of daily living (ADLs): Refers to participants needing any help 

or supervision from another person, or use of assistive devices, at their usual residence or at the 

adult day services center, with up to five limitations in ADLs (bathing, dressing, transferring in 

and out of a chair, toileting, and eating) that reflect a participant’s capacity for self-care.

Emergency department visits: Includes participants who were treated in a hospital emergency 

department at least once in the 90 days prior to the survey.

Falls: Includes participants with at least one on-site or off-site fall in the 90 days prior to the 

survey.

Heart disease: Includes conditions such as congestive heart failure, coronary or ischemic heart 

disease, heart attack, and stroke.

Other race and ethnicity: Includes participants of the following racial and ethnic backgrounds: 

non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Native 

Hawaiian or Other Pacific Islander, non-Hispanic of two or more races, other category not 

reported in the adult day services center’s system, and unknown race and ethnicity.

Overnight hospital stays: Includes participants with at least one discharge from an overnight 

hospital stay in the 90 days prior to the survey. 

Ownership type: For-profit includes private for-profit centers, publicly traded centers, and limited 

liability centers. Nonprofit includes private nonprofit centers as well as federal, state, county, and 

local government-owned centers.
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Participants with some or all services paid by Medicaid: Includes participants who had some 

or all of their long-term care services paid by Medicaid during the 30 days prior to the survey, 

including funding from a Medicaid state plan, Medicaid waiver, Medicaid managed care, or 

California regional center.

Data source and methods

Data are from the Adult Day Services Center Survey component of the 2016 wave of the biennial 

National Study of Long-Term Care Providers (NSLTCP), conducted by the National Center for 

Health Statistics. The survey used a census of adult day services centers in the National Adult 

Day Services Association’s database. More details on the NSLTCP survey, including eligibility 

criteria, design, and outcomes, are published elsewhere (1,7).

Although the 2016 NSLTCP includes an estimated 286,300 participants in 4,600 adult day 

services centers nationwide, the analyses in this report are based on the 285,100 participants 

in adult day services centers for which ownership status was known. Cases with missing data 

were excluded from the analyses, ranging from less than 1% for ownership status to 14.1% in 

diagnoses of heart disease. Missing data greater than 10% are noted in the data.

Differences by ownership status were evaluated using t tests, and a ratio of weighted sums for 

each subgroup was computed for comparison. All statistical significance tests were two-sided, 

using p < 0.05 as the significance level. All differences reported are statistically significant 

unless otherwise indicated. Data analyses were performed using SAS version 9.3, SAS-callable 

SUDAAN version 11.0.0, and Stata/SE version 14.

About the authors

Jessica Penn Lendon and Vincent Rome are with the National Center for Health Statistics, 

Division of Health Care Statistics, Long-Term Care Statistics Branch.

References

1. National Center for Health Statistics. 2016 National Study of Long-Term Care Providers 

survey methodology for the Adult Day Services Center and Residential Care Community 

components. Hyattsville, MD. 2017. Available from: https://www.cdc.gov/nchs/data/nsltcp/

NSLTCP_2016_survey_methodology_documentation.pdf.

2. Dwyer LL, Harris-Kojetin LD, Valverde RH. Differences in adult day services center 

characteristics by center ownership: United States, 2012. NCHS Data Brief, no 165. Hyattsville, 

MD: National Center for Health Statistics. 2014. Available from: https://www.cdc.gov/nchs/data/

databriefs/db165.htm.

3. Rome V, Harris-Kojetin LD, Park-Lee E. Variation in operating characteristics of adult day 

services centers, by center ownership: United States, 2014. NCHS Data Brief, no 224. Hyattsville, 

MD: National Center for Health Statistics. 2015. Available from: https://www.cdc.gov/nchs/data/

databriefs/db224.htm.
NCHS Data Brief ■ No. 296 ■ February 2018

4. Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde R, Caffrey C, 

Rome V, Lendon J. Long-term care providers and services users in the 

United States: Data from the National Study of Long-Term Care Providers, 

2013–2014. National Center for Health Statistics. Vital Health Stat 3(38). 2016. 

Available from: https://www.cdc.gov/nchs/data/series/sr_03/sr03_038.pdf.

5. Park-Lee E, Harris-Kojetin LD, Rome V, Lendon JP. Variation in adult 

day services center participant characteristics, by center ownership: United 

States, 2014. NCHS Data Brief, no 227. Hyattsville, MD: National Center 

for Health Statistics. 2015. Available from: https://www.cdc.gov/nchs/data/

databriefs/db227.htm.

6. Dwyer LL, Harris-Kojetin LD, Valverde RH. Differences in adult day 

services center participant characteristics by center ownership: United States, 

2012. NCHS Data Brief, no 164. Hyattsville, MD: National Center for Health 

Statistics. 2014. Available from: https://www.cdc.gov/nchs/data/databriefs/

db164.htm.

7. National Center for Health Statistics. 2016 National Study of Long-Term 

Care Providers (NSLTCP) Adult Day Services Center Survey restricted data 

file: Data description and usage (readme). Hyattsville, MD. 2017. Available 

from: https://www.cdc.gov/nchs/data/nsltcp/NSLTCP_2016_ADSC_

Readme_RDC.pdf.

Suggested citation

Lendon JP, Rome V. Variation in adult day 

services center participant characteristics, 

by center ownership: United States, 2016. 

NCHS Data Brief, no 296. Hyattsville, MD: 

National Center for Health Statistics. 2018.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Denys T. Lau, Ph.D., Acting Director

Alexander Strashny, Ph.D., Associate 

Director for Science

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