NCHS Data Brief ■ No. 224 ■ December 2015

u.s. department of health and human services

Centers for Disease Control and Prevention

National Center for Health Statistics

Variation in Operating Characteristics of Adult Day Services 

Centers, by Center Ownership: United States, 2014

Vincent Rome, M.P.H; Lauren D. Harris-Kojetin, Ph.D.; and Eunice Park-Lee, Ph.D.

Key findings 

Data from the 2014 

National Study of LongTerm Care Providers

● In 2014, a higher percentage 

of nonprofit (71%) than forprofit (46%) adult day services 

centers had been in operation 

for 10 years or more. 

● Compared with nonprofit 

centers, for-profit centers 

received a higher percentage of 

revenue from Medicaid and a 

lower percentage from private 

sources. 

● A higher percentage of 

for-profit than nonprofit 

centers offered disease-specific 

programs for participants 

with cardiovascular disease, 

depression, and diabetes. 

● A higher percentage of 

nonprofit than for-profit adult 

day services centers primarily 

served participants with select 

diagnoses.

More than one-quarter of a million participants were enrolled in 4,800 adult 

day services centers in the United States in 2014 (1,2). Unlike other long-term 

care providers, such as nursing homes, home health agencies, hospices, and 

residential care communities, the majority of adult day services centers are 

nonprofit (3). However, for-profit ownership of adult day services centers has 

increased, from 27% in 2010 to 40% in 2012, and more recently to 44% in 

2014 (4,5). This report presents the most current national estimates of selected 

adult day services center operating characteristics, and compares these 

characteristics by center ownership. State estimates for the characteristics 

presented in this data brief are available online at: http://www.cdc.gov/nchs/

nsltcp/nsltcp_products.htm. 

Keyword: National Study of Long-Term Care Providers

In 2014, a higher percentage of nonprofit than for-profit adult 

day services centers had been in operation for 10 years or 

more. 

Figure 1. Selected operating characteristics of adult day services centers, by center ownership:

United States, 2014

1

Differences between for-profit and nonprofit centers are significant at the p < 0.05 level.

NOTE: Figure excludes cases with missing data; see “Data source and methods” for details. 

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2014.

In operation

10 years or more1

Chain-affiliated

All centers For-profit Nonprofit

Having one or more participants who

stopped using services due to cost1

60

46

71

42 41 43

14 12

15

Percent 0

20

60

40

80
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● About 7 in 10 nonprofit and 5 in 10 for-profit centers had been in operation 10 years or more 

(Figure 1).

● Similar percentages of nonprofit (43%) and for-profit (41%) centers were chain-affiliated. 

● Fifteen percent of nonprofit and 12% of for-profit centers had one or more participants who 

had stopped using the center in the last 12 months because of cost.

Sources of adult day services center revenue varied by center ownership.

● Among nonprofit centers, 41% of revenue was from Medicaid, compared with 65% among 

for-profit centers (Figure 2). 

● More than one-quarter of revenue among nonprofit centers was from other government 

sources (29%), compared with 16% among for-profit centers. 

● Twenty-one percent of revenue among nonprofit centers was from private sources, 

compared with 13% among for-profit centers.

Figure 2. Revenue among adult day services centers, by source and center ownership: United States, 2014

NOTES: Imputed data were used for sources of revenue; all sources of revenue are from paid participant fees only. 

Differences between for-profit and nonprofit centers are significant at the p < 0.05 level for all sources of revenue.

Percentages are based on unrounded numbers. Estimates may not add to totals because of rounding. 

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2014.

All centers For-profit Nonprofit

Other government

sources

Private sources

(out of pocket and 

private insurance)

Other sources

Medicaid

Percent

0

20

60

80

40

100

52

65

41

29

21

8

16

13

7

23

17

8
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A higher percentage of for-profit than nonprofit adult day services centers 

offered disease-specific programs for select conditions.

● Similar percentages of for-profit (70%) and nonprofit centers (68%) offered disease-specific 

programs for participants with Alzheimer’s disease or other dementias (Figure 3). 

● Among for-profit centers, 72% offered disease-specific programs for participants with 

diabetes, compared with 58% of nonprofit centers.

● A higher percentage of for-profit (67%) than nonprofit (52%) centers offered diseasespecific programs for participants with cardiovascular disease.

● Similarly, a higher percentage of for-profit (61%) than nonprofit (49%) centers offered 

disease-specific programs for participants with depression.

Figure 3. Disease-specific programs offered for selected conditions among adult day services centers, by

center ownership: United States, 2014

1

Differences between for-profit and nonprofit centers are significant at the p < 0.05 level.

NOTE: Figure excludes cases with missing data; see “Data source and methods” for details. 

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2014.

Alzheimer’s disease 

or other dementias

Diabetes1 Cardiovascular

disease1

Depression1

All centers For-profit Nonprofit

Percent

0

20

60

80

40

69 68

64

58 59

54

61

49

67

52

72 70
NCHS Data Brief ■ No. 224 ■ December 2015

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A higher percentage of nonprofit than for-profit adult day services centers 

primarily served participants with select diagnoses. 

● Almost one-quarter of nonprofit centers primarily served participants with a diagnosis of 

intellectual or developmental disability (24%), compared with 17% of for-profit centers 

(Figure 4). 

● Among nonprofit centers, 18% primarily served participants with a diagnosis of Alzheimer’s 

disease or other dementias, compared with 10% of for-profit centers.

Figure 4. Adult day services centers that primarily serve participants with a specific diagnosis, by center

ownership: United States, 2014

NOTES: Centers that primarily serve participants with a specific diagnosis are defined as those having 80% or more of

currently enrolled participants with the specific diagnosis. Differences between for-profit and nonprofit centers are 

significant at the p < 0.05 level for all diagnoses. Figure excludes cases with missing data; see “Data source and methods”

for details. 

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2014.

Intellectual or

developmental disability

Alzheimer’s disease 

or other dementias

All centers For-profit Nonprofit

Percent

0

20

30

21

17

24

14

10

18

10
NCHS Data Brief ■ No. 224 ■ December 2015

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Summary 

In 2014, adult day services centers differed by ownership on a variety of operating characteristics, 

including years in operation, chain affiliation, programs offered, revenue sources, and the 

diagnoses of participants served. A lower percentage of for-profit than nonprofit centers had 

been in operation for 10 years or more. For-profit centers received a lower percentage of their 

revenue from private sources (e.g., out-of-pocket payments by participant or family and private 

insurance), and a higher percentage from Medicaid, compared with nonprofit centers. 

A higher percentage of for-profit than nonprofit centers offered disease-specific programming for 

participants with diabetes, cardiovascular disease, and depression. Although a similar percentage 

of for-profit and nonprofit centers offered disease-specific programs for Alzheimer’s disease 

or other dementias, a lower percentage of for-profit than nonprofit centers primarily served 

participants with a diagnosis of Alzheimer’s disease or other dementias or with an intellectual or 

developmental disability.

Findings on differences by center ownership provide useful information to policy makers, 

providers, researchers, and consumer advocates as they plan to meet the needs of seniors and 

persons with disabilities. Corresponding state estimates and their standard errors for the national 

figures in this data brief are available in a supplemental table at: http://www.cdc.gov/nchs/nsltcp/

nsltcp_products.htm.

Definitions

Adult day services center: A community-based center that provides an array of long-term care 

services including structured activities, health monitoring, socialization, or assistance with 

activities of daily living to seniors or younger adults with disabilities. These centers are generally 

open 5 days a week for a minimum of 6 hours a day. 

Cardiovascular disease: Includes conditions such as heart disease, stroke, and high blood 

pressure.

Centers primarily serving participants diagnosed with a specific condition: Based on centers 

having 80% or more of currently enrolled participants with the specific diagnosis. The 

methodology used to determine the cutoff for communities that primarily serve specific 

populations of participants was derived from a recent study (6).

Chain affiliation: Ownership by a person, group, or organization that owns or manages two or 

more adult day services centers, including corporate chains.

Disease-specific programs: Programs that target participants who have a specific diagnosis 

and may include one or more of the following services—educational, physical activity, diet or 

nutrition, medication management, and weight management programs. 

Ownership type: Categorization of adult day services centers into two ownership types, for-profit 

and nonprofit. For-profit includes private, publicly traded, and limited liability centers. Nonprofit 

includes private as well as federal, state, county, and local government-owned centers. 

Revenue among adult day services centers: Reflects sources of revenue from paid participant 

fees only. Other government sources include the percentage of center revenue from Medicare, 
NCHS Data Brief ■ No. 224 ■ December 2015

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U.S. Department of Veterans Affairs, area agencies on aging, state and local government sources, 

Older Americans Act, and other government sources not including Medicaid. Private sources 

include the percentage of center revenue from private insurance and out-of-pocket payments by 

participants and families.

Data source and methods

Data are from the Adult Day Services Center Survey component of the 2014 wave of the biennial 

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

Control and Prevention’s (CDC) National Center for Health Statistics. The survey used a census 

of adult day services centers in the National Adult Day Services Association’s database. To be 

eligible for the study, an adult day services center must: a) have been in operation as of March 

28, 2014; b) be licensed or certified by the state specifically to provide adult day services, or 

authorized or otherwise set up to participate in Medicaid; c) have average daily attendance of one 

or more participants based on a typical week; and d) have one or more participants enrolled at the 

center at the designated location at the time of the survey. More details about the NSLTCP survey 

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

Although, 4,800 adult day services centers operate nationwide, the analyses in this data brief 

are based on the 4,700 adult day services centers for which ownership status was known; 50 

centers were excluded from the analyses because ownership status was unknown. The weighted 

frequencies for for-profit and nonprofit centers do not add up to 4,800 due to rounding. 

Differences among subgroups were evaluated using chi-square and t tests. All statistical 

significance tests were two-sided, using p < 0.05 as the level of significance. All differences 

reported are statistically significant unless otherwise indicated. Data analyses were performed 

using both SAS version 9.3 (8) and SAS-callable SUDAAN version 11.0.0 statistical packages 

(9) and Stata/SE version 12.1 (10). Imputed data were used for sources of revenue in Figure 2. 

About 4% of cases were missing for Medicaid, Medicare, other government, out-of-pocket, and 

private insurance sources of revenue from paid participant fees. About 5% of cases were missing 

for “other sources” of revenue from paid participant fees. For all other variables, the percentage 

of cases with missing data was less than 4.3%; cases with missing data were excluded from the 

analyses on a variable-by-variable basis. Because estimates were rounded, individual estimates 

may not sum to totals.
NCHS Data Brief ■ No. 224 ■ December 2015

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About the authors

Vincent Rome, Lauren D. Harris-Kojetin, and Eunice Park-Lee are with the CDC’s National 

Center for Health Statistics, Division of Health Care Statistics.

References

1. National Center for Health Statistics. 2014 National Study of Long-Term Care Providers, 

Survey methodology and documentation. Available from: http://www.cdc.gov/nchs/data/nsltcp/

NSLTCP_2014_survey_methodology_and_documentation.pdf.

2. Park-Lee E, Harris-Kojetin LD, Rome V, Lendon JP. Characteristics of participants enrolled 

in adult day services centers, by center ownership: United States, 2014. NCHS data brief, no 227. 

Hyattsville, MD: National Center for Health Statistics. 2015.

3. Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde R. Long-term care services in the United 

States: 2013 overview. National Center for Health Statistics. Vital Health Stat 3(37). 2013.

4. Anderson KA, Dabelko-Schoeny H, Johnson TD. The state of adult day services: Findings 

and implications from the MetLife National Study of Adult Day Services. J Appl Gerontol 

32(6):729–48. 2013.

5. 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.

6. Anderson KA, Park JH, Monteleone RG, Dabelko-Schoeny HI. Heterogeneity within adult 

day services: A focus on centers that serve younger adults with intellectual and developmental 

disabilities. Home Health Care Serv Q 33(2):77–88. 2014.

7. National Center for Health Statistics. 2014 National Study of Long-Term Care Providers, 

Adult Day Services Center Survey: Restricted data file, data description and usage (readme). 

2015. Available from: http://www.cdc.gov/nchs/data/nsltcp/NSLTCP_2014_ADSC_Readme_

RDC_Release.pdf.

8. SAS Institute. SAS (Release 9.3) [computer software]. 2011.

9. RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

10. StataCorp. Stata Statistical Software (Release 12.1) [computer software]. 2011.
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Suggested citation

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.

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

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

Alexander Strashny, Ph.D., Associate 

Director for Science