NCHS Data Brief ■ No. 164 ■ September 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Differences in Adult Day Services Center Participant 

Characteristics by Center Ownership: United States, 2012

Lisa L. Dwyer, M.P.H.; Lauren D. Harris-Kojetin, Ph.D.; and Roberto H. Valverde, M.P.H.

Key findings

Data from the National 

Study of Long-Term Care 

Providers

• In 2012, more than one-third 

of participants in adult day 

services centers were younger 

than 65. A higher percentage of 

participants in nonprofit centers 

than in for-profit centers were 

younger than 65.

• About one-half of participants 

in adult day services centers 

were non-Hispanic white 

persons. A higher percentage of 

participants in for-profit centers 

than in nonprofit centers were 

Hispanic or were non-Hispanic 

and of a race other than black 

or white. 

• Almost one-third of adult 

day services center participants 

had Alzheimer’s disease or 

other dementias, and about onequarter had a developmental 

disability. A lower percentage 

of participants in for-profit 

than in nonprofit centers had 

Alzheimer’s disease or other 

dementias or a developmental 

disability. 

The 4,800 adult day services centers nationwide provide a variety of services 

to their 273,200 participants, the majority of whom are older adults and 

women (1). The number of for-profit adult day services centers has grown 

in recent years (2). The 1,900 for-profit centers, representing 40% of centers 

nationally, served nearly one-half (47%) of center participants in 2012 (3). 

Using data from the National Study of Long-Term Care Providers, this report 

presents selected characteristics of adult day services center participants in 

2012 and compares the characteristics of participants in for-profit centers with 

those in nonprofit centers. State-level estimates for characteristics presented 

in this data brief are available from: http://www.cdc.gov/nchs/nsltcp/nsltcp_

products.htm.

Keywords: National Study of Long-Term Care Providers • medical conditions • 

activities of daily living

The majority of adult day services center participants were 

aged 65 and over.

37 34 39

20 28

13

47 51 43

17

15

19

17 15 18

16

20

12

47

37

57

0

20

40

60

80

100

All

85 and 

over

65–84

Under 65

NonHispanic

white

NonHispanic

other1

NonHispanic

black

Hispanic

For-profit

centers

Nonprofit

centers

All For-profit

centers

Nonprofit

centers

1

Non-Hispanic other refers to participants who were non-Hispanic and of a race other than black or white.

NOTES: Differences between for-profit and nonprofit center participants are significant at the p < 0.05 level for all characteristics. 

Figure excludes cases with missing data; see "Data source and methods" for details. Percentages may not add to 100 because 

of rounding.

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2012. Percent

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

by center ownership: United States, 2012
NCHS Data Brief ■ No. 164 ■ September 2014

■  2  ■

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

were aged 65 and over, with the greatest difference seen among those aged 65–84: 51% of 

participants in for-profit centers were aged 65–84 compared with 43% in nonprofit centers 

(Figure 1).

• A higher percentage of participants in nonprofit (57%) than in for-profit (37%) adult day 

services centers were non-Hispanic white persons. A higher percentage of participants in 

for-profit centers than in nonprofit centers were Hispanic (28% compared with 13%) or 

non-Hispanic and of a race other than black or white (20% compared with 12%).

A higher percentage of participants in for-profit than in nonprofit adult day 

services centers were enrolled in Medicaid.

• Fifty-five percent of participants in adult day services centers had some or all of their 

long-term care services paid by Medicaid (Figure 2).

• A higher percentage of participants in for-profit (71%) than in nonprofit centers (42%) were 

enrolled in Medicaid.

NOTES: Differences between participants in for-profit and nonprofit centers are significant at the p < 0.05 level. Figure excludes cases with missing data; 

see "Data source and methods" for details.

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2012.

55

71

42

All For-profit centers Nonprofit centers

Figure 2. Medicaid enrollment among adult day services center participants, by center ownership: United States, 2012 Percent

0

20

40

60

80
NCHS Data Brief ■ No. 164 ■ September 2014

■ 3  ■

A higher percentage of participants in nonprofit adult day services centers 

were diagnosed with Alzheimer’s disease or other dementias or with 

developmental disabilities, whereas a higher percentage of participants in 

for-profit centers were diagnosed with depression or severe mental illness.

• Thirty-seven percent of participants in nonprofit adult day services centers had a diagnosis of

Alzheimer’s disease or other dementias, compared with 27% in for-profit centers (Figure 3).

• Thirty-one percent of participants in nonprofit adult day services centers had a diagnosis of

developmental disability, compared with 19% in for-profit centers. 

• Nineteen percent of participants in nonprofit adult day services centers had a diagnosis of

depression, compared with 29% in for-profit centers.

• Nine percent of participants in nonprofit adult day services centers had a diagnosis of severe

mental illness, compared with 12% in for-profit centers.

NOTES: ADSC is adult day services center. Differences between participants in for-profit and nonprofit centers are significant at the p < 0.05 level for all 

selected medical conditions. Figure excludes cases with missing data; see "Data source and methods" for details.

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2012. Percent

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

United States, 2012

32

25

24

10

27

19

29

12

37

31

19

9

0

10

20

30

40

Alzheimer's disease

or other dementias

Developmental 

disability

Depression Severe mental illness

All ADSC

participants

Participants in 

for-profit centers

Participants in

nonprofit centers
NCHS Data Brief ■ No. 164 ■ September 2014

■  4  ■

Participants in adult day services centers differed by center ownership in 

their need for assistance with some activities.

• A higher percentage of participants in nonprofit adult day services centers needed assistance 

with toileting (40%) compared with those in for-profit centers (32%) (Figure 4).

• A higher percentage of participants in nonprofit adult day services centers needed assistance 

with eating (29%) compared with those in for-profit centers (22%). 

• A higher percentage of participants in for-profit centers received medication assistance (38%) 

compared with those in nonprofit centers (30%). 

• Similar percentages of participants in nonprofit and for-profit adult day services centers needed 

assistance with locomotion or walking (46% and 47%, respectively) and needed assistance with 

transferring in or out of a chair (29% and 28%, respectively).

1

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

NOTES: ADSC is adult day services center. Figure excludes cases with missing data; see "Data source and methods" for details.

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2012.

Figure 4. Need for assistance with selected activities of daily living and receipt of medication assistance among 

adult day services center participants, by center ownership: United States, 2012

47

36

28

25

34

47

32

28

22

38

46

40

29 29 30

0

10

20

30

40

50

Locomotion

or walking

Toileting1 Transferring in

or out of chair

Eating1 Medication assistance

(receipt of)1

Percent

All ADSC

participants

Participants in 

for-profit centers

Participants in

nonprofit centers
NCHS Data Brief ■ No. 164 ■ September 2014

■  5  ■

Less than 10% of participants in adult day services centers had an 

emergency department visit or were discharged from an overnight hospital 

stay in the last 90 days, while almost 20% of participants discharged from 

an overnight hospital stay were readmitted within 30 days of discharge. 

• Similar percentages of participants in nonprofit and for-profit adult day services centers (7% 

and 6%, respectively) had an emergency department visit in the last 90 days (Figure 5).

• Equal percentages of participants in nonprofit and for-profit adult day services centers (6%) 

had been discharged from an overnight hospital stay in the last 90 days.

• Nearly one in five participants in both nonprofit (17%) and for-profit (18%) adult day services 

centers who was discharged from an overnight hospital stay in the last 90 days was readmitted to 

the hospital within 30 days of discharge.

NOTES: ADSC is adult day services center. Differences between participants in for-profit and nonprofit centers are not significant at the p < 0.05 level for all 

variables. Figure excludes cases with missing data; see "Data source and methods" for details.

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2012.

Figure 5. Emergency department visits, overnight hospital stays, and readmissions among adult day services center

participants, by center ownership: United States, 2012 Percent

6% 6%

17%

6% 6%

18%

7%

6%

17%

0

5

10

15

20

Emergency department

visit in last 90 days

Discharged from

overnight hospital stay

in last 90 days

Readmitted within

30 days of discharge from

overnight hospital stay

15,700 7,200 8,500 15,100 7,100 8,000

2,600 1,300 1,300

All ADSC

participants

Participants in 

for-profit centers

Participants in

nonprofit centers

Summary

On any given day in 2012, more than a quarter million participants (273,200) were enrolled in an 

estimated 4,800 adult day services centers operating in the United States (1); participants were 

about evenly distributed between for-profit (47%) and nonprofit (53%) centers (3). 

Adult day services center participants are more diverse than users of other major long-term 

care services with respect to race, ethnicity, and age (1). Twenty percent of adult day services 

center participants in 2012 were Hispanic, and 17% were non-Hispanic black. There were more 

than twice as many Hispanic participants in for-profit centers as in nonprofit centers. More than 

one-third (37%) of adult day services center participants in 2012 were under age 65, supporting 

previous research on the increasing role of these centers in serving younger persons with 
NCHS Data Brief ■ No. 164 ■ September 2014

■  6  ■

intellectual and developmental disabilities and the growing numbers of veterans with traumatic 

brain injuries (2,4). 

A sizeable percentage of all adult day services center participants in 2012 had a diagnosis 

of Alzheimer’s disease or other dementias (32%), suggesting that these conditions may be a 

common precipitating factor for using formal long-term care services (5), including adult day 

services. Nonprofit adult day services centers served a higher percentage of participants with 

dementia (37%) compared with for-profit centers (27%).

Reducing potentially avoidable emergency department visits and inpatient hospital admissions 

is a policy priority (6). Older adults comprise a large and growing percentage of emergency 

department patients (7,8). In 2012, adult day services center participants had nearly 63,000 

emergency department visits. Also, almost one-fifth of the 15,100 participants with an overnight 

hospital stay in the 90 days before the survey had a readmission within 30 days of their discharge, 

potentially representing more than 10,000 participants in a year. 

These findings provide a current national picture of participants enrolled in U.S. adult day 

services centers. 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 from: http://www.cdc.gov/nchs/nsltcp/nsltcp_

products.htm. These national and state estimates establish a baseline for monitoring trends among 

adult day services center participants.

Definitions

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

services, including structured activities, health monitoring, socialization, and 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.

Assistance with selected activities of daily living: Needing any help or supervision from another 

person, or use of special equipment for locomotion or walking, toileting, transferring in or out of 

a chair, or eating. 

Hospital emergency department visit: Refers to when adult day services center participants are 

treated in a hospital emergency department in the 90 days prior to the survey. 

Medication assistance: Refers to managing, supervising, or storing medications; administering 

medications; or providing assistance with self-administration of medications. 

Overnight hospital stay: Includes discharges from an overnight hospital stay in the 90 days prior 

to the survey. Trips to the hospital emergency department that did not result in a discharge from 

an overnight hospital stay are excluded.

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

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

includes private nonprofit centers and federal, state, county, or local government-owned centers. 
NCHS Data Brief ■ No. 164 ■ September 2014

■  7  ■

Non-Hispanic and of a race other than black or white: Race and ethnicity category that includes 

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 race and ethnicity 

category not reported in the center’s system, and unknown race.

Participants with some or all long-term care services paid by Medicaid: Refers to adult day 

services center participants who had some or all of their long-term care services paid by Medicaid 

during the 30 days prior to the survey.

Readmission after an overnight hospital stay: Refers to readmission to a hospital for an overnight 

stay within 30 days of a hospital discharge. Based on a question asked when a respondent 

reported having at least one participant with a discharge from an overnight hospital stay in the 90 

days prior to the survey.

Data source and methods

Data from the adult day services component of the 2012 National Study of Long-Term Care 

Providers (NSLTCP) conducted by the Centers for Disease Control and Prevention’s (CDC) 

National Center for Health Statistics (NCHS) were used for these analyses. All adult day services 

centers that participated in NSLTCP (a) self-identified as adult day care, adult day services, 

or adult day health services centers; (b) were included in the National Adult Day Services 

Association’s database; and (c) were in operation on or before May 31, 2012.

NSLTCP used a multimode survey protocol with mail, Web, and telephone follow-up for 

nonresponse. The final frame consisted of 5,254 adult day services centers, which were all 

included in the data collection efforts. A total of 476 (9.1%) adult day services centers were 

identified as invalid or out of business. All remaining centers (n = 4,778) were assumed eligible. 

The survey questionnaire was completed for 3,212 centers, for a weighted response rate of 67.2%. 

Although 273,200 participants were served by the 4,800 adult day services centers nationwide, 

the analyses in this data brief are based on the 272,300 participants in adult day services centers 

for which ownership status was known. Aggregate data on participant demographics were 

collected from each participating adult day services center.

Differences among subgroups were evaluated using chi-square tests. All significance tests were 

two-sided, using p less than 0.05 as the level of significance. Lack of comment regarding the 

difference between any two statistics does not necessarily suggest that the difference was tested 

and found to be not statistically significant. Data analyses were performed using SAS-callable 

SUDAAN. 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.

About the authors

Lisa L. Dwyer, Lauren D. Harris-Kojetin, and Roberto H. Valverde are with CDC’s National 

Center for Health Statistics, Division of Health Care Statistics.
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

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Hyattsville, MD 20782

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NCHS Data Brief ■ No. 164 ■ September 2014

References

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services in the United States: 2013 overview. Hyattsville, MD: National 

Center for Health Statistics. 2013.

2. 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.

3. 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.

4. Department of Defense. DoD worldwide numbers for traumatic 

brain injury. Washington, DC. Available from: http://dvbic.dcoe.mil/dodworldwide-numbers-tbi.

5. Thies W, Bleiler L; Alzheimer’s Association. 2013 Alzheimer’s disease 

facts and figures. Alzheimers Dement 9(2):208-45. 2013. Available from: 

http://www.alz.org/downloads/facts_figures_2013.pdf.

6. Ouslander JG, Maslow K. Geriatrics and the triple aim: Defining 

preventable hospitalizations in the long-term care population. J Am Geriatr 

Soc 60(12):2313–8. 2012.

7. Terrell KM, Hustey FM, Hwang U, Gerson LW, Wenger NS, Miller 

DK; Society for Academic Emergency Medicine (SAEM) Geriatric Task 

Force. Quality indicators for geriatric emergency care. Acad Emerg Med 

16(5):441−9. 2009.

8. Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory 

Medical Care Survey: 2006 emergency department summary. National health 

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2008.

Suggested citation

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.

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

Clarice Brown, M.S., Director

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