NCHS Data Brief ■ No. 165 ■ 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 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, 40% of the 4,800 

adult day services centers 

were for-profit entities, serving 

nearly one-half of the 272,300 

center participants. 

• About 60% of adult day 

services centers used a 

standardized tool to screen 

for cognitive impairment, and 

about 20% used a standardized 

tool for depression screening. A 

greater percentage of for-profit 

than nonprofit centers used 

these tools.

• More than one-half of adult 

day services centers provided 

skilled nursing, therapeutic, 

and social work services, 

while less than one-half of 

centers provided mental 

health, pharmacy, and dental 

services. With the exception of 

social work services, a greater 

percentage of for-profit than 

nonprofit centers provided these 

services.

• Almost all adult day 

services centers provided daily 

transportation to and from the 

center.

The most recent data estimate that 4,800 adult day services centers nationwide 

serve nearly a quarter million participants daily (1). 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 (1). However, for-profit ownership of adult day services centers 

appears to be increasing, from 27% in 2010 to 40% in 2012 (2). Using data 

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

national estimates for characteristics of adult day services centers in 2012 

and compares them by type of center ownership. 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 • health-related 

services • transportation services

Compared with for-profit adult day services centers, 

a greater percentage of nonprofit centers had been in 

operation 10 or more years and were chain-affiliated.

NOTES: ADSC is adult day services center. LTC is long-term care. Differences between for-profit and nonprofit centers are 

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

United States, 2012

39

60

41

87

48 45

39

88

33

69

43

86

0

20

40

60

80

100

Average daily

attendance

In operation 

10 or more years

ChainaffiliatedServed any participants

with LTC services paid by

Medicaid in last 30 days

All ADSCs For profit Nonprofit

Percent
NCHS Data Brief ■ No. 165 ■ September 2014

■  2  ■

• The average daily attendance at nonprofit adult day services centers was 33 participants, fewer 

than that at for-profit centers, with 48 participants (Figure 1).

• A higher percentage of nonprofit (69%) than for-profit (45%) adult day services centers had 

been in operation 10 or more years.

• A higher percentage of nonprofit (43%) than for-profit (39%) adult day services centers were 

affiliated with a chain organization. 

• A slightly higher percentage of for-profit (88%) than nonprofit (86%) adult day services centers 

had at least one participant who had some or all of their long-term care services in the past 30 

days paid by Medicaid.

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

screened participants for cognitive impairment and depression and offered 

disease-specific programs.

• Sixty-three percent of for-profit adult day services centers used a standardized tool to conduct 

a formal assessment of participants before or upon admission to identify those with cognitive 

impairments. Fifty-seven percent of nonprofit centers conducted this formal assessment for 

cognitive impairment (Figure 2).

• A slightly higher percentage of for-profit (74%) than nonprofit (72%) adult day services centers 

offered disease-specific programs for participants with Alzheimer’s disease and other dementias. 

• A slightly higher percentage of for-profit (22%) than nonprofit (19%) adult day services centers 

screened participants for depression with a standardized tool as part of the admission process.

NOTES: ADSC is adult day services center. Differences between for-profit and nonprofit centers are 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 2. Screening and disease-specific programs for Alzheimer's disease and other dementias and for depression

among adult day services centers, by center ownership: United States, 2012 Percent

60

73

20

58

63

74

22

67

57

72

19

52

0

20

40

60

80

Cognitive impairment

screening

Alzheimer's disease

 or other dementias

programs

Depression screening Depression programs

All ADSCs For profit Nonprofit
NCHS Data Brief ■ No. 165 ■ September 2014

■ 3  ■

• Two-thirds (67%) of for-profit adult day services centers offered disease-specific programs for

participants with depression, compared with 52% of nonprofit adult day services centers. 

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

centers provided skilled nursing, therapeutic, mental health, and pharmacy 

services.

• Eighty percent of for-profit adult day services centers offered skilled nursing services,

compared with 64% of nonprofit centers (Figure 3). 

• Sixty-eight percent of for-profit adult day services centers offered therapeutic services,

compared with 61% of nonprofit centers. 

• More than one-half (51%) of for-profit adult day services centers provided mental health

services, compared with 45% of nonprofit centers.

• Forty-four percent of for-profit adult day services centers provided pharmacy services,

compared with 29% of nonprofit centers. 

• Less than one-fifth of for-profit (18%) and nonprofit (16%) adult day services centers provided

dental services.

• Similar percentages of nonprofit (64%) and for-profit (63%) adult day services centers

provided social work services.

1

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

NOTES: ADSC is adult day services center. Services could be provided directly by center employees, by others through arrangement, or both. 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. Provision of selected health-related services among adult day services centers, by center ownership:

United States, 2012 

16

18

17

29

44

35

45

51

47

64

63

63

61

68

64

64

80

70

0 20 40 60 80 100

Dental1

Pharmacy1

Mental health1

Social work

Therapeutic

(physical, occupational,

or speech)1

Skilled nursing1

All ADSCs

For profit

Nonprofit
NCHS Data Brief ■ No. 165 ■ September 2014

■  4  ■

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

centers provided transportation services to and from the center, for 

medical or dental appointments, and for social and recreational activities or 

shopping.

• Ninety-two percent of for-profit adult day services centers provided daily roundtrip 

transportation service to and from the center, compared with 84% of nonprofit centers (Figure 4).

• Sixty-five percent of for-profit centers provided transportation services for medical or dental 

appointments, while 48% of nonprofit centers provided this service.

• Eighty-one percent of for-profit adult day services centers provided transportation for social 

and recreational activities or shopping, compared with 75% of nonprofit centers.

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

services. 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. Provision of transportation services by adult day services centers, by center ownership: United States, 2012 Percent

87

55

78

92

65

81 84

48

75

0

20

40

60

80

100

Daily roundtrip

to and from center

For medical or

dental appointments

For social and recreational

activities or shopping

All ADSCs For profit Nonprofit
NCHS Data Brief ■ No. 165 ■ September 2014

■  5  ■

Summary

Adult day services centers enable participants with physical and cognitive limitations to live in 

the community by providing daytime services and supports in a congregate setting, while also 

providing respite for their caregivers (3). These centers often act as an alternative or supplement 

to home care and an alternative to living in an assisted living community or a nursing home. In 

2012, an estimated 4,800 adult day services centers were operating in the United States, with 

an average daily attendance of 39 participants. In 2010, there were an estimated 4,600 adult day 

services centers with an average daily attendance of 34 (2). The increase in the number of centers 

and in the size of a typical center is likely to continue in the coming years.

On average, for-profit centers were larger than nonprofit centers, with an average daily census of 

48 compared with 33 participants. In addition, for-profit and nonprofit adult day services centers 

in 2012 differed on other selected organizational characteristics. More for-profit centers (65%) 

than nonprofit centers (48%) offered transportation to medical or dental appointments. A higher 

percentage of for-profit centers (67%) than nonprofit centers (52%) offered disease-specific 

programs for participants with depression, a difference that may be driven by participant need: 

In 2012, more participants in for-profit centers (29%) had depression compared with participants 

in nonprofit centers (19%) (4). A higher percentage of for-profit centers than nonprofit centers 

offered skilled nursing, therapeutic, mental health, and pharmacy services, indicating that 

participants enrolled in for-profit centers tended to have greater access to these services than those 

enrolled in nonprofit centers. Whether these differences are related to differences in service needs 

between participants in for-profit compared with nonprofit centers or to other factors remains to 

be determined.

These findings provide a current national picture of adult day services centers in the United 

States. 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 in the adult day 

services industry.
NCHS Data Brief ■ No. 165 ■ September 2014

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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. 

Chain affiliation: Having more than one adult day services center under common ownership or 

management. This may include centers in the same state or across multiple states. If centers were 

owned by a chain, group, or multicenter system, they were considered chain-affiliated.

Cognitive impairment screening: Refers to center practice based on self-report by the respondent 

to the following question, “Before or upon admission, does this center use a standardized tool to 

conduct a formal assessment of its participants to identify anyone with a cognitive impairment?”

Dental services: Includes routine and emergency dental services provided by a licensed dentist. 

Depression screening: Refers to center practice based on self-report by the respondent to the 

following question, “As a part of the admission process, does this center screen participants for 

depression with a standardized tool such as the Geriatric Depression Scale, Beck Depression 

Inventory, or the Center for Epidemiological Studies Depression Scale?”

Disease-specific programs: Programs that target participants with a specific diagnosis and may 

include one or more of the following services: educational programs, physical activity programs, 

diet or nutrition programs, medication management programs, or weight management programs. 

Mental health services: Services that target participants’ mental, emotional, psychological, 

or psychiatric wellbeing and include diagnosing, describing, evaluating, and treating mental 

conditions. 

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. 

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.

Pharmacy services: Includes filling and delivery of prescriptions. 

Skilled nursing services: Services that must be performed by a registered nurse or a licensed 

practical nurse and are medical in nature. 

Social work services: Services provided by a licensed social worker or person with a bachelor’s 

or master’s degree in social work, and that include an array of services such as psychological 

assessment, individual or group counseling, and referral services. 

Therapeutic services: Physical, occupational, or speech services.
NCHS Data Brief ■ No. 165 ■ September 2014

■  7  ■

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%. 

Of the 3,212 adult day services centers that responded to the survey, there were 12 for which 

ownership was unknown; however, the weighted frequency for these 12 centers does not affect 

the rounded total of 4,800 adult day services centers nationally.

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.

References

1. Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde R. Long-term care 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. National Adult Day Services Association (NADSA). Comparing long term care services. 

Fuquay Varina, NC: NADSA. Available from: http://nadsa.org/news-center/comparing-long-termcare-services/.

4. 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.
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NCHS Data Brief ■ No. 165 ■ September 2014

Suggested citation

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.

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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