Service Provision, Hospitalizations, and Chronic Conditions in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers

Questions for Lead Author Christine Caffrey, Health Statistician, of “Service Provision, Hospitalizations, and Chronic Conditions in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers.”

Q: Why did you decide to do a report on hospitalizations and chronic conditions by service provision in adult day services centers?

CF: A primary goal of adult day services centers is to help individuals remain living in the community and preventing or delaying institutionalization.  As part of this goal, adult day services centers offer a variety of services, including mental health, social work, therapeutic, dietary and nutritional, and skilled nursing services.

Hospitalizations among older adults are a strong predictor of future institutionalization or nursing home admission, and are associated with health and disability declines, lower quality of life, and greater health care costs. The increased risks associated with hospitalizations are of particular concern to adult day services centers, and reducing hospitalizations and readmissions is a main goal for them.  Often adult day services centers have participants with diverse health needs, including common chronic conditions, such as Alzheimer disease and other dementias, depression, diabetes, and heart disease.  These chronic conditions have been found to be associated with hospitalizations and readmissions in long-term care settings.

Having a participant case mix with hospitalizations and several different chronic conditions may increase the need to provide a wider variety of services. Despite adult day services centers main goals of reducing hospitalizations and readmissions and managing chronic conditions among participants through service provision, national estimates on the relationship between service provision and hospitalizations and chronic conditions are limited. This report fills this gap by presenting 2016 national estimates of the percentages of hospitalizations in the past 90 days and the number of chronic conditions among ADSCs, by service provision.

Q: How did the data vary by service provision?

CF: Overall, more than one-half of adult day services centers (52.6%) provided all five services, about 37.0% of centers provided one to four of the five services, and approximately one-tenth of centers (10.2%) provided none of the five services.  Nearly one-tenth (8.4%) of adult day services centers provided all of the five services with employees and 10.3% provided all of the five services by arrangement or referral.  The prevalence of hospitalizations varied by service provision.

Almost three-fourths of adult day services centers that provided all five services (74.3%) reported at least one hospitalization in the past 90 days compared to almost one-third (31.5%) of adult day services centers that provided none of the five services.  Among adult day services centers that provided all five services with employees, 81.7% had hospitalizations compared with 59.4% of centers that provided all five services by arrangement or referral.  The number of chronic conditions in an adult day services center also varied by service provision.  Across adult day services centers that provided all five services, 17.5% had zero to three of the four chronic conditions in their center and 82.5% had all four conditions.  In adult day services centers that provided none of the five services, 70.6% had zero to three of the four chronic conditions in their center and 29.4% had all four conditions.

Among adult day services centers that provided all five services with employees, 3.8% had zero to three of the four chronic conditions in their center and 96.2% had all four conditions.  In adult day services centers that provided all five services by arrangement or referral, 36.3% had zero to three of the four chronic conditions in their center and 63.7% had all four conditions.

Q: Was there a specific finding in your report that surprised you?

CF: That adult day services center with greater levels of participant needs, as indicated by increased hospitalizations and the number of chronic conditions, are more likely to provide a greater number of services in general, and these services are more often provided by employees and not solely by arrangement or referral.

Q: What is the take home message for this report?

CF: This report demonstrates that adult day services centers with greater levels of participant needs, as indicated by increased hospitalizations and the number of chronic conditions, are more likely to provide a greater number of services in general and these services are more often provided by employees and not solely by arrangement or referral. The level of participant needs, as indicated by hospitalizations, and chronic conditions among participants, were lower in adult day services centers that provided select services by arrangement or referrals and in adult day services centers that did not provide select services.