Adult Day Services Beyond the Borders

Policymakers are beginning to realize the impact of the aging population and that they need a different approach to addressing the need for long term care by the elderly.  Since private spending plays a more important role for funding institutional long term care than home care, it is essential that consideration be given to alternative approaches and care integration over costly institutional care or repeated/long stays in hospitals.  Adult day services provide an innovative, efficient model of care that can bridge the gap in services around the globe and integrate services for people who need daytime supervised care in a community setting.

All industrialized countries are facing an unprecedented issue of how to deal with frail elderly and people with disabilities—populations that were previously viewed as a problem that families could and should manage.  Significant life expectancy increases since about 1970 have resulted in more people who need help with activities of daily living and formal care services but without families to meet those needs (Swartz, Miake, & Farag, 2012).  Prevalence rates for dementia and having multiple chronic conditions increases significantly with age.  Countries lack structure to respond to this increasingly common social problem.  Fewer than a dozen countries have governmental-organized, formal long term care policies and a standard definition of long term care does not exist across countries (Swartz, Miake, & Farag, 2012).  Scandinavian countries and the Netherlands developed policies in the 1950s and 1960s, but other industrialized countries did not begin to enact national policies until the late 1980s or mid-1990s.

According to the OECD Health Project, public spending remains the most important source of financing long term care services in most countries (Katz, 2011).

In the United States, non-medical adult day centers tend to focus on socialization and prevention services, while medical models include skilled assessment, treatment and rehabilitation goals.  These structured community-based programs operate less than 24 hours for people requiring supervised care, and who attend on a planned basis during specified hours.  Models are sometimes defined according to the services provided, e.g. medical care, social services, or according to their targeted populations with specific needs, e.g. dementia, traumatic brain injury (TBI), persons with intellectual disabilities.  This diversity allows centers to adapt services to meet the needs of their communities and the participants.  However, there is also considerable overlap of services provided among the models intended to help maintain the independence of participants for as long as possible, e.g. meals, therapeutic activities, supervision, social work, personal care services.


Katz, P. R. (2011, September). An International Perspective on Long Term Care; Focus on Nursing Homes. Journal of the American Medical Directors Association, pp. 487-492.

Swartz, K., Miake, N., & Farag, N. (2012). Long-Term Care: Common Issues and Unknowns. Journal of Policy Analysis and Management, 31(1), pp. 139-152.

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