Adult Day Care Explained – What it Is, What to Expect & How to Pay For It

What It Is

Like adult day care, adult health care provides a safe, caring setting for adults who require supervision or care during the day. Adult health programs are designed for individuals who require a more skilled level of care. These programs offer medical services, like rehabilitation, therapy, nursing care and special nutrition. The programs are structured and designed, often through the development of a personal care plan, to cover the daily individual needs of each participant. Participants of adult care require some health care, unlike adult day care participants.

What to Expect

Adult care is based primarily around participants’ health care needs. Most programs offer meals and some provide transportation. The activities and programming reflect the diverse needs of participants and their levels of functioning. Common activities include current events classes, arts and crafts, music, mind-stimulating games, and exercise, as appropriate to each individual.

Adult care centers provide many health and social services for a set daily fee. Many centers have sliding scales. Medicare, Medigap and Managed Care do not cover adult day health care.

Read a detailed description of all types of reimbursements.

Medicaid

What It Covers

Medicaid usually covers all adult day health services.

Conditions and Limitations

In some instances, Medicaid approves coverage for fewer days per week than an individual requires. If, for example, Medicaid approves only three days per week, but the individual requires five days, then the individual is financially responsible for the two additional days of attendance. Medicaid approves the number of days based on a doctor’s recommendation.

LTCI

What It Covers

Homecare Only and Comprehensive policies pay benefits in an adult day health care facility, but the amount of coverage depends on the individual policy. For information on how to determine what kind of LTCI policy suits your needs, visit our Financing Long Term Care Expert Column.

Veterans Benefits

What It Covers

Veterans Benefits cover adult day health care services.

* Conditions and Limitations Veteran must meet eligibility criteria for VA benefits, and

* Demonstrate need for this type of care.

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