Alzheimer's Disease Services, Staffing, and Outcomes in Adult Day Health Centers

Objectives: Increasing rates of Alzheimer disease and related dementia (ADRD) has resulted in greater reliance on adult day health centers (ADHCs) and their skilled workforce. Little is known about staffing in ADHCs that provide ADRD services compared with ADHCs that do not. This study examines whether there are differences in staffing between ADHCs that offer ADRD services versus those that do not, and whether the percentage of ADHC participants with ADRD is associated with staffing levels. It also ex-amines whether staffing levels and provision of ADRD services are associated with participant outcomes.Design: Cross-sectional analysis of secondary survey data.Setting and Participants: We used facility-level data from the 2014 National Post-acute and Long-term Care Study Adult Day Services Center module. This survey is completed by administrators of ADHCs, who provide information about their ADHC's organization, services, participants, sources of payment, staffing, and participant outcomes. Methods: Bivariate comparisons and multivariate regressions were used to compare scope of services, staffing, and participant outcomes for ADHCs that offered ADRD programs compared with those that did not.Results: ADHCs with ADRD programs had similar average daily attendance, less revenue from Medicaid and self-payment, and greater proportions of Black and female participants. ADHCs with ADRD programs had similar staff hours per participant day for all staff categories; licensed nurse staffing increased and social worker staffing decreased with the proportion of participants with ADRD. Staffing had significant associations with participant outcomes. Conclusions and Implications: ADHCs that have more participants with ADRD have greater staffing of licensed nurses but fewer social workers. Participant outcomes are associated with staffing, but the results suggest that there are unmeasured dimensions of participant risk that confound the relationship.(c) 2022 The Authors. Published by Elsevier Inc. on behalf of AMDA -The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

Automated summary

This study compares staffing in adult day health centers (ADHCs) that provide Alzheimer disease and related dementia (ADRD) services with those that do not, and examines the association between the percentage of ADHC participants with ADRD and staffing levels. The results show that ADHCs with ADRD programs have similar attendance rates, less revenue from Medicaid and self-payment, and higher proportions of Black and female participants. Staffing levels in ADHCs with ADRD programs are associated with participant outcomes, with increased licensed nurse staffing and decreased social worker staffing as the proportion of participants with ADRD increases.