Adult Day Services Centers

Long-term Care and COVID-19

The National Post-acute and Long-term Care Study (NPALS) collects data on adult day services centers (ADSCs) every two years for all 50 states and the District of Columbia. The goal is to monitor the diverse post-acute and long-term care sectors. The 2020 survey provided an opportunity to collect COVID-19-related data in this important healthcare setting. These data are not available from other data systems.

The data shown in these figures are based on preliminary data collected for the 2020 NPALS beginning in November 2020 through March 2021. The data collected about ADSC’s COVID-19 experiences, as reported by ADSC directors/administrators in the questionnaire, are retrospective beginning from January 2020 through the questionnaire completion date. The latest response date in the preliminary data is March 25, 2021. The results are based on survey responses from 1,631 eligible ADSCs from a census of over 5,500 centers and are weighted to be nationally representative. The data used in these figures are considered preliminary and the results may change after the release of the final 2020 NPALS data file, which will be updated in 2022. Data represent ADSCs and not individuals. For more details about the ADSC preliminary data see Technical Notes and for more information about NPALS, please visit https://www.cdc.gov/nchs/npals/about_npals.htm.

Long-term Care Settings

Figure 1: Number of COVID-19 cases, hospitalizations, and deaths among adult day services center participants and staff since January 2020 through March 2021

This figure shows the number of presumptive positive or confirmed COVID-19 cases, hospitalizations, and deaths reported by ADSCs from January 2020 through March 2021 grouped by U.S. Census region and metropolitan statistical areas. Data are presented for both participants and staff separately.

  • COVID-19 Cases are reported by directors/administrators and include cases that are either presumptive positive or confirmed by testing.
  • Participant includes any participant enrolled in the ADSC at any time since January 2020.
  • Staff includes direct employees and contractors at the ADSC at any time since January 2020.
  • Hospitalizations and Deaths due to COVID-19 are reported by directors/administrators.
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population

Figure 2: Number of COVID-19 cases since January 2020 through March 2021 among adult day services center participants and staff, by center characteristics

This figure shows the number of presumptive positive or confirmed COVID-19 cases between January 2020 and March 2021 grouped by U.S. Census region and metropolitan statistical areas, according to five key characteristics of ADSCs. Data are presented for both participants and staff separately.

  • COVID-19 Cases are reported by directors/administrators and include cases that are either presumptive positive or confirmed by testing.
  • Participant includes any participant enrolled at the ADSC at any time since January 2020.
  • Staff includes direct employees and contractors at the ADSC at any time since January 2020.
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population
  • ADSC Size: small (1-25 users), medium (26-100 users), and large (101 or more)
  • Medicaid certification: whether an ADSC is authorized or set up to participate in Medicaid
  • Chain affiliation: whether an ADSC is owned by a person, group, or organization that owns/manages two or more ADSCs, including corporate chains
  • Ownership type: whether an ADSC is for profit (private or publicly traded/limited liability company) or nonprofit (including government)
  • Any PPE shortage: whether an ADSC experienced a shortage of eye protection, gloves, face masks, isolation gowns, and N95 respirators at any time since January 2020

Figure 3: Percentage of adult day services centers that experienced personal protective equipment shortages since January 2020 through March 2021

This figure shows the percentages of ADSCs that experienced a shortage of personal protective equipment at any time since January 2020 and by four time periods (January 2020 through March 2020, April 2020 through June 2020, July 2020 through September 2020, and October 2020 through March 2021), grouped by U.S. Census region and metropolitan statistical areas.

  • Personal Protective Equipment Shortages displays “yes” responses out of three options (yes, no, don’t know) during each time period included:
    • Eye protection, gloves, face masks, and isolation gowns
    • N95 respirators
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population

Figure 4: Percentage of adult day services centers with selected practices for the prevention, response, or management of COVID-19 infections since January 2020 through March 2021

This figure shows the percentages of ADSCs with infection control practices in their prevention, response, or management of COVID-19 infections between January 2020 and March 2021, grouped by U.S. Census region and metropolitan statistical areas.

  • Infection control practices:
    • Screening participants daily for fever or respiratory symptoms
    • Notifying all participants or families of cases in the center within 24 hours
    • Use of telephonics or audio-only calls to assess, diagnose, monitor, or treat participants with presumptive positive or confirmed COVID-19 infection
    • Use of telemedicine or telehealth (ie., audio with video, web videoconference) to assess, diagnose, monitor, or treat participants with presumptive positive or confirmed COVID-19 infection
    • Limiting of hours or temporary closure of this center
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population

Figure 5: Percent of adult day services centers that imposed in-person restrictions since January 2020 through March 2021

This figure shows the percentages of ADSCs with in-person restrictions on individuals from entering the building, grouped by U.S. Census region and metropolitan statistical areas.

  • In-person restrictions included five response options for never, sometimes or often, always, and don’t know for the following types of individuals:
    • Family and relatives
    • Visitors
    • Volunteers
    • Non-essential consultant personnel (e.g. barbers, delivery personnel)
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population

Technical Notes

  • The preliminary data only includes survey submissions through mail and web who responded by March 25, 2021, excluding later mail and web submissions and all CATI survey mode respondents, which may introduce response bias and estimates may change once data are final.
  • 14.6% of ADSCs reported being temporarily closed and not providing any services to participants at the time of the survey.
  • Data are weighted and are nationally representative.
  • Cases with missing data are excluded on a variable-by-variable basis.
  • Data represent adult day services centers, not individual participants.
  • To be eligible to participate in NPALS, an ADSC must be licensed or certified by the state specifically to provide adult day services, or accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), or authorized or otherwise set up to participate in Medicaid (Medicaid state plan, Medicaid waiver, or Medicaid managed care), or part of a Program of All-Inclusive Care for the Elderly (PACE); have an average daily attendance of one or more participants based on a typical week; and have one or more participants enrolled at the ADSC at the designated location at the time of the survey.
  • All estimates shown meet the NCHS Data Presentation Standards for Proportions https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdfpdf icon and meet NCHS confidentiality standards.

Data Source

The preliminary data presented are from National Center for Health Statistics’ 2020 National Post-acute and Long-term Care Study adult day services center survey. For more details please visit https://www.cdc.gov/nchs/npals/questionnaires.htm.

Page last reviewed: August 10, 2021