Adult Day Care in South Carolina: Identification of Need and Opportunity

Objectives

To investigate pre- and post-pandemic demographic profiles of attendees at adult day care (ADC) facilities in the US South, and survey providers for their experience during the pandemic.

Design

Retrospective analysis and prospective interviews and survey.

Setting and Participants

We received administrative data for South Carolina Medicaid recipients in 2019 (pre-pandemic, n = 21,969) and 2022 (post-pandemic, n = 25,118), prospectively interviewed 6 facility owners and surveyed 62 of 82 ADC facilities in South Carolina (75.6% response).

Methods

We compared age, sex, race, and county distributions between Medicaid recipients who attended facilities in 2019 and 2022. We summarized interviews qualitatively. We assessed attendee and provider profiles using a 55-item survey.

Results

In 2019, 2398 (10.9%) of Medicaid recipients attended ADC facilities at least 24 times, decreasing significantly to 1745 (6.9%) in 2022 (P < .001). Attendees’ median age fell from 62 years in 2019 to 59 years in 2022 (P < .001). Attendance was highest among Black or African American individuals (71.0% in 2019 and 62.2% in 2022, P < .001). Eleven of 46 counties, all rural, did not have a facility. A median of 25 miles was the farthest distance traveled one way by attendees to a facility (range, 4–60). ADC facility nurses were the primary source of medical oversight and COVID-19 information during the 3-month shutdown. More than 90.0% of facilities served adults who had cognitive impairment, multiple chronic conditions, or intellectual or developmental disabilities. Most facilities (53.2%) received government funding during the pandemic. Staffing shortages, decreased attendance, and increased costs were major challenges faced by ADCs post-pandemic.

Conclusions and Implications

These findings demonstrate the importance of ADC facilities to the health and well-being of Black or African American individuals, a population that was disproportionately burdened during the COVID-19 pandemic, and suggests potential underutilization of facilities and more resources allocated to one-on-one in-home care than might be economically feasible.