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

Alzheimer's disease (AD) and AD-related dementia (ADRD) is a profoundly debilitating disease with risk increasing with age (Alzheimer's Foundation of America, 2016). This disease will quickly burden a growing percentage of Americans and pose a great challenge for the U.S. health care system. Adult Day Health Centers (ADHCs) are a vital community service whose staff provide specialized care to persons with ADRD and respite to caregivers, which allows them to work, meet obligations, and recover from the daily care burden (O'Keefe & Siebenaler, 2006). It is essential that ADHCs and other LTC providers be readily equipped with the appropriate services and staffing structures to properly care for persons with ADRD. This project will assess the scope of services and staffing models of ADHCs that provide care to persons with AD and ADRD, as compared to those that do not. We will use secondary data from the National Study of Long-Term Care Providers (NSLTCP) to measure staffing differences overall and by region, program size, and ownership type, as well as whether staffing is associated with adverse events. Information gained from this study will help BHW identify which facility characteristics and staffing models best address and, hopefully, improve the health care and health outcomes for older patients with ADRD.


Key Questions

  • Does staffing of ADHC providers differ based on whether or not ADHCs offer specialized ADRD services?
  • Does the staff-to-patient ratio differ based on whether or not ADHCs offer specialized ADRD services or the proportion of patients who have ADRD?
  • Does staffing of ADHC providers vary by characteristics such as daily attendance, current enrollment, ownership type, payer mix, chain affiliation, state, region, and metro vs. non-metro location?
  • Do adverse events (emergency room, hospitalizations, and falls) differ by staffing level and by whether ADHCs provide specialized ADRD services?



Spetz, J, Flatt, JD. Alzheimer’s Disease Services, Staffing, and Outcomes in Adult Day Health Centers. JAMDA, online January 6, 2023. doi:


For questions, contact: Joanne Spetz