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.