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Adult Day Care Centers in the CACFP Study

December 4, 2024

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The “Characteristics of Adult Day Care Centers that Participate in the USDA’s Child and Adult Care Food Program” study by USDA seeks to better understand key characteristics of adult day care centers participating in CACFP. Adult day care centers have been eligible to operate the CACFP since 1987. Adult day care centers receive payments for serving nutritious meals to adults who are age 60 or older, or who are physically or mentally impaired to an extent that limits their independence and ability to carry out activities of daily living. The study conducted in 2024 and collected data from 2,495 adult day care centers that participated in CACFP in Fiscal Year 2023.

Why It Matters

There have been very few studies about the operation of the CACFP in adult day care centers, so this study helps to fill an important information gap in the CACFP. This study helps FNS and CACFP stakeholders better understand the characteristics, services offered, populations served, and barriers to participation for adult day care centers.

Key Findings

  • The number of adult day care centers participating in CACFP varied widely from state to state and was not always proportional to the state’s population of older adults and people with disabilities.
    • Over half of the 2,495 CACFP-participating adult day care centers in FY 23 were in just five states: Texas (14.1%), California (11.6%), Florida (9.1%), New Jersey (8.2%), and New York (7.3%).
  • About half of centers (48.1%) operate CACFP independently, while fewer centers (43.3%) have a sponsoring organization that supports the administration of CACFP.
  • Over one third of centers (35.8%) stated that they had no major challenges to CACFP participation. However, the most likely challenge faced by centers was reported to be the meal reimbursement rate (29.2%).

CACFP Adult Day Care Centers and Participants

  • Just over half (51.7%) of centers identified themselves as private, for-profit organizations.
  • Most centers (69%) serve both adults over age 60 and adults under age 60 with disabilities.
  • Two-thirds (67.1%) of the population served at centers in October 2023 were adults over age 60.
  • Adults who participated in CACFP at adult day care centers were substantially more likely to be non-White than the general population of older adults and people with disabilities. Adults identifying as Asian were much more likely to participate in CACFP at adult day care centers compared to their share of the population.

Meal Services Offered at Participating Centers

  • According to FNS administrative data, nearly all meals claimed by adult day care centers in October 2023 were free (96%). Survey results indicate that nearly all participants (92.5%) who ate a CACFP meal at adult day care centers in October 2023 were certified for free meals.
  • Most centers (59%) only claimed free meals in October 2023. Another 16.7% claimed free and paid meals, while 16.1% claimed free, reduced-price, and paid meals.
  • Most centers (58.1%) claimed breakfast, lunch, and snack services.
  • Almost every center claimed lunch (96.9%) in October 2023, and very few centers (6.7%) claimed suppers.
  • Most centers (55.6%) prepared CACFP meals on site, and just over one quarter (27.1%) purchased meals from a commercial vendor.
  • Most centers (60.8%) served individual meals, either pre-plated or “boxed”.
  • The top five non-meal services centers provided were: exercise/physical activities (88.5%); assistance with activities of daily living (85.9%); music or art therapy (75.6%); nursing and other health-related services (70.5%); and mental, behavioral health, or social work services (56.0%).

For-profit Vs. Nonprofit Centers

  • For-profit adult day care centers are only eligible to participate in CACFP if they receive compensation under Title XIX (Medicaid) and/or Title XX (Social Services Block Grant) of the Social Security Act and at least 25% of enrolled participants receive Title XIX or Title XX benefits. Just over half (54%) of for-profit centers reported that all CACFP participants were also Title XIX or Title XX recipients.
  • Most for-profit centers (97%) are in just 14 states. In the four states with the most CACFP adult day care centers, most centers were for-profit: Texas (91% of all centers), California (79%), Florida (70%), and New Jersey (80%).
  • For-profit centers accounted for about 72 % of all meals claimed in the adult daycare component of CACFP in October 2023, while private, nonprofit centers accounted for 24.9%. The remaining 3.3% of meals were claimed by public centers.
  • Compared to non-profit centers, for-profit centers were significantly more likely to claim free meals and to serve a larger proportion of adults over age 60.

For more information, visit USDA’s webpage or read the full report Characteristics of Adult Day Care  Centers that Participate in the USDA’s  Child and Adult Care Food Program. The report was written by Susannah Barr, PhD, MPH of the Child Nutrition Research and Analysis Division in the Office of Policy Support within USDA Food and Nutrition Service and published in December 2024.