Standards for public agencies

2020 Edition

Adult Day Services (PA-AD) 5: Service Elements

Social, education, health, and supportive services promote regular participation, optimal functioning, and independence.
2020 Edition

Currently viewing: ADULT DAY SERVICES (PA-AD)



Individuals who participate regularly in Adult Day Services achieve and maintain an optimal level of well-being, functioning and health, and remain in their preferred community residence.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Program curriculum or sample daily program schedule
  • Participant/personnel ratios
  • Education curricula
  • Examples of health and wellness activities
  • Interviews may include:
    1. Program director
    2. Relevant Personnel
    3. Persons served
  • Review case records


PA-AD 5.01

A varied program of social, educational, and supportive activities developed with program participants provides opportunities for:
  1. stimulation of talents and abilities;
  2. skill development and maintenance;
  3. acquiring and using practical information; and
  4. supported or competitive employment, as applicable to the service population.
Examples: Programming takes into account issues such as age-related dementia, brain injuries, mental illness, HIV/AIDS, gender/sexuality, and race/ethnicity.


PA-AD 5.02

Programs are:
  1. age-appropriate;
  2. culturally diverse; and
  3. adjusted to the functional levels of individual program participants.


PA-AD 5.03

An activity schedule is published and provides participants with choices.


PA-AD 5.04

Service recipients have the opportunity to interact with the community through:
  1. presentations, lectures, or workshops provided by community members; and
  2. planned trips within the community.

Fundamental Practice

PA-AD 5.05

The health and well-being of each service recipient is promoted through:
  1. contact with the person's physician at intake, as needed;
  2. education designed to enhance the individual’s optimum level of functioning and independence;
  3. basic assistance with activities of daily living;
  4. a nutrition program that meets individual needs and preferences;
  5. emergency medical and dental services, and first aid when needed; and
  6. notification of caregivers when changes in functioning are observed.
Examples: Nutrition programs can include:
  1. culturally competent nutrition;
  2. education;
  3. nutritious snacks; and 
  4. one or more balanced meals prepared according to the dietary needs of persons served and the current recommendations.
Health services can include:
  1. health assessments and monitoring;
  2. medication administration and help with self-administered medications; and 
  3. skilled nursing services.

Fundamental Practice

PA-AD 5.06

The ratio of personnel to participants is defined for all programs and activities, and is:
  1. adjusted according to degree of frailty or disability; 
  2. frequently reassessed in response to the changing needs of the group; and
  3. reviewed annually.


Generally, the ratio is at least one adult for every five to ten participants. The ratio for Alzheimer's patients is one adult for every four participants. Ratios may be achieved by use of volunteers in support positions.