IMPLICATIONS OF THE ADULT DAY HEALTH-CARE EVALUATION STUDY FOR PROGRAM REVISION AND RESEARCH

With no additional effort to revise adult day health care (ADHC) servi ces or the types of patients who receive them, it would appear that ad ding an ADHC program to a VA Medical Center would not achieve the desi red objectives. The authors discuss here the advantages, disadvantages , and feasibility of 2 options for program revision. The first is to t arget ADHC to those types of patients who may be most likely to benefi t. A targeting scheme should use the most objective criteria possible and may need to be implemented as part of a case-managed package of co mmunity-based services. The second option for program revision is to r educe the costs of ADHC services. A cost model developed as a part of the study demonstrated the effect of possible revisions, including inc reasing enrollment, reducing staffing costs, decreasing length of stay in ADHC, and increasing substitution of ADHC for other services. Thes e changes differ in the level of administrative support and clinician behavior change needed for their implementation. This report then conc ludes with a discussion of the implications of the results for impleme ntation of VA-ADHC versus contract ADHC, and a discussion of possible directions for future research.