Participant Eligibility in Adult Day Care Center

This Management Bulletin (MB) updates, clarifies, and condenses previous guidance addressing adult day care participant eligibility in the Child and Adult Care Food Program (CACFP). Specifically, this MB clarifies the purpose of the adult day care component of CACFP and participant eligibility. Please note, there are two additional MBs recently posted regarding adult day care, USDA-CACFP-20-2012 and USDA-CACFP-22-2012, which can be viewed on the CACFP Bulletins web page.

Background

The adult day care component of the CACFP was authorized by the Older Americans Act Amendments of 1987 and codified in Title 7, Code of Federal Regulations (7 CFR), Section 226.19(a). Congress issued guidance relating to adult day care immediately following the addition of the adult day care component to CACFP. Since that time, the USDA has incorporated much of the guidance into the CACFP regulations, thereby making the USDA memoranda obsolete. In addition, the USDA has changed some regulations related to adult day care agencies that are not reflected in previous guidance from the USDA.

Rescinding U.S. Department of Agriculture Policies

The following USDA Child Care Food Program Adult Day Care Provisions memoranda are rescinded because they include guidance that was later codified in regulation or instruction:

• Operational Memorandum 2—Participation of Institutionalized Adults, March 15, 1989
• Operational Memorandum 3—Center Eligibility, March 16, 1989
• Operational Memorandum 8—Center and Participant Eligibility, April 3, 1989
• Operational Memorandum 2, Revision 1—Institutionalized Adults, September 15, 1989
• Operational Memorandum 17—Plans of Care, May 16, 1991         

Purpose of the Program

Per Title 42, U.S. Code, Section 1766(o)(1), adult day care centers are considered eligible agencies for reimbursement for meals served to persons sixty years of age or older or to functionally impaired persons in a nonresidential group setting.

The purpose of the adult day care component of the CACFP is to provide nutritional support to enable elderly and functionally impaired adults to remain in the community and avoid premature institutionalization. In previous guidance, the USDA indicated that eligible individuals are those who (1) remain in the community, and (2) reside with family members or other caregivers who would benefit from the respite adult day care services could provide. However, it is clear that many frail, elderly adults, as well as functionally impaired adults, live in their community on their own. Therefore, the California Department of Social Services (CDSS) believes it is appropriate to define individuals remaining in the community as those residing either in their own home or in the home of a family member, guardian, or other caregiver.

This MB clarifies that CACFP benefits are not limited to those individuals who are living with caregivers, but also are extended to eligible individuals who are able to live on their own in the community with the support of adult day care services.

Participant Eligibility

The CACFP regulations in 7 CFR, Section 226.2 define an adult participant as “…a person enrolled in an adult day care center who is functionally impaired or sixty years of age or older” and define functionally impaired adults as “…chronically impaired disabled persons eighteen years of age or older, including victims of Alzheimer’s disease and related disorders with neurological and organic brain dysfunction, who are physically or mentally impaired to the extent that their capacity for independence and their ability to carry out activities of daily living is markedly limited.”

An “enrolled eligible participant” is an individual enrolled with a center to receive adult day care services. Any enrolled individual eligible for CACFP benefits (i.e., functionally impaired or sixty years of age or older) must be included in all enrollment counts for the purposes of determining CACFP eligibility and receipt of CACFP reimbursement. 

“Drop-in” adults who eat meals at a center but are not enrolled to receive care at the center are not eligible. Meals served to center volunteers, regardless of age, who help with the meal service or other center activities are not eligible for reimbursement unless they are actually enrolled at the center and meet CACFP eligibility requirements.

Additionally, because the program is intended to benefit adults living in their community, enrolled participants who reside in a residential facility are not eligible for participation. However, residential facilities may serve meals to eligible enrolled adults that live in the community and attend a facility for day care. Individuals residing in an institution on a temporary basis for respite care, crisis intervention, or other reasons are not eligible for CACFP benefits until they have returned to their permanent residence in their community.

Plans of Care

Adult day care centers are required to provide an individual plan of care for each enrolled functionally impaired participant. Such a plan must demonstrate a center’s ability to provide a variety of health, social, and supportive services for its enrolled participants, per 7 CFR, Section 226.19a(b)(1). For CACFP purposes, participating centers do not need an individual plan of care for participating adults sixty years of age or older who are not functionally impaired. They must, however, have a plan for each functionally impaired participating adult.

Additional Questions

If your agency has questions regarding this MB, please contact the CACFP Specialist assigned to your agency. You will find a list of contact information for specialists on the Child and Adult Food Care Program Contact List or in the Download Forms section of the Child Nutrition Information and Payment System as Form ID CACFP 01. You may also contact the CACFP Office Technician by email at CACFPinfo@dss.ca.gov.

This institution is an equal opportunity provider.
Esta institución es un proveedor que ofrece igualdad de oportunidades.