CAADS - California Association for Adult Day Services

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Register today for Transforming the Continuum of Care, and join us as we celebrate CAADS 40 Year Anniversary!

Adult Day Health Care: An Unbelievable Cost Containment Resource that Is Underfunded and Underutilized

For those who think Adult Day Health Care (ADHC) is just day care…think again! Yes, it’s a place for family members to drop-off their aging parents while they head off to work, run errands or simply use the time to get a little (and often much needed) respite from their 24/7 caregiving duties. But, ADHCs are so much more than a place to drop off Mom and Dad for part of a day. Read Russell D. Foster's featured article in MAZARS USA HEALTHCARE TRENDS,Sept 2017.

The Effect of Adult Day Program Attendance on Emergency Room Registrations, Hospital Admission and Days in Hospital: A Propensity-Matching Study

Research by Ronald Kelly, PhD finds a decreased reliance on costly health care services by seniors who attend adult day programs. Read Abstract and Full Article | JUN 2017 | The Gerontologist, Volume 57, Issue 3, Pages 552–562.

HELP II Loan Program -- Affordable Capital

The HELP II Loan Program, administered by the California Health Facilities Financing Authority (CHFFA) within the State Treasurer’s Office, offers low cost loans to assist eligible health facilities wanting to expand and improve services to their clients and the greater community. Learn more at

What's New . . . OCTOBER 16, 2017

MSSP Transition Framework Stakeholder Comments

OCT 10, 2017 | CA Department of Health Care Services (DHCS)
Sarah Brooks, Deputy Director, Health Care Delivery Systems

The Department of Health Care Services (DHCS) has released two documents on the Multipurpose Senior Services Program (MSSP) Transition Framework for stakeholder comment. Comments are due by 5 p.m. on Friday, October 20, 2017, to

Click here to review the MSSP Transition Framework history and proposal.

As proposed in the Governor's January 2017 budget, the MSSP transition into managed care has been delayed to no sooner than January 1, 2020. This reflects the lengthened demonstration period for the Coordinated Care Initiative and will give managed care plans, MSSP sites, stakeholders, and beneficiaries sufficient time to work together to plan for a smooth transition.

Your feedback on this critical process is appreciated!

Cal MediConnect Enrollment:
Why Are Dual-Eligible Consumers in Los Angeles County Opting Out?

SEPT 27, 2017 | UCLA Center for Health Policy Research

Three in five of the poorest, sickest residents in Los Angeles County have rejected a managed health care program meant to improve their access to health services, according to a policy brief by the UCLA Center for Health Policy Research. As a result, the county’s opt-out rate for the program is the highest in California, pushing overall enrollment far lower than expected. READ FULL POLICY BRIEF

Adult Day Health Care:
An Unbelievable Cost Containment Resource
that Is Underfunded and Underutilized

Featured Article by Russell D. Foster

For those who think Adult Day Health Care (ADHC) is just day care…think again! Yes, it’s a place for family members to drop-off their aging parents while they head off to work, run errands or simply use the time to get a little (and often much needed) respite from their 24/7 caregiving duties. But, ADHCs are so much more than a place to drop off Mom and Dad for part of a day. READ FULL ARTICLE

Cal Duals CCI Monthly Update: September 2017

PDF | Word

Supporting People with Dementia and Their Caregivers in the Community

SEPT 14, 2017 | American Society on Aging | Download Publication

The number of people with Alzheimer’s disease, the most common cause of dementia, is projected to increase to 13.8 million by 2050. To help educate about and combat Alzheimer’s, ASA is pleased to introduce a special supplement to Generations, “Supporting People with Dementia and Their Caregivers in the Community.”

The supplement focuses on efforts underway to establish dementia-capable home and community-based service systems, and to develop effective, evidence-based services for people with Alzheimer’s disease and related dementias and their caregivers. The content features research and writing by dementia experts at RTI International, as well as many others well-known in the field of dementia research and advocacy. This content paves the way for service providers, families, and caregivers to provide person-centered, evidence-based, effective home- and community-based service systems for people with dementia and their caregivers.

This supplement to Generations was funded by the Administration for Community Living (ACL), at the U.S. Department of Health and Human Services, in conjunction with the National Alzheimer’s and Dementia Resource Center, which is funded by the ACL and staffed by Research Triangle Institute (RTI) International.

ASA is pleased to offer this supplemental issue of Generations at no cost to you.

Transforming the Continuum of Care

2017 CAADS Conference Logo


November 6-8, 2017 | Doubletree Anaheim - Orange County

Lodging || Event Brochure || Register: Fill-In Form :: Write-On Form

CE Eligible Sessions || Order CE's: Fill-In Form :: Write-On Form

Donate a Raffle Prize: Fill-In Form :: Write-On Form

Be an Exhibitor: Details & Contract || Be a Sponsor: Opportunities

Health Savings Accounts Won't Help Most Older Adults

SEPT 6, 2017 | Justice in Aging | Issue Brief • August 2017

Proposals to expand the use of Health Savings Accounts (HSAs) have been raised repeatedly in the health care debate. This new issue brief looks at how expanding HSAs would impact the affordability of health care coverage for low and moderate income older adults by examining how HSAs would have functioned under one proposal, the Better Care Reconciliation Act (BCRA), had it become law.

The paper finds that the combination of HSA contributions and premium costs can easily reach 20% to 30% of an older adult’s income. It concludes that HSAs are not a path to affordable health care for older adults. Read the brief.

CBAS Updates

SEPT 1, 2017 | California Department of Aging, CBAS Branch

Status Report on the New CBAS Individual Plan of Care (IPC)

The new Community-Based Adult Services (CBAS) Individual Plan of Care (IPC) form and instructions, along with the revised CBAS provisions of the Medi-Cal Provider Manual, continue to be under review by the California Department of Health Care Services (DHCS). There are multiple steps to this review process and it is uncertain when the review will be completed. Therefore, CBAS providers are to continue using the current IPC form.

The California Department of Aging (CDA) will inform CBAS providers, managed care plans, software vendors and other interested stakeholders via an All Center Letter (ACL) and the CBAS Updates newsletter when the revised IPC form and instructions have been approved. CDA will host a webinar training to review the new IPC form and instructions before requiring implementation. We want to ensure that CBAS providers, managed care plans and software vendors have sufficient notice and training to begin using the new IPC. READ MORE

Esther Darling smiles as she sign legal documents in Darling v Douglas case



Ester Darling, lead plaintiff in the Darling v Douglas lawsuit of 2011, shown here signing the Darling v Douglas legal settlement, died peacefully in her sleep July 18, 2017, at age 80, in Woodland, CA.

Esther faced many challenges during her life but none were as life changing as the stroke she suffered in 1996. With her left side paralyzed, this once independent woman found herself unable to manage her own care.

Determined to be discharged from the post-acute nursing home despite no family to depend on, she was referred to Yolo Adult Day Health Center.

There, with additional support from In-Home Supportive Services, Esther was able to move back to her apartment. At the ADHC center she continued her therapies, received timely nursing and social work support and thrived in the company of fellow participants.

Early in 2011, during an emergency budget session of the Legislature, adult day health care was eliminated as an optional Medi-Cal benefit. Esther and 35,000 other low-income Californians feared the worst. When she was approached by Disability Rights California to serve as a plaintiff for the class action suit being filed, Esther, along with seven other plaintiffs, was more than willing to share her personal story in hopes of saving her center and the 300 other centers throughout the State.

As the ADHC case made its way through federal court, first one and then a second lead plaintiff passed away. Esther agreed to become the lead plaintiff. The case was settled in December 2011 and Esther beamed with pride as she signed the settlement agreement that meant adult day health care was saved as a Medi-Cal benefit for her and tens of thousands of others like her.

Rarely does a poor small town girl from Oklahoma get a chance to truly shape the lives of many thousands for many years to come. Esther Darling's name will forever be memorialized in the settlement and she will lovingly be remembered for her role in saving ADHC for future generations. She is resting in peace at Monument Hill in Woodland, California.

Kelley v Kent
Spousal Impoverishment

AUG 10, 2017 | Justice in Aging

Pat Kelley, a 67-year-old veteran and former Los Angeles radio announcer, needs 24-hour care as a result of primary progressive multiple sclerosis. He desperately wants to remain at home, but he and his wife have exhausted almost all of their savings paying for supplementary in-home care. They were facing a draconian choice: either impoverish themselves or move Pat into a nursing home, where Medicaid would help pay for his care. But they shouldn’t have had to.

Since 2014, a federal law has required the spouse of someone who needs Medicaid-funded in-home care to keep some additional income and assets so that they can pay the rent, buy food, and meet their other needs, while their spouse qualifies for Medicaid. This law was intended to help people like Mr. Kelley avoid unnecessary institutionalization. But California failed to implement the law.

On July 7, 2017, working with partners, we filed a lawsuit against the state of California to compel the state to implement the law.

Already, as a result of the lawsuit, on July 19, California’s Department of Health Care Services instructed counties to apply spousal impoverishment provisions to married individuals who apply for Home and Community-Based Services (HCBS). We’ll keep you updated as the case progresses.

Read more about the case.

Class Certified for Medicare Patients in "Observation Status" Case

AUG 8, 2017 | Justice in Aging

Nancy Niemi was hospitalized for 39 days after a visit to an emergency room. She’s 84-years-old and eligible for Medicare. The hospital, however, categorized her as an outpatient receiving “observation services” for her entire stay. Medicare covers hospital care through an inclusive payment under Part A if the stay is classified as inpatient, but patients may incur unexpected cost sharing if the stay is classified as “outpatient” observation covered under Part B. Ms. Niemi was now in debt for thousands of dollars for her entire 39-day stay, and, in addition, Medicare does not permit beneficiaries to appeal when they are classified as receiving observation services when they are in the hospital, so she had no way to challenge the lack of coverage.

Due to a federal court decision issued last week, Nancy Neimi is now a member of a nationwide class of hospital patients who may gain the right to appeal their placement on observation. Hospitals commonly classify patients under observation, and, until March of this year, often without their knowledge. This practice has left many older adults and others with thousands of dollars in surprise bills not just for the hospital stay, but also medicine and other services received while classified as under observation. Class members could number in the hundreds of thousands. One study found that, in 2009 alone, 918,180 Medicare beneficiaries experienced observation stays.

Justice in Aging filed the original lawsuit (now named Alexander v. Price) along with the Center for Medicare Advocacy in 2011. The case was initially dismissed, but plaintiffs appealed to the 2nd Circuit and prevailed. The case is now going forward on the Due Process claim. Specifically, the plaintiffs allege that Medicare must allow beneficiaries to challenge the decision they are only receiving observation services. The class certification order was issued on July 31, 2017 and can be read here.

If you have a client who you think may be a member of the class, you can submit their story here. Otherwise, no action is required at this time. We’ll keep you updated on the case as it moves forward.

Support National Level Advocacy!

AUG 8, 2017 | National Adult Day Services Association (NADSA)

NADSA has launched an Advocacy / Public Policy Initiative to raise funds needed to increase our visibility in Congress and the Executive Branch, strengthen our voice on national policy issues, and support Adult Day Services providers in serving clients and families. The most important thing we can do together is to support advocacy that none of us can do alone.

NADSA’s Advocacy / Public Policy initiative has five main objectives:

  • Support NADSA’s legislative presence with Congress and the Executive Branch to fight deep Medicaid funding cuts and advance the expansion of Adult Day Services as a Medicare benefit;
  • Ensure that NADSA has strong visibility on the national stage with organizations that impact ADS and participants and families;
  • Help NADSA work with state associations to strengthen ADS advocacy in communities across the United States;
  • Support the creation and dissemination of ADS advocacy materials and tools for NADSA members and to strengthen ongoing communications on policy issues; and
  • Strengthen and enhance NADSA’s annual Policy Event in Washington D.C.

While it is an uncertain time for health-related issues, there are also opportunities to make a difference. Nearly 50 advocates joined us for our annual Public Policy Event in Washington D.C. this May and were well-received by members of Congress. Our work on gaining support for Veteran’s services is realizing success. We have momentum in our favor but the threat of deep funding cuts are all too real.

There has never been a greater need for NADSA to invest in building its public policy and advocacy capacity.

To do this, we need your financial support. We need resources beyond what dues provide to ensure that current Medicaid funding is protected from deep cuts, and, also to achieve our goal of ADS as a Medicare benefit. Any donation amount is appreciated.

Please go to to make your donation. We will acknowledge your contribution on the NADSA website and continue to keep you apprised of our work protecting and championing ADS.

Governor and lawmakers reach final deal on new state budget

JUN 13, 2017 | Los Angeles Times | Melanie Mason and John Myers

With a deadline looming, there's a deal between Gov. Jerry Brown and lawmakers on a new state budget

Your Donations Help!

Three (3) great opportunities to further support Adult Day Services:


Learn more and DONATE today -- thank you!


California Association for Adult Day Services, a 501 (c) 6 non-profit grassroots-driven organization, advocates for the growth and development of adult day services in California and nationally. CAADS was the first state association formed in the United States for the purpose of advancing adult day services. Centers in membership with CAADS provide innovative day programs that support individuals with physical or mental disabilities and older adults with Alzheimer's disease and their families.

A nationally recognized leader in the field of aging, the Association is governed by the CAADS Board of Directors and provides timely information, analysis, advocacy, technical assistance, education, and networking opportunities for its members. CAADS members agree to abide by the Association's Bylaws, Code of Ethics, and Anti-trust Policy.

CAADS Board of Directors: 2017
CAADS Annual Report: 2016 | 2015
Bylaws | Code of Ethics | Anti-trust Policy

The CAADS Members Only page features information and technical assistance specific to Adult Day Services, as highlighted below. For membership information, click here.

  • State Budget Proposals, Legislative Alerts & Advocacy
  • CBAS Waiver
  • Medi-Cal Issues
  • Medicare and Medi-Cal Dual Beneficiaries News & CCI / CalDuals Updates
  • Managed Care Health Plans & CA Dept of Managed Health Care Updates
  • ADHC / CBAS Licensing & Regulations (DPH, DHCS, CDA)
  • Adult Day Program (ADP) Licensing & Regulations (DSS, CCLD)
  • Funding Sources
  • Education & Training Materials / Webinar Recordings
  • Membership Roster


ALE logoThe Alliance for Leadership and Education (A.L.E.) is a non-profit 501(c)(3) public benefit arm of CAADS. Its mission is to advance innovation and quality in Adult Day Service through research and analysis, education and training, and leadership for the benefit of consumers and their caregivers.



CAADS is a proud member of the National Adult Day Services Association.

Three representatives from California currently serve on the NADSA Board of Directors:

Corinne Jan, RN, PHN (NADSA Treasurer)
CEO, Family Bridges / Hong Fook Centers

Lydia Missaelides, MHA
Executive Director, CAADS

Amanda Sillars, MSW, LCSW
CEO, Total ADHC Solutions, Inc.


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Call DHCS Medi-Cal Fraud Hotline:


The call is free and you can remain anonymous.


The California Senior Medicare Patrol offers free fraud prevention education throughout the state.
To schedule a presentation, call 855-613-7080

See the SMP/Medicare fraud section at, for more information on ways to protect yourself from healthcare fraud and how to detect it.

If you come across any suspicious activity,




California Association for Adult Day Services
1107 9th Street, Suite 701 || Sacramento, CA 95814–3610
T: (916) 552-7400 || F: (866) 725-3123

CAADS 40th Anniversary logo


Human Kindness--it just flows around here
[Download Real Player]

Click to view the clip from CAADS 25th anniversary video
Honoring Adult Day Services pioneers and those they serve.

More Videos / Podcasts


Everything You Need To Know About Block Grants - The Heart of GOP's Medicaid Plans
California Healthline
Shefali Luthra | 1/25/17


As Care Shifts From Hospital To Home, Guarding Against Infection Falls To Families
SEPT 19, 2017
California Healthline
Melissa Bailey
As more medical care shifts from hospital to home, families take on more complex, risky medical tasks | caregivers of patients young and old

Latest Obamacare repeal bill would hit California hard
SEPT 19, 2017
Michelle Faus
Affordable Care Act | Medi-Cal | block grants to states | health care needs | Medi-Cal eligibility or capped enrollment

Last-Ditch Effort By Republicans To Replace ACA: What You Need To Know
SEPT 19, 2017
California Healthline
Julie Rovner
Affordable Care Act | ACA | Graham-Cassidy proposal | Medicaid | health program for low-income people

Medi-Cal programs to the state: Can we stop printing and mailing directories the size of phone books?
SEPT 4, 2017
Los Angeles Times
Soumya Karlamangla
Medi-Cal | L.A. Care | Medi-Cal health plan | Affordable Care Act | Medi-Cal managed care plans | low-income Americans | California Department of Health Care Services | Health Net | Molina Healthcare | Centers for Medicare and Medicaid Services

Transportation access for Riverside County communities can be difference between life of pain or comfort
AUG 30, 2017
The Desert Sun
Katie Gagliano
Health care for people in low-income communities | transportation to health care | barriers to access | inadequate or unreliable transportation | low-income patients with chronic conditions

Susan Crosby: A guide to the amazing Adult Day Care program
AUG 15, 2017
Lodi News-Sentinel
Adventist Health Lodi Memorial Adult Day Care | ADC | caregiver | long-term care | not-for-profit adult day care | San Joaquin County Department of Aging

Why low Medi-Cal payments to hospitals also hurt patients
AUG 14, 2017
The Sacramento Bee
C. Duane Dauner
Medi-Cal program | access to timely health care services | health plans | Medi-Cal payments to providers

Medi-Cal Sued For Pushing Patients Into Managed Care Despite Judges’ Orders
AUG 10, 2017
California Healthline
Emily Bazar
complex and debilitating medical conditions | Medi-Cal | Medicaid health insurance program for low-income residents | managed care plans | California Department of Health Care Services (DHCS) | fee-for-service | Medical Exemption Request

California talks big on health, but so few docs take Medi-Cal that it violates civil rights
AUG 9, 2017
The Sacramento Bee
Bill Lann Lee
seniors | people with disabilities | Medi-Cal | Medicaid health insurance program for low-income Californians | access to healthcare | Latino Medi-Cal patients | Medi-Cal payments | fee-for-service or managed care

California Funds Nonprofits To Serve Food As Medicine
AUG 9, 2017
California Healthline
Kellen Browning
chronic illnesses | adults with disabilities | Medi-Cal | Medicaid | low-income people | heavy Medi-Cal users | Department of Health Care Services | DHCS | long-term care facilities

Why more Medi-Cal patients ended up at the ER after UC Davis cut their primary care
AUG 8, 2017
The Sacramento Bee
Alexandra Yoon-Hendricks
Medi-Cal | vulnerable patients | paying out of pocket | Affordable Care Act | federally qualified health centers | safety net | Medi-Cal managed care plans

SF court reverses approval on lowered Medi-Cal outpatient rates
AUG 7, 2017
SF Gate
Bob Egelko
Medi-Cal | California lowered all of its Medi-Cal rates by 10 percent to balance its budget | access to care | Medicaid | state Department of Health Care Services | low-income state residents

Paying doctors more – now will they treat more poor Californians?
AUG 7, 2017
The Mercury News
Matt Levin, CalMatters
low-income patients | low-income health insurance program | Obamacare | Medi-Cal | Medi-Cal reimbursement rates | Medicaid | access to care | health plans | fee-for-service | Medi-Cal managed care organizations | Medicare | Affordable Care Act | clawbacks | California Department of Health Care Services

Loneliness is deadlier than obesity, study suggests
AUG 6, 2017
The Telegraph
Sarah Knapton
major public health hazard | social isolation and loneliness | elderly | aging population

Want a better Obamacare rate? You may have to call the movers.
AUG 4, 2017
Sacramento Bee
Capitol Alert
Jim Miller and Sharon Okada
Covered California | California Association of Health Plans | Anthem | Kaiser Permanente | Health Net | Department of Managed Health Care

Santa Maria's Wisdom Center wants community to 'Step Up for Seniors'
AUG 3, 2017
Santa Ynez Valley News
April Charlton
Santa Maria Wisdom Center | adult day care center | medically frail, elderly adults living with disabilities | dementia or Alzheimer's | Lifesteps Foundation | reduce the premature institutionalization | licensed community-based adult services program

Average Medicare Part D plan premium expected to decline in 2018
AUG 3, 2017
Fierce Healthcare
Leslie Small
Medicare Part D premium | Centers for Medicare & Medicaid Services | seniors | Medicare beneficiaries | Department of Health and Human Services

Feinstein ‘Deeply Concerned’ With Anthem Rollback of Coverage
AUG 2, 2017
Laura Klivans
Anthem Blue Cross | Medicare | Medi-Cal | Covered California | low-income consumers | Affordable Care Act | Obamacare

Despite Anthem’s pullback, outlook remains sunny for Covered California
AUG 2, 2017
Fierce Healthcare
Leslie Small
Covered California premiums | Anthem | health plan options | ACA’s health insurance tax | cost-sharing reduction payments | surcharge | Affordable Care Act

Senate OKs emergency spending package to fund Veterans Choice program
AUG 2, 2017
Fierce Healthcare
Ilene MacDonald
Veterans Choice Program | VA health programs | care and access

Court allows states to intervene in CSR case; senators plan bipartisan healthcare hearings
AUG 2, 2017
Fierce Healthcare
Leslie Small
Affordable Care Act subsidy program | cost-sharing reduction (CSR) payments | out-of-pocket costs | ACA | healthcare policy

Supporting caregivers
AUG 1, 2017
Heather Shelton
Humboldt Senior Resource Center’s Alzheimer’s Services program | caregivers | Adult Day Health and Alzheimer’s Services | Caregiver Resource Centers

Consider a day in the life of a caregiver
AUG 1, 2017
Half Moon Bay Review
Senior Coastsiders | seniors | caregivers | Aging and Adult Services | Medi-Cal | Coastside Adult Day Health Center program

Hospitals prepare to care for an aging ER population
AUG 1, 2017
Fierce Healthcare
Paige Minemyer
elderly patients | seniors | geriatric-specific emergency departments | fall risk | delirium | improve outcomes for elderly patients | geriatric specialists | multiple comorbidities

More Media Coverage
Please Direct Questions and Comments to


Photo of Lydia Missaelides

Lydia Missaelides, MHA
Executive Director

Photo of Kathryn Atkinson

Kathryn Atkinson
Membership & Communications Director

Photo of Sherice Dean

Sherice Dean
Education & Events Manager

Photo of Coni Segretto-Ricci

Coni Segretto-Ricci
Office Assistant

(not pictured)

Phyliss Regino
Office Assistant

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