Adult Day Sector Sees Growth in Tennessee

After her mother was diagnosed with dementia in 2023, Vivian Rocha, of Spring Hill, and her siblings started taking shifts so her mom could have 24-hour care in her own home.

But that quickly became overwhelming for Rocha, 40, who was also juggling a full-time job and raising her 6-year-old son.

“I was like, ‘I need a break.’ I have family, I have work, I have, you know, just life,” says Rocha. She did not want to move her mom into a nursing home, and she found the cost of in-home care to be “insanely” expensive.

So she opted for an alternative: an adult day center where her mom, who is 80, could find connection and engagement during the day. The center first opened in 2023—part of a growth spurt in adult day services in Tennessee.

The sector has grown about 10 percent over the last three years, giving more older adults social interaction, communal meals and activities such as art, music and exercise. It means they can age at home, not in a nursing or assisted living facility.

Professionals in the field hope to boost those numbers even more—a necessary step, given Tennessee’s aging population and the fact it has far fewer adult-day slots available than similarly sized states.

“The overwhelming majority of older Tennesseans want to age at home,” says Mia McNeil, AARP Tennessee state director. “Adult day services are key to making that possible, providing social, physical and mental health benefits that keep loved ones active and engaged outside the home.”

Bill Zagorski, who operates three centers in the state and is board chair of the National Adult Day Services Association, is pushing to make adult day more robust and visible in Tennessee.

“No one wakes up and says, ‘I can’t wait ‘til I get to move into an assisted living or a ... nursing home,’ ” he says. In addition to providing an alternative to institutional care, adult day centers offer much-needed respite for caregivers like Rocha, he notes.

State still underserved

Tennessee ranked 40th in the country for adult day services on AARP’s most recent long-term care scorecard, with 15 slots per 10,000 adults 65-plus.

By comparison, California ranked No. 1, with 154 slots per 10,000 adults 65-plus, while Arizona and Oregon tied for last with 4 slots for that cohort, scorecard data shows.

By 2040, nearly 8 million Tennesseans, or almost 20 percent of the state’s population, will be 65 or older, according to estimates by the University of Tennessee, Knoxville.

Zagorski says there are currently about 40 to 45 adult day centers across the state—roughly one for every four counties. But even as the state’s population grows and demand for long-term care services increases, there’s been little attention from policymakers, Zagorski and others say.

“They lump us together with childcare,” says Georgina Dench, director of FiftyForward Friends Adult Day Services, the center Rocha’s mom attends.

Many of the licensing regulations for adult day centers are the same as those for childcare, she says. But she sees signs of progress, such as a new working group of licensing officials who are hoping to make the regulations more appropriate for adult day services.

Zagorski says adult-day advocates plan to push state lawmakers—either in this year’s legislative session or next year’s—to replace the term “adult day care” with “adult day services” in the code that governs the sector.

“It is infantilizing and ageist, not to mention does not reflect the depth and breadth of services and supports provided,” he says.

He also wants the adult day centers that offer health services to have additional certification criteria—so families know that they provide a higher level of care that involves a medical component. In addition to social and cognitive activities, adult day health centers usually have nurses, dieticians and social workers, and may also offer physical and occupational therapy.

For Rocha, any step that brings attention to such services is a net positive. She says her mother’s time at FiftyForward has given her a much-needed break—and eased the “caregiver guilt” she felt when she was juggling and unable to give her mother her full attention.

The center has also helped her mother, who enjoys the monthly trips to the library and other activities.

“She talks about her friends, the crafts and things she’s proud of,” Rocha says. “There’s a sense of belonging.” ■

Sheila Burke, a freelance writer in Nashville, has written for the Bulletin for more than 10 years.

Also of interest:

• Adult Day Care: What Family Caregivers Need to Know
• What Are the Pros and Cons of Receiving Pay as a Family Caregiver?
• How to Be a Caregiver for Someone With Dementia