Adult Day Care Regulations in Georgia

Who regulates adult day care in Georgia

The Healthcare Facility Regulation Division (HFRD) of the Georgia Department of Community Health (DCH) licenses adult day centers through its Personal Care Home Program. DCH also runs Georgia Medicaid.

The operating standards are the Rules and Regulations for Adult Day Centers, Chapter 111-8-1. They are adopted under the Adult Day Center for Aging Adults Licensure Act, O.C.G.A. section 49-6-80 et seq.

Types of adult day programs in Georgia

Georgia licenses one facility type, the adult day center: a facility serving aging adults that provides adult day care or adult day health services for compensation to three or more people. The license covers two service models.

• Adult day care: the social model, focused on social and recreational activities with limited personal care, supervision or assistance.
• Adult day health services: the medical model, adding nursing, health monitoring, medication administration and therapies under individual plans of care.
• Mobile adult day centers: a center may operate at more than one location if the Department classifies and approves it as a mobile adult day center.

The rules exempt programs that operate without compensation, programs serving only one or two participants, day habilitation programs serving only people with developmental disabilities, and respite care programs as the rules define them (Rule 111-8-1-.03). Any other program that meets the definition, social or medical, needs a license.

How to get licensed in Georgia

You need a DCH license before you operate, and each center needs its own application and license. Applications go through the GaHLES online portal, and HFRD's initial review period is 30 business days (Adult Day Center Application Packet).

1. Show legal authority to do business, such as Secretary of State registration, plus local zoning approval and proof of ownership or a lease.
2. Get a fire safety inspection report dated within six months that shows no violations and the capacity load, plus water and sewage approval.
3. Prepare a labeled floor sketch with room measurements and photos of an accessible bathroom and shower.
4. Complete fingerprint background checks through the Georgia Criminal History Check System (GCHEXS) for administrators and owners with a 10 percent or greater interest.
5. Add what applies to you: a food service permit for 24 or more participants, vehicle insurance and registration if you transport, and an RN license for adult day health services.
6. Submit the application, owner form and notarized identity affidavit in GaHLES, and pay fees through the HFRD payment portal.

DCH inspects each center before licensure and periodically after that (Rule 111-8-1-.26). The license states the maximum participants per day, based on usable floor space and the fire occupancy load. Licenses cannot be transferred or moved, and an annual renewal fee applies.

Key requirements

• Staffing: a staff or volunteer to participant ratio of at least 1:8, counting only direct service staff, and at least one person with current first aid and CPR certification on site at all times (Rule 111-8-1-.13). Confirm these requirements in the current rule text.
• Adult day health nursing: an RN assesses each participant and develops and supervises the plan of care within three business days of admission, and LPNs work under RN supervision.
• Directors: adult day health directors need a bachelor's degree or four years of experience in health, human services or a related field (Rule 111-8-1-.14).
• Space: the rule requires "at least 35 feet of usable floor space for each participant," not counting passageways, bathrooms, storage and staff areas, and one toilet for every 12 participants (Rule 111-8-1-.10). The rule text omits the word "square"; confirm the current figures in the rule.
• Services: supervision, social and leisure programming, activities, and nutrition if the center is open more than four hours a day (Rule 111-8-1-.12).
• Admission: an in-person interview, a negative TB test or chest x-ray within 12 months, a National Sex Offender Registry search, and for adult day health a medical exam within six months (Rule 111-8-1-.15).
• Personnel: fingerprint records checks for directors and direct access staff before they start, and training within 90 days that includes CPR and dementia care (Rule 111-8-1-.14).
• Emergencies: fire drills at least quarterly with all staff and participants, and a disaster plan reviewed and rehearsed every year (Rule 111-8-1-.09).

Medicaid funding for adult day in Georgia

Georgia Medicaid covers adult day health care through the Elderly and Disabled Waiver. DCH's guide to Medicaid waiver programs (last revised 2021) lists adult day health care in both of the waiver's programs, the Community Care Services Program (CCSP) and SOURCE. Confirm current coverage in the approved Elderly and Disabled Waiver. Members must be eligible for Medicaid, and CCSP applicants must qualify for nursing home level of care.

People seeking CCSP contact their local Area Agency on Aging, and people seeking SOURCE contact the SOURCE case management agency serving their county. DCH posts waiver documents and proposed amendments on its Home and Community Based Services page.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• DCH Healthcare Facility Regulation Division
• HFRD Licensure Forms and Applications
• Chapter 111-8-1, Rules and Regulations for Adult Day Centers
• DCH Home and Community Based Services
• LeadingAge Georgia
• VA Adult Day Health Care

Frequently asked questions

Do I need a license to open an adult day center in Georgia?

Yes, if you provide adult day care or adult day health services for compensation to three or more aging adults. You must get a DCH license before you open, and each location needs its own license.

Is social adult day care regulated in Georgia?

Yes. The adult day center license covers both the social model (adult day care) and the medical model (adult day health services), with extra nursing and therapy rules for the medical model.

Does Georgia Medicaid pay for adult day care?

Yes. DCH's waiver guide (last revised 2021) lists adult day health care as a service in the Elderly and Disabled Waiver's CCSP and SOURCE programs, for Medicaid members who meet the waiver's requirements. Confirm current coverage in the approved waiver.

Who inspects adult day centers in Georgia?

DCH's Healthcare Facility Regulation Division does. The rules call for an inspection before licensure and periodic inspections after that, and DCH may also investigate complaints.