The purpose of the Adult Day Care Service Effectiveness Study was to identify types of services provided by the Agency A, e.g. health monitoring, physical therapy, education, socialization, etc., utilization of services, and the impact of services upon clients' quality of life. The initial design called for a comparison between health outcomes of Agency A clients and another adult day care program, as well as a quality of life measurement and client satisfaction survey. After numerous attempts to identify a control group that collected medical data failed, the plan was refocused to measure health indicators three months prior and three months post entry into care. The quality of life instrument was used to gauge the effectiveness of the program and was based on client recall. With an average daily attendance of 22 and total of 47 active clients, 25 clients were recruited to participate in the study. Each participant signed the necessary consents and all completed the quality of life (QOL) survey. The medical providers identified by the clients were contacted and chart reviews were conducted. Out of the 25 consents for medical chart review, 18 charts were made available to researchers.

For comparison purposes, the period from March 1999 through January 2000, the average daily number of clients receiving services was 32. Of these clients, 84% (27) were male and 16% (5) female. The race/ethnicity of the population was 44% (14) African American, 31% (10) White, 21% (7) Hispanic, and 4% 91) Asian/Pacific Islander. Ages of the majority of participants (80.6% or 26) fell in the 20 - 45 years range, with 19.4% (6) being older than 45 years. Utilization of the ADC program services increased from the period of March 1999-February 2000 to March 2000- February 2001. Although the average daily attendance has increased by only 1%, total units of service increased by 6% and total hours of service by 12%, indicating clients are receiving an increased number of services or the services have increased in duration. At the current level of utilization, current funding from Title I will be exhausted by May, 2001 with three months remaining in the fiscal year indicating a need for increased funding in future years.

Review of Agency A charts and interaction with the clients indicated that the reasons for enrollment in the program were not always dependent on the stage of HIV disease, but rather were associated with the severity of the disability and the relative ability of self-care. Some of the disabilities noted were HIV-related brain damage, HIV-related blindness, dementia, congenital blindness, mental retardation, severe mental illness and brain damage resulting from a gunshot wound.

Over 40% of the clients in the study have less than 200 CD4 cells for all months except the third month after starting the ADC program. The fact that the level of CD4 cells is less than 500 for 70% or more clients in the study for all months, both prior to and following enrollment in the ADC program, indicates that the majority of clients have had HIV for some time and have progressed in the disease process. It may be assumed that the clients enrolled in the Agency A Adult Day Care Program by and large have multiple, complex health problems that require regular, careful monitoring. In the comparison of viral loads for those with data, 40% had undetectable viral loads, suggesting that the referral by the physician into the ADC program was based upon more than HIV health status alone. There was a relative change in the occurrence of opportunistic infections after program enrollment, improving 32.21%. This may be a significant indicator of improved health status related to better patient compliance with medication and regular health assessments that occur at the ADC program.

Of the six hospitalizations reported in the study, at an estimated expense of $105,600 according to recent research that indicates an average hospitalization for someone with HIV is $17,600 per visit (AIDS Alert, Vol.16, No 2, p26), five occurred prior to entering ADC. The sixth episode was a non-HIV related ER visit. This may be an indicator that hospitalizations can be averted with consistent day care as well as a good indicator of the positive health impact of an adult day care program.

In regard to the QOL component of the study, social activities and creation of new friendships were high on this list as it would be likely that those to whom these issues were important would enter a program like this. The findings show that exercise, which was rated as "improved" by 69.2% of clients, and physical health, rated as "improved" by 64% of clients, are two areas in which the many of the clients have significant disabilities.

There was a 5-way tie for the highest percentage of satisfaction; the areas of food/meal quality, food/meal quantity, variety of activities offered, number of days the program is open, and the general treatment of the clients all received high ratings from 72% of the clients. When asked what they liked most about the Program, 50% of the clients answered that it was their relationships with other clients.

Funded by the Harris County Ryan White Planning Council.