Adult Day Care in Pennsylvania

All states: adult day services map

Pennsylvania adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Pennsylvania?

Pennsylvania licenses adult day programs for older adults as older adult daily living centers, through the Pennsylvania Department of Aging. There is one license type, so adult day care and adult day health care are not licensed separately, and every center must provide the same core services, including nursing. Medicaid pays for this service under the name Adult Daily Living, at a standard level and an enhanced level.

Three layers of rules can apply to a Pennsylvania center, and each comes from a different agency:

• Licensing (Department of Aging). The Bureau of Quality Assurance, Division of Licensing, enforces 6 Pa. Code Chapter 11, issued under the Older Adult Daily Living Centers Licensing Act (62 P.S. 1511.1 to 1511.22). These rules cover the license, staffing, space, services, records and incident reporting for every center, whether it is for-profit, nonprofit, publicly funded or privately funded.
• Medicaid (DHS). The DHS Office of Long-Term Living runs the Community HealthChoices (CHC) waiver, through managed care organizations, and the OBRA waiver. Its provider rules for OBRA and Act 150 providers are in 55 Pa. Code Chapter 52, and 55 Pa. Code 1101.51 sets recordkeeping rules for all Medical Assistance providers. The DHS Office of Developmental Programs (ODP) also pays for an Older Adult Daily Living Centers service in its waivers, and LIFE is Pennsylvania's version of PACE.
• Other funding. The Department of Aging OPTIONS program, run through local Area Agencies on Aging, lists adult day services as one of its main services. The U.S. Department of Veterans Affairs pays for adult day health care for some veterans.

Under the licensing rules, a center is a place that serves 4 or more clients who are not relatives of the operator, at the same time, for part of a 24-hour day (6 Pa. Code 11.2, 11.3). Clients are Pennsylvania residents age 60 or older, or age 18 or older with post-stroke dementia, Parkinsonism or a similar dementia-related disease, who need help with personal needs and daily activities. Chapter 11 does not cover vocational facilities, partial hospitalization, summer and camping programs, socialization clubs, certain nursing home adult day care and certain developmental training facilities.

Where the layers overlap, Department of Aging licensing is the layer that sets how a center must operate. Medicaid builds on it: the OBRA waiver allows day services only in settings licensed under 6 Pa. Code Chapter 11 or 55 Pa. Code Chapter 2380, or holding listed CARF accreditation. Medicaid then adds its own eligibility rules (nursing facility level of care for CHC, and an intermediate care level for OBRA), documentation rules and a longer record retention period. We did not find the published provider qualifications for Enhanced Adult Daily Living.

Do you need a license to open an adult day center in Pennsylvania?

Yes, if your program will serve 4 or more clients who are not your relatives at the same time, and they are age 60 or older or adults with a dementia-related disease. The Department of Aging licenses these centers whatever the payer. A first-time operator at a location starts with an interim license of up to 6 months, then moves to a regular license of up to 12 months.

How to apply. The Department explains the process on its Apply for Adult Day Center Licensing page and its Adult Day Center FAQ:

• Request an application packet from the Division of Licensing mailbox, RA-AIADULTLICENSING@pa.gov, and return it there. New applications are accepted by email only.
• Required forms include AGL-02 Application for License, AGL-07 Provider Self Certification and Civil Rights Compliance, AGL-08 Center Operations and Demographics, an initial application checklist and an interim policy and procedure checklist.
• You need a valid occupancy permit for the building. The Department FAQ says the certificate of occupancy must carry use group I-4 (6 Pa. Code 11.14).
• After the Department reviews your application, a Licensing Representative inspects the center on site, and an interim license may be issued. The interim inspection generally happens 3 to 6 weeks after the application is accepted.

Fees. Annual license fees are set by maximum licensed capacity: $10 for 4 to 10 clients, $20 for 11 to 20, $30 for 21 to 35 and $40 for 36 or more. The fee is paid before the license is issued or reissued (6 Pa. Code 11.251, 11.252).

Local permits. If your occupancy permit is withdrawn or restricted, you must tell the Department orally within 1 working day and in writing within 2 working days.

Certificate of need. We did not find a certificate of need, moratorium or limit on new centers. The adult day rules and the Department's licensing pages do not address one. Confirm with the Division of Licensing and your local zoning office before you sign a lease.

One license per site. Each center needs its own application (6 Pa. Code 11.231), and the current license must be displayed in a public area of the center.

License types. Regular licenses last up to 12 months. Interim licenses, for first-time operators at a location, last up to 6 months and cannot be renewed. Provisional licenses last up to 6 months each, with no more than 3 in a row for a total of 18 months (6 Pa. Code 11.263 to 11.265).

Buying a center. A license cannot be transferred. It becomes void when ownership, location or profit status changes. You must give the Department notice of a change in legal entity, name, location or profit status at least 60 days ahead, and file a new application at least 30 days ahead. Other changes, such as a new responsible person, are reported within 30 days after they happen (6 Pa. Code 11.268 to 11.270).

Renewal and inspections. Reapply at least 60 days before the license expires (6 Pa. Code 11.232). The Department inspects each center at least once every 12 months and may also make announced and other inspections, and inspection summaries are public through its Adult Day Center Directory (6 Pa. Code 11.241 to 11.243). Each center also needs a documented onsite fire safety inspection every year by the local fire department or another fire safety authority (6 Pa. Code 11.83).

Waivers of a rule. The Department may grant time-limited written waivers of specific rules when client health, safety and service quality are not affected, and it reviews them each year (6 Pa. Code 11.5). Centers that are also licensed by another agency can ask for a waiver of inspection under Aging Program Directive 14-20-01.

Programs outside the license. A program that serves 3 or fewer non-relative clients at a time falls outside the license definition, as do socialization clubs and the other excluded programs listed above.

What are the staffing rules for adult day centers in Pennsylvania?

Pennsylvania licensing rules require at least 1 program staff member for every 7 clients at all times, close enough to watch clients and respond right away to emergencies. We did not find a Medicaid ratio for adult day, so the 1:7 licensing ratio is the one to staff to. The rules set no separate ratio for clients with dementia.

The ratio is in 6 Pa. Code 11.39.

• Licensing (Department of Aging): 1 program staff per 7 clients at all times. The director must name a supervisor for times the director is away.
• Medicaid (DHS Office of Long-Term Living): no ratio specified in 55 Pa. Code Chapter 52. OBRA and Act 150 providers must complete criminal history checks before hiring staff who have contact with participants, train staff on a service before they provide it, and give annual training on listed topics (55 Pa. Code 52.19 to 52.21). We did not find staffing rules for the Enhanced Adult Daily Living level.
• Other funding: we did not find Area Agency on Aging contract staffing standards.
• Separate model: adult training facilities certified by DHS need at least 1 direct service worker per 6 individuals at all times (1 per 10 during staff meetings or training), at least 2 staff present at all times, and 1 program specialist per 30 individuals (55 Pa. Code 2380.33, 2380.35). These rules do not apply to older adult daily living centers.

Minimum staff on site. Chapter 11 sets no fixed headcount beyond the 1:7 ratio. Enough staff must hold CPR and first aid certification that at least one certified person is present at all times.

Who counts toward the ratio. The ratio counts program staff, meaning employees who directly assist clients or provide services. Volunteers serve without pay and supplement staff under staff supervision, but the rule does not say whether they count toward the ratio. Ask the Division of Licensing before you count a volunteer.

Required positions. Every center needs a program director or administrator, a nurse, an activities coordinator and program assistants or aides. The nurse is a Pennsylvania-licensed RN, or an LPN working under an RN or physician, and may be full-time, part-time or a consultant. One person may fill more than one position if qualified for each (6 Pa. Code 11.32 to 11.37). We did not find nurse hours that increase with the number of clients.

Qualifications. The director needs a bachelor's degree plus 2 years of social or health services experience, or a high school diploma or GED plus 3 years of that experience and supervisory skills. The activities coordinator needs a bachelor's degree or 2 years of human services experience. Aides need a diploma or GED, 1 year of related experience, nursing assistant qualification, or training provided by the center.

Training. Staff need orientation within 3 months of hire, training on listed topics within 3 months and every year, and at least two training sessions a year totaling at least 8 hours (6 Pa. Code 11.33). All directors, and staff who manage the center when the director is away, must take the Department's online Adult Day Services Director Training (about 4.25 hours). New directors must finish it within 3 months, and it counts toward the yearly training hours.

Background checks. Operators and all staff, including drivers, need a Pennsylvania State Police criminal history check, plus an FBI check for anyone who has not lived in Pennsylvania for the prior 3 years (6 Pa. Code 11.18, 11.31). The Department FAQ says the Older Adult Protective Services Act and 6 Pa. Code Chapter 15 now govern these checks. Listed convictions, a substantiated elder abuse finding or a Nurse Aide Registry finding disqualify a staff member.

Health screening. Staff with direct client contact or food duties need a physical within 12 months before hire and every 2 years, including a negative TB skin test within 2 years. A chest X-ray is used only after a prior positive test (6 Pa. Code 11.132). We did not find other required vaccinations.

What does an adult day center in Pennsylvania have to provide?

Every licensed Pennsylvania center must provide personal care, nursing, social services, therapeutic activities, nutrition and emergency care. Centers must serve a full meal to clients who stay 4 hours or more and provide at least 50 square feet of program space per client. Transportation is optional, but rules apply when the center provides it directly.

Core services. The core services are set in 6 Pa. Code 11.123. Nursing reviews of health status, medications, personal care policies and staff training happen at least every 3 months. A non-binding statement of policy (6 Pa. Code 11.402, 11.403) describes optional services such as physical, occupational and speech therapy, medical, dental, pharmacy, psychiatric and podiatry services.

Meals. Clients present 4 or more hours get a full meal that provides at least one-third of recommended daily allowances. Clients present more than 6 hours also get a snack. Menus are posted at least 1 program day ahead and kept for 2 months (6 Pa. Code 11.152).

Medications. Medications that clients do not take on their own must be given by licensed professionals, or by staff who completed the DHS medication administration course, and those staff may give only oral and topical medications and eye and ear drops. Giving insulin also requires an approved diabetes education program (6 Pa. Code 11.146).

Transportation. Centers may provide or arrange transportation. When a center provides it directly, clients must be safely restrained in the vehicle, a driver's assistant is required when needed, and drivers must be 18 or older with a valid license (6 Pa. Code 11.161 to 11.165). The rules set no staffing ratio for vehicles.

Space and capacity. Under 6 Pa. Code 11.52 and 11.69:

• At least 50 square feet of indoor program space per client, measured wall to wall. This figure sets the center's maximum capacity.
• Bathrooms, dining areas, kitchens, hallways, offices and similar spaces do not count unless they are used for programming at least half of each program day.
• A center that shares a building with other services must have its own identifiable space during operating hours, unless it shares space with an adult training facility licensed by DHS or the Department of Education.
• For centers licensed or built after October 12, 1993, one toilet and one sink for every 14 clients present. Centers serving 15 or more clients at once need two separate bathrooms, with accessible fixtures when a client has a physical disability.

Hours. We did not find a minimum number of days or hours a center must be open. The rules define a center only as serving clients for part of a 24-hour day.

Written policies. The licensing rules require written policies and procedures for:

• Eligibility and admission (11.4).
• Administration, including accounting, personnel, admissions and discharges, records, unusual incidents, and safety, including fire, emergencies and infection control (11.13).
• Unusual incidents (11.16) and grievances (11.20).
• Emergency procedures, reviewed with staff at least every 3 months (11.21).
• A staff training curriculum (11.33).
• Evacuation, posted in program areas (11.82), plus procedures for deaf or hearing-impaired clients and for fire monitoring if the alarm fails (11.86).
• Smoking safety, if smoking occurs (11.91).
• Discharge, available at admission (11.110).
• Record confidentiality, access, copying and release (11.196).

OBRA and Act 150 Medicaid providers also need written critical incident policies and a Quality Management Plan (55 Pa. Code 52.17).

Safety and postings. Fire drills are required at least every 6 months, and clients get fire safety instruction at admission and every 3 months. Centers post client rights in English and the community's main language, emergency and advocacy phone numbers at each outside phone, evacuation procedures and the license.

Other requirements. Centers complete an annual survey questionnaire on a Department form and carry personal and professional liability insurance (6 Pa. Code 11.22, 11.23). A non-binding statement of policy suggests meeting with an advisory committee at least twice a year and reviewing policies at least once a year.

What rules protect participants in Pennsylvania adult day centers?

Pennsylvania rules require intake screening and a physical exam before admission, a signed enrollment agreement, a care plan within 30 days, and at least 30 days' notice before a center-initiated discharge. Restraints are banned. Serious incidents such as abuse or police involvement are reported to the Department of Aging within 24 hours.

Who can enroll. A client must have a functional impairment, need a structured program and be able to be transported, and must have intake screening within 60 days before admission. People who are bedfast, or who have an uncontrolled communicable disease or behaviors the center cannot manage, may not be admitted. Applicants who are turned down are told within 30 days of screening (6 Pa. Code 11.4, 11.101). Medicaid participants must also meet the level of care their program requires.

Physical exam. Each client needs a physical exam within 3 months before admission and every year, including a negative TB skin test within 2 years (6 Pa. Code 11.102).

Enrollment agreement. The agreement must cover services and goals, billing units and payment due dates, the conditions for ending services, center rules and a release of information. Clients get a signed copy, the grievance procedure, the client bill of rights and contact details for the local Ombudsman (6 Pa. Code 11.20, 11.103).

Care plan. An individual care plan is due within 30 calendar days of admission and is reviewed at least every 6 months. Staff write progress notes at least once a month (6 Pa. Code 11.104, 11.105, 11.109).

Discharge. For a discharge the center starts, it must give oral and written notice at least 30 days ahead, plus a discharge summary with referrals. Immediate discharge is allowed only for a sudden change in the client's functioning that poses a threat (6 Pa. Code 11.110 to 11.112).

Restraints. Restraints, seclusion and aversive conditioning are banned. Protective devices such as helmets or mitts may be used only for a limited time, up to 3 months after admission, with checks every 15 minutes and removal for 10 minutes every 2 hours (6 Pa. Code 11.171 to 11.174).

Records. Client records include identification and a photo taken in the last 5 years, intake, medical reports, care plans, progress notes, incident reports, a release of information and the enrollment agreement (6 Pa. Code 11.193, 11.195). The two layers set different retention periods, and Medicaid is stricter:

• Licensing: at least 4 years after the client leaves, or until audits or lawsuits end.
• Medicaid, all providers: medical and fiscal records for at least 4 years (55 Pa. Code 1101.51).
• Medicaid, OBRA and Act 150 providers: at least 5 years after the end of the fiscal year (55 Pa. Code 52.43).

Attendance. The licensing rules do not list attendance or sign-in and sign-out records. Medicaid providers must keep records that support service dates, amount and duration (see the Medicaid section below).

Incidents. Unusual incidents are reported to the responsible party and family right away. Abuse or suspected abuse, fire department involvement or police action is reported orally to the Department within 24 hours (no later than the next working day), with a written report within 3 working days. Deaths are reported within 24 hours (6 Pa. Code 11.16, 11.17). OBRA and Act 150 Medicaid providers also report critical incidents on a DHS form (55 Pa. Code 52.17).

How does Medicaid pay for adult day in Pennsylvania?

Pennsylvania Medicaid pays for Adult Daily Living through the Community HealthChoices and OBRA waivers, both run by the DHS Office of Long-Term Living. The OBRA fee schedule pays by the day or half day under code S5102, about $58 to $61 a day depending on region. ODP waivers pay for an Older Adult Daily Living Centers service in 15-minute units, and LIFE (Pennsylvania's PACE) includes adult day health services.

Community HealthChoices (CHC). CHC is Pennsylvania's managed long-term services program, delivered through managed care organizations. It serves adults 65 and older and adults 21 to 64 with physical disabilities who meet nursing facility level of care, and Adult Daily Living is a listed service. The current waiver (0386.R05.00) runs from January 1, 2025 through December 31, 2029 (Medicaid.gov waiver list). CHC plan rates are negotiated and not published, and we did not confirm which billing codes or units the plans use. Ask each plan you contract with.

OBRA Waiver. The OBRA waiver (0235.R07.00) serves people 18 to 59 with developmental physical disabilities who meet an intermediate care level of care. It is run by the Office of Long-Term Living's Bureau of Fee for Service Programs. The OLTL fee schedule effective January 1, 2022 lists these rates for Regions 1, 2, 3 and 4:

• S5102, Adult Daily Living, 1 day: $58.39, $58.91, $60.86 and $59.80.
• S5102 U5, half day: $29.20, $29.45, $30.43 and $29.90.
• S5102 U4, Enhanced Adult Daily Living, 1 day: $75.01, $71.79, $68.42 and $75.01.
• S5102 U3, Enhanced half day: $37.51, $35.90, $34.21 and $37.51.

These per-day amounts match a 2012 fee notice. The only 2026 OBRA fee schedule notice we found changed other codes, not Adult Daily Living, but confirm current rates with the Office of Long-Term Living. We did not find how many hours make a full day or a half day.

Transportation. The OLTL waiver service descriptions say transportation between home and the center is part of the Adult Daily Living service, but its cost is not included in the rate. We did not find how CHC plans or ODP handle transportation for adult day.

ODP waivers. The Office of Developmental Programs pays for an Older Adult Daily Living Centers service under state code W7094 in its Consolidated, Community Living and P/FDS waivers. The fee schedule effective July 1, 2024 sets $4.02 per 15 minutes statewide, or $4.76 with enhanced communication (54 Pa.B. 5541). We did not find a later notice changing that rate.

LIFE. LIFE (Living Independence for the Elderly) serves people 55 and older who meet nursing facility level of care. Adult day health services and transportation are included services, and DHS lists 13 LIFE provider organizations. LIFE pays a set amount per enrollee, so adult day is not billed by the unit.

Licensing comes first. The OBRA waiver allows day services only in settings licensed under 6 Pa. Code Chapter 11 or 55 Pa. Code Chapter 2380, or holding listed CARF accreditation.

Attendance documentation. The licensing rules do not require attendance records. OBRA and Act 150 providers must document service delivery, use the DHS-designated information system for service plan information, and keep records that support the dates, amount and duration of services. Electronic records are acceptable if they meet format and integrity conditions (55 Pa. Code 52.15, 52.43). We did not find a state rule that requires electronic attendance tracking or sign-in and sign-out for adult day, or CHC plan attendance rules, so ask each plan you bill how it wants attendance documented.

Can a private-pay adult day center operate in Pennsylvania without Medicaid?

Yes, a center can be fully private pay, but it still needs a Department of Aging license if it serves 4 or more eligible clients at once. Chapter 11 applies to for-profit, nonprofit, publicly funded and privately funded centers alike. Programs serving 3 or fewer non-relative clients at a time, and socialization clubs, fall outside the license.

What an unlicensed program may do. The rules do not list specific services that an unlicensed program may not provide. If you are unsure whether your program needs a license, ask the Division of Licensing.

Protections for private-pay clients. Every client gets a written enrollment agreement that states billing units and payment due dates, a client bill of rights, grievance procedures, access to the Ombudsman and 30 days' notice of a center-initiated discharge (6 Pa. Code 11.7, 11.9, 11.20, 11.103, 11.111). The nondiscrimination rule cites civil rights laws but does not mention source of payment. We did not find fee disclosure rules beyond the enrollment agreement.

Other funding.

• OPTIONS. Adult day services is one of the main services of the Department of Aging OPTIONS program, for Pennsylvania residents 60 and older with unmet needs that affect daily functioning. There is no income limit, but participants may owe a sliding-scale co-payment. People apply through their local Area Agency on Aging.
• Area Agency on Aging and VA contracts. The Department FAQ notes that centers may contract with Area Agencies on Aging and Veterans programs, and that a contract does not guarantee referrals. We did not find the service standards in those contracts.
• VA. The U.S. Department of Veterans Affairs offers Adult Day Health Care at VA medical centers, State Veterans Homes or community organizations for enrolled veterans who meet clinical criteria. A copay may apply.

The market. The state association is the Pennsylvania Adult Day Services Association (PADSA). We did not find a current state count of licensed centers. The Department's Adult Day Center Directory lists licensed centers and their inspection summaries, so families can check a center there.

What is changing next for adult day in Pennsylvania?

As of our last check on October 21, 2026, we did not find a scheduled change to Pennsylvania's adult day licensing rules or Medicaid adult day payment. Two proposals are in progress but not final, and neither is known to change adult day services.

• OBRA waiver renewal and CHC waiver amendment (proposed). DHS proposed an OBRA waiver renewal and a CHC waiver amendment with a proposed start of July 1, 2026, covering items such as teleservice options, settings rule language and complaint process updates (Pennsylvania Bulletin notice). Neither notice lists changes to Adult Daily Living, and we did not confirm federal approval.
• Senate Bill 482 (pending). SB 482, the Keeping Seniors Safe at Home bill, would amend the Human Services Code, including LIFE program provisions. It passed the Senate in June 2026 and is in the House Aging and Older Adult Services Committee. We did not confirm whether it would affect adult day centers.
• CHC waiver renewal (in effect). The current Community HealthChoices waiver took effect January 1, 2025 and runs through December 31, 2029.

Pennsylvania adult day sources

• 6 Pa. Code Chapter 11: Older Adult Daily Living Centers
• PA Department of Aging: Adult Day Center FAQ
• PA Department of Aging: Apply for Adult Day Center Licensing
• 55 Pa. Code Chapter 2380: Adult Training Facilities
• 55 Pa. Code Chapter 52: Long-Term Living Home and Community-Based Services
• Medicaid.gov: Pennsylvania waiver list (CHC and OBRA waivers)
• DHS Office of Long-Term Living: HCBS rates effective January 1, 2022
• DHS Office of Long-Term Living: waiver service descriptions
• Pennsylvania Bulletin 54 Pa.B. 5541: ODP fee schedule rates effective July 1, 2024
• PA Department of Aging: Apply for the OPTIONS Program

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Effective Transportation Tracking for Elder Day Centers
• Podcast: How Adult Day Services Let You Serve 50 Clients with Just 8 Staff
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states that license or certify every adult day center

California, Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Maine, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, Tennessee, Texas, Utah, Wyoming. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.