Adult Day Care in South Carolina

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South Carolina adult day services at a glance

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

How is adult day care regulated in South Carolina?

South Carolina has one license for adult day programs, the Day Care Facility for Adults license, issued by the South Carolina Department of Public Health (DPH). There is no separate adult day health care license. Adult Day Health Care (ADHC) is the name of a Medicaid waiver service that a licensed center can offer after it enrolls and contracts with the South Carolina Department of Health and Human Services (SCDHHS), the state Medicaid agency.

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

• Licensing (DPH). Regulation 60-75, Standards for Licensing Day Care Facilities for Adults, adopted under S.C. Code Sections 44-7-130 and 44-7-260. Its most recent revision was published in the State Register on May 23, 2025. These rules cover the license, staffing, space, services, records and incident reporting for every center, whatever the payer.
• Medicaid (SCDHHS). The Adult Day Health Care Scope of Services (July 1, 2025) sets the extra rules for centers that serve participants in the Community Choices, Intellectual Disability/Related Disabilities (ID/RD) and Community Supports waivers. SCDHHS also runs PACE with four PACE organizations.
• Other funding. The South Carolina Department on Aging funds caregiver respite that can take place at an adult day facility, and the U.S. Department of Veterans Affairs pays for adult day health care for some veterans. We did not find adult day service standards from either one.

The licensing rule defines a day care facility for adults as a group program of individual and group activities and therapies for adults 18 or older, open at least 4 and no more than 14 hours a day. Social and health-focused programs fall under the same license. A center that offers an Alzheimer's special care program must describe that care in its policies under the South Carolina Alzheimer's Special Care Disclosure Act (S.C. Code Section 44-36-510), but we did not find a separate dementia license.

Where the layers overlap, the Medicaid ADHC rules are stricter for centers serving waiver participants. They add nursing hours, a longer operating day, location limits and more documentation. Licensing alone applies to private-pay centers and to everyone else.

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

Yes. State law requires a license for any day care facility for adults that cares for 2 or more unrelated adults, and no one may operate, advertise or market a center without a DPH license. You may not enroll participants until the license is in effect. This applies whether participants pay privately, through Medicaid or some other way.

How to apply. Under Regulation 60-75 (Sections 102.F, 102.G and 1903), the initial application includes:

• Owner and facility details and a signed oath.
• Proof of ownership or a lease.
• The administrator's qualifications.
• The number of participants you plan to serve.

Plans for new construction must be prepared by a South Carolina registered architect or engineer and approved by DPH before work begins. DPH inspects before it issues the first license. The DPH Day Care Facilities for Adults page is the starting point.

Fees. Regulation 60-75 sets these fees:

• License fee: $3.00 per participant, for an initial license, a capacity increase and renewal (renewal is based on average census).
• Inspection fee: $225 plus $10 per participant for initial, relocation and routine inspections, and $125 plus $10 per participant for follow-up visits or capacity increases.
• Plan review for construction: $750 to $2,500 and up, with $500 site inspections at 50, 80 and 100 percent completion.
• Late renewal: $75 or 25 percent of the fee, whichever is greater. A center becomes unlicensed 30 days after its license expires if the fee is not paid.

Certificate of need. Adult day facilities are not on the list of facilities that need a certificate of need under S.C. Code Section 44-7-160, which covers nursing homes and hospitals. We did not find a moratorium on new centers.

Local permits. The regulation requires compliance with local, state and federal codes but does not list specific zoning or occupancy permits. Check with your city or county before you sign a lease.

One license per site. Each location needs its own license, though separate buildings on the same or adjoining grounds with one level of care may share one. Different facility types on the same property are licensed separately. The license states your licensed capacity, which you may not exceed, and it must be posted.

Buying a center. Licenses are not transferable. A new license application is required before a change in controlling interest or legal entity. An amended license is required before a change of location, name, address or licensed capacity, and a change of administrator must be reported to DPH in writing within 72 hours. The rule says to apply before the change but sets no specific notice period, so contact DPH early in any purchase.

Renewal and inspections. DPH sets the license term, and the regulation does not state a fixed renewal period or routine inspection schedule. After the first license, DPH inspects as it deems appropriate, and inspections may be unannounced. Ask DPH Healthcare Quality how long your license will run.

Extra steps for Medicaid. To offer Adult Day Health Care, a licensed center also enrolls with SCDHHS. New ADHC providers are trained on the federal home and community-based settings rule and get a site visit confirming full compliance before enrollment. DPH and SCDHHS check qualifications at enrollment, within the first year, and then for a sample of providers every 18 months (HCBS Provider Manual). An ADHC center may not be on the grounds of or next to a public institution, on a parcel with more than one state licensed facility, or in a building that provides inpatient institutional treatment.

What are the staffing rules for adult day centers in South Carolina?

South Carolina licensing rules require at least 1 direct care staff member or volunteer for every 8 participants, and the center must document that it meets this ratio. The Medicaid ADHC rules repeat the same 1:8 ratio and add registered nurse (RN) time on site that grows with the number of waiver participants. We did not find a separate ratio for participants with dementia in any layer.

• Licensing (DPH): 1:8 direct care staff or volunteers to participants (Regulation 60-75, Section 503).
• Medicaid (SCDHHS ADHC): the same 1:8 ratio, plus nursing hours by waiver census (see below).
• Other funding: no ratio specified.

Minimum staff on site. Whenever participants are in the center, at least one staff member certified in first aid and CPR must be present (a licensed nurse needs CPR but not first aid). The center needs a full-time administrator and a named staff member to act when the administrator is away.

Who counts toward the ratio. Direct care staff, including employees and contractors, and volunteers count. The rule does not say whether the administrator counts.

RN hours for Medicaid centers. Under the ADHC Scope of Services (Section D.1), an RN must be on site while waiver participants are present for these minimums. The bands count waiver participants only.

• 1 to 10 waiver participants: 2 hours. 11 to 20: 3 hours. 21 to 25: 4 hours. 26 to 35: 5 hours. 36 to 44: 6 hours.
• 45 to 88: one RN plus one more RN or LPN for at least 5 hours.
• 89 to 133: one RN plus two RNs or LPNs, or one RN, one RN or LPN, and one case manager, each for at least 5 hours.
• 134 or more: one RN plus three RNs or LPNs, or one RN, two RNs or LPNs, and one case manager, each for at least 5 hours.

Any change from these levels needs written SCDHHS approval, and an RN vacancy must be reported by the next business day.

Qualifications. The administrator needs a bachelor's degree, or at least two years of college or technical school plus four more years of experience in nursing, social service, sociology, psychology or a related field. For Medicaid centers, the nursing supervisor must be a South Carolina licensed RN with at least one year of experience in a related health or social services program and one year of administrative or supervisory experience. A case manager used to meet staffing at 89 or more waiver participants needs a bachelor's degree in health or social services. Prescription medications must be given by a licensed nurse or other authorized healthcare provider, and that person must be the one who prepared the dose.

Training. Orientation is due within 24 hours of a new worker's first day. Before contact with participants and at least once a year, all staff and volunteers are trained in fire safety, infection control, participant rights including abuse prevention, confidentiality, and care specific to the people served, such as dementia care. The rule sets no minimum number of training hours.

Background checks. Licensing requires a criminal background check under S.C. Code Section 44-7-2910 for direct care staff before hire, with no convictions for crimes against children or for abuse, neglect or exploitation of a vulnerable adult. Medicaid centers have stricter rules: all staff are checked against the CNA registry and the federal OIG exclusions list before hire and at least every two years, and direct care and administrative staff get a SLED criminal check covering South Carolina and any state lived in during the prior ten years, also before hire and every two years. Non-violent felonies ten or more years old are allowed with the participant's written acknowledgment.

Health screening. Staff and volunteers with participant contact need a health assessment within the 12 months before contact, TB screening (a two-step skin test or a blood test) before contact, and annual TB training. We did not find other required vaccinations.

What does an adult day center in South Carolina have to provide?

Every licensed South Carolina center offers a regular program of varied activities, supervision and personal care training, and meals for participants who stay 4 hours or more. Centers must have at least 50 net square feet of activity space per participant. Centers that serve Medicaid waiver participants must also open at least 8 hours a day on weekdays and provide daily nursing and community outings.

Services and activities. Under Regulation 60-75, activities include group and individual, social, educational and recreational activities, and the monthly schedule must be posted. For Medicaid participants, the daily ADHC rate includes nursing by or under an RN (vital signs, observation, medication supervision and care plan oversight), help with personal care and daily living activities, daily planned therapeutic activities with participant input, and outings in the community (ADHC Scope of Services, Section C.4).

ADHC Nursing. This is a separate Medicaid waiver service for skilled procedures during attendance. It is limited to ostomy care, urinary catheter care, wound care, tracheostomy care, tube feedings and nebulizer treatments with medication.

Hours. Licensing allows a program to run 4 to 14 hours a day. Medicaid ADHC centers must operate at least 8 hours a day, Monday through Friday, between 7:00 a.m. and 6:00 p.m. Weekend hours are optional. A waiver participant may stay up to 8 hours when no one is home to care for them.

Meals. Licensing requires at least one meal for participants who attend 4 or more hours and two meals for 10 or more hours, unless a physician directs otherwise. Snacks must be offered between meals at no extra cost, and a week of menus must be posted. Meals come from an on-site kitchen permitted under Regulation 61-25 or from a graded food establishment under contract. For Medicaid participants, the rate includes one meal and one snack that together meet one third of the recommended daily allowance.

Transportation. We did not find a licensing requirement to provide transportation. For Community Choices participants, ADHC transportation has been provided through the Medicaid non-emergency medical transportation broker since July 1, 2022, instead of as a separate waiver service. The ADHC scope names ModivCare as the broker contact.

Space and capacity. Under Regulation 60-75, Sections 1901 and 2601 to 2602:

• At least 50 net square feet of usable activity space per participant, not counting halls, storage, the kitchen, toilets, the resting area or offices. A center sharing a building may use 25 net square feet of activity or dining space per participant if the space is used only by participants and separated by a permanent one-hour rated barrier.
• At least one group activity room and one resting room, with one resting bed (not a roll-away) for every 30 licensed participants, privacy screening, and a call signal at each bed, bath and toilet.
• Bathrooms with grab bars and privacy. We did not find a required number of toilets per participant.
• Participant areas on the level of exit discharge unless there is an elevator, a covered drop-off and two exits remote from each other.

Written policies. The center's written policies must explain how it meets each part of the regulation, including staffing and training, incident reporting, closure and zero census, participant records, care and services, participant rights, medication management, admission and discharge, fire prevention, housekeeping and infection control. A center also needs a disaster and emergency evacuation plan, a plan for keeping essential services running, a fire and evacuation plan coordinated with the fire department, written dietary policies and a preventive maintenance program for emergency equipment. Policies are reviewed on a schedule the center sets, no more than two years apart, and signed by the administrator (Section 400). Medicaid ADHC centers also keep a policy and procedure manual for their SCDHHS contract, run an ongoing infectious disease education program, and post complaint information and their holiday schedule.

Safety and postings. Fire drills are required at least monthly, and staff get annual fire response training. The license, the Statement of Rights of Adult Day Care Participants, the activity schedule, a week of menus and the evacuation plan must be posted.

What rules protect participants in South Carolina adult day centers?

South Carolina requires a physical exam within 60 days before enrollment, a signed agreement that discloses all fees, a care plan within 30 days, and daily attendance records. Serious incidents must be reported to DPH within 24 hours. The rules require written notice of discharge but set no minimum number of days of advance notice.

Who can enroll. A physician or other authorized provider must examine the participant within 60 days before enrollment, covering activity limits, diet and medications, and at least every two years after. A center may not enroll or keep a person who is confined to bed (Regulation 60-75, Sections 800 and 1100).

Enrollment agreement. The signed written agreement explains the care, services and activities provided, discloses the fees for all of them, and is revised when anything changes. Participants also sign an acknowledgment of the Statement of Rights.

Assessment and care plan. The center does an initial assessment within a time it sets. The Individual Plan of Care is due within 30 days of enrollment and is reviewed as needs change and at least every six months. Progress notes are due at least every quarter.

Medicaid participants. For waiver participants, the center gets SCDHHS Form 122 DC from the physician, the RN writes a care plan based on the participant's service plan or service authorization, and services start only on the authorized date. The center must tell the case manager within two working days about a change in condition, a hospital or nursing home stay, a death, a move, a wish to stop attending, possible loss of Medicaid, an unexplained absence, or a report of abuse, neglect or exploitation. Referrals must be accepted or declined within two working days (ADHC Scope of Services). Centers must also give participants written information on advance directives.

Discharge. A participant may not be kept beyond 30 days if the center cannot meet their needs or their condition or behavior is unsafe. Once discharge is decided, the center gives written notice right away with the reason, the proposed date and contacts for community resources. We did not find a minimum notice period in days in either layer.

Attendance and records. Centers keep an accurate daily census and daily attendance records for at least 12 months. Participant records are kept at least six years after discharge. Other required documents are kept at least 12 months or since the last DPH general inspection, whichever is longer.

Incidents. Crimes, abuse, neglect or exploitation, a hospital stay or death from an incident, elopement, medication errors, injuries needing medical attention, fractures, attempted suicide and fire are reported to DPH electronically and to the responsible party within 24 hours. A written investigation report goes to DPH within 5 calendar days, and incident records are kept six years after the participant's discharge (Section 601).

Closing or pausing. DPH must be told in writing before a permanent closure and 15 days before a temporary closure (48 hours in an emergency). A center that has had no participants for 90 days must tell DPH within 100 days, and a closure or zero census longer than one year means the center must be relicensed.

How does Medicaid pay for adult day in South Carolina?

South Carolina Medicaid pays for Adult Day Health Care through three home and community-based waivers run by SCDHHS: Community Choices, ID/RD and Community Supports. Centers bill a daily rate under code S5102, listed at $80.00 per day, for a day of at least 5 hours at the center. PACE also covers adult day center care for eligible people in its service areas.

The waivers.

• Community Choices Waiver (SC.0405), for older adults and adults with physical disabilities, run by SCDHHS Community Long Term Care. It was renewed effective July 1, 2026 (waiver renewal SC.0405.R05.00).
• Intellectual Disability/Related Disabilities (ID/RD) Waiver (SC.0237), run by SCDHHS with the Office of Intellectual and Developmental Disabilities (OIDD, formerly the Department of Disabilities and Special Needs).
• Community Supports Waiver (SC.0676), also run by SCDHHS with OIDD.

Billing codes and rates. The SCDHHS HCBS waiver fee schedule effective November 1, 2025 lists the same rates in all three waivers:

• S5102, Adult Day Health Care: $80.00 per day.
• S5105, ADHC Nursing: $15.00 per day, for the listed skilled procedures.

That date is when the fee schedule took effect, not necessarily when the ADHC rate last changed.

What counts as a billable day. A participant must be at the center at least 5 hours, not counting travel time. The minimum is 4 hours when a medical appointment shortens the day and the case manager is told. Services start only on the date authorized in the participant's service plan.

Transportation. For Community Choices participants, ADHC transportation runs through the Medicaid non-emergency medical transportation broker, not as a service the center bills to the waiver. The ID/RD waiver also uses the broker. We did not find an ADHC transportation code in the fee schedule for the Community Supports waiver, and we did not confirm how transportation works for that waiver, so ask OIDD or SCDHHS.

Attendance documentation. ADHC providers must keep a daily attendance log with each participant's arrival and departure times and a separate log of staff arrival and departure times. Providers must use the automated systems SCDHHS requires to document and bill for services, check eligibility each month in the Phoenix Provider Portal, and may keep paperless records with a reliable backup. We did not find which system SCDHHS requires for adult day attendance, so ask SCDHHS before you set up billing.

PACE. The Program of All-Inclusive Care for the Elderly serves people 55 and older who meet nursing home level of care and live in specific counties. South Carolina has four PACE organizations: BoldAge PACE, Prisma Health SeniorCare PACE Midlands, Prisma Health SeniorCare PACE Upstate, and The Orangeburg Senior Helping Center. Many PACE services are centered in PACE adult day health centers. PACE is paid a set amount per enrollee, so adult day is not billed by the day.

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

Yes, a center can be fully private pay, but it still needs a DPH license if it serves 2 or more unrelated adults. South Carolina's licensing rules apply whatever the payer, and DPH may order an unlicensed location to stop operating. State law exempts only certain listed settings, such as community housing sponsored by OIDD.

Protections for private-pay participants. Private-pay participants have the same protections as everyone else under Regulation 60-75: a written agreement that discloses all fees, the right to be told about services and charges at enrollment, a grievance procedure that includes DPH contact details, and the posted Statement of Rights. We did not find a rule that bars treating people differently by how they pay.

Other funding.

• Family Caregiver Support Program. The South Carolina Department on Aging, through Area Agencies on Aging, pays for caregiver respite that can take place in an adult day facility, among other settings. It is funded by the Older Americans Act and state caregiver funds, and more than $5.7 million went to caregiver services in state fiscal year 2025.
• Alzheimer's Resource Coordination Center (ARCC) grants. The ARCC Grants Program, funded each year by the General Assembly, awards competitive grants to community organizations for dementia-specific respite, education and new programs.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical criteria, at VA medical centers, State Veterans Homes or community organizations. A copay may apply. We did not confirm which South Carolina VA medical centers contract with community adult day centers.
• Councils on aging. Some county councils on aging are enrolled as Community Choices providers of Adult Day Health Care and are paid the same rates as other providers.

The market. We did not find a published count of licensed day care facilities for adults. The DPH facility search tool lists licensed centers but gives no total, so contact DPH Healthcare Quality for a count. We also did not find a South Carolina adult day services association.

What is changing next for adult day in South Carolina?

As of our last check on October 21, 2026, we did not find a final, scheduled change to South Carolina's adult day licensing rules or adult day payment. One proposal is pending: SCDHHS has posted a draft renewal of the ID/RD waiver, which includes Adult Day Health Care. Recent changes that are already in effect are listed below.

• Proposed ID/RD waiver renewal (not final). SCDHHS posted a draft five-year renewal of the ID/RD waiver and held a public webinar on August 27, 2026. The draft proposes a start date of January 1, 2027, but the renewal is not final and the date could change. Watch the SCDHHS waivers page for the approved version.
• Community Choices renewal, July 1, 2026. The waiver was renewed and keeps Adult Day Health Care and ADHC Nursing, with transportation through the Medicaid transportation broker.
• New ADHC Scope of Services, July 1, 2025. SCDHHS reissued the Medicaid rules for ADHC providers, including the RN staffing levels and attendance logs described above.
• Licensing rule revised, May 23, 2025. The licensing rule, now Regulation 60-75 under DPH, was last revised in the State Register on this date.

South Carolina adult day sources

• Regulation 60-75: Standards for Licensing Day Care Facilities for Adults (SC DPH)
• SC Department of Public Health: Day Care Facilities for Adults
• S.C. Code Title 44, Chapter 7 (licensing and certificate of need)
• SCDHHS: Adult Day Health Care Scope of Services, July 1, 2025
• SCDHHS: HCBS Waiver Fee Schedule, effective November 1, 2025
• SCDHHS: Community Choices Waiver renewal SC.0405.R05.00 (2026)
• SCDHHS: Waivers
• SCDHHS: Home and Community-Based Services Provider Manual
• SCDHHS: Program of All-Inclusive Care for the Elderly (PACE)
• SC Department on Aging: Family Caregiver Support 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, Pennsylvania, Rhode Island, 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.